|Title:||A randomized controlled trial (RCT) to compare the effectiveness of an individualized therapeutic seating intervention with the conventional seating system|
|Subject:||Hong Kong Polytechnic University -- Dissertations|
Sitting position -- Health aspects
Sitting position -- Measurement
|Department:||Jockey Club Rehabilitation Engineering Centre|
|Pages:||ix, 86 leaves : ill. (some col.) ; 30 cm|
|Abstract:||Elderly seating is a major area of clinical problem in health care. Chair bound induced problems are the priority area to overcome in daily caring practice. The most common problems encountered by care taker included: poor seating posture in terms of leaning to one side, sliding out of chair and pressure sores. This study aims to investigate the difference in treatment effect of three commonly used model of seating interventions. These include seating in standard wheelchair, geriatric chair and Occupational Therapist prescribed chair. Their effect would be measured in terms of postural measurements including frontal shoulder line, frontal trunk line, frontal pelvic line and sliding forward distance as well as peak seating interface pressure. This was a randomized controlled single Blinded crossover trial carried out in a local hospital, Caritas Medical Centre. Twenty-six patients with diagnosis of stroke were recruited and randomized to receive the three different chair designs. Sitting posture and seating interface pressure were measured by a blinded assessor. Crossover to receive another chair was conducted according to a randomized sequence. The study was completed within three working days to minimize possible time effect on the outcome measurements. Sitting posture data involved measurements of "Frontal Shoulder Line (FSL)" and "Frontal Pelvic Line (FPL)", taken using Palpation Meter (Intra-class correlation coefficient (ICC) for interrater was 0.979 for shoulder and 0.873 for pelvic) while "Frontal Trunk Line (FTL)" was measured using a digital inclinometer with (Intra-class correlation coefficient for interrater was 0.89). Peak seating interface pressure was measured using a seat pressure measurement system (Tekscan USA). The data collected were analyzed using General Linear Model (GLM) - multivariate analysis to check whether "chair design" would affect significantly the outcome of interest and Post hoc multiple comparisons for observed means would be used to differentiate the sub-group effect. A total of 26 subjects had been successfully recruited. These included 6 males and 20 females with age ranged from 50 to 105 years (mean of 78.7 years). Twelve of them were "left hemiplegia", another thirteen were "right hemiplegia" and one with bilateral stroke. Body Mass Index (BMI) ranging from 14.04 to 30.79, mean 21.33. Result of General Linear Model (GLM) multivariate analysis revealed that there was an overall significant "chair" effect (p<0.001) but not "sequence" effect (p>0.05).The variables that contribute to significant "chair" effect include: peak seating interface pressure at both 10 minutes and 25 minutes intervals (F=7.4, p=0.001 at 10 minutes interval and F=9.42, p=0.000 at 25 minutes interval) and FSL at 25 minutes (F=5.02, p=0.09).Post hoc multiple comparison results revealed that therapist prescribed chair had more significant peak sitting interface pressure reduction at both 10 and 25 minutes interval (p=0.001 at 10 minutes, p=0.000 at 25 minutes) and better stability as reflected by a smaller angle of frontal shoulder line (p=0.0l6 at 10 minutes,p=0.01 at 25 minutes) as compared to ordinary wheelchair.The therapist prescribed chair was found to be more effective in preserving shoulder alignment at 25 minutes interval with significant result (p=0.007) and minimal distance of sliding forward (p=0.035) when compared with geriatric chair but not significant as compared with ordinary wheelchair. This study suggested that therapist prescribed chair given by the Occupational Therapist was more effective in terms of improving the sitting posture and decreasing seating interface pressure than the ordinary wheelchair. Therapist prescribed chair was also more effective in providing frontal postural control and prevention of sliding forward than geriatric chair. However, this study only revealed a snapshot postural effect major in frontal plane, and little information could be obtained for sagittal plane of postural control. Moreover, although the sample size recruited was larger than the minimum sample size calculated, the power of generalization could have improved with recruitment of more subjects from multiple centers and more male subject recruitment. Further studies were needed to study the effects of different seating intervention in sagittal plane postural control and functional outcome.|
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