Sitting upright can improve clinical outcomes for plus size patients

All patient groups, where clinically appropriate, will benefit from time spent in an upright position1 and this is especially true when caring for plus size people. Providing safe access to comfortable seating is an important aspect of care. Sitting upright can help improve clinical outcomes in a number of areas such as lung function and blood circulation.2 This also has positive benefits for combating immobility and provides an opportunity for social interaction, which enhances quality of life.3 Safe transfer solutions to and from the chair are available for individual patient needs, making access a simple procedure.

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Sitting in the correct sized chair ensures the patient’s comfort and well-being. The optimum chair can be identified following an assessment of the patient, taking into account factors such as weight, body shape, weight distribution and skin integrity. The chair should offer a satisfactory safe working load, pressure redistributing seat cushion and adequate seat dimensions that provide enough space for the patient’s hips and adipose tissue, as well as easy access for applying patient slings.4

To retain a person’s independence, appropriate posture must be maintained as a poor posture can lead to imbalanced weight distribution which may eventually result in tissue damage and morbidity.The position of the pelvis is the basis for a good sitting posture. If the pelvis is tilted to the front, back or side due to postural deformity or inadequate support, the muscles in the hips, trunk and neck will need to work harder to maintain a seated position. For example, extensor tone in the trunk and lower extremities can cause a person to slide forwards in the chair, increasing shear.  

Any seating provided needs to address the clinical and postural needs of each individual i.e. the seating requirements of a plus size person in hospital will differ greatly from a person with a long term disability in the community; the individual’s lifestyle, expectations and personal choice should also be considered. However, a number of general principles should be addressed within each assessment:5 

  • physical health and functional ability
  • seating time6
  • seating surface (bed, chair, wheelchair)7
  • does the person have dynamic or static sitting balance?8
  • transfer methods
  • continence status
  • repositioning and off-loading capability
  • existing skin changes, sensationpressure ulcers, moisture associated skin
  • muscle atrophy and level of spasticity
 

Selecting a chair and cushion is complex and dependent on the activity to be undertaken such as work, leisure and sport.  A chair and cushion needs to be able to reduce the amount and/or duration of pressure and shear, which can lead to tissue distortion, as well as be suitable for the environment it is to be used in, comfortable and user friendly. Clinical judgement and product evaluation data should be used to prescribe a seating/ cushion solution to meet individual need.9,10

Equipped with the right solutions, care facilities have the ability to improve the quality of life and help improve the safety of patients. With the right solutions, plus size patients can experience comfortable and dignified care – through every step of their journey.

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References
1. 
DeanE., Perme,C.(2008). "Effects of positioning and mobilisation". Physiotherapy for Respiratory and Cardic Problems, Adults and Paediatrics. UK, Churchill Livingstone Elsevier.
2. Dean, E. (1999) The effect of positioning and mobilisation on oxygen transport. Cited in: Pryor JA & Webber BA (eds) Physiotherapy for respiratory and cardiac problems(2nd edition), Churchill Livingstone, London pp. 121-136
4. Tierney, M. (2013) The Clinician’s Seating Handbook publication, a reference guide for clinical Seating provision.
5. Stephens M, Bartley CA (2018) Understanding the association between pressure ulcers and sitting in adults what does it mean for me and my carers? Seating guidelines for people, carers and health & social care professionals http://dx.doi.org/10.1016/j.jtv.2017.09.004
6. Collins, F. (2004). ‘Seating assessment and selection’. Journal of Wound Care / Therapy Weekly;May: pp. 9-12
7. Crawford SA, Stinson MD, Walsh DM, Porter-Armstrong AP. Impact of sitting time on seat-interface pressure and on pressure mapping with multiple sclerosis patients. Archives of Physical Medicine and Rehabilitation 2005; 86: 1221-5
8. Medical Devices Agency, Wheelchair Cushions, Static and Dynamic: A comparative evaluation. (London: HMSO), 1997.
9. Stockton L, Rithalia S. Is dynamic seating a modality worth considering in the prevention of pressure ulcers? Journal of Tissue Viability 2008, 17(1): 15-21.
10. Tissue Viability Society (2017) Seating Guidelines https://tvs.org.uk/wp-content/uploads/2017/10/TVS-SEATING-GUIDELINES.pdf [Accessed January 2019]