Development and Pilot Evaluation of a Sensor-Infused Monitoring and Training System to Prevent Pressure Injuries in Individuals With Spinal Cord Injury

Approximately one-third of individuals with spinal cord injury (SCI) experience a pressure injury and complications contribute to a leading cause of death. Currently, there is a lack of adoption and evidence demonstrating the effectiveness of technologies aimed at preventing pressure injuries. This study presents and evaluates a new monitoring and feedback system to facilitate pressure relief activity performance in 22 manual wheelchair users with SCI. After a two-week baseline, participants received pressure injury education, set goals, and were instructed on how to use the system. Data were then collected using the system for 8 months, and a Technology Acceptance Model (TAM) questionnaire was used to assess usability, with 10 participants identified as Responders. Immediately following goal setting and system biofeedback activation, Responders showed a four-fold increase in pressure relief activity (4.48±4.24 vs. 23.37±14.85 s/h, p=0.004) but activity eventually declined to Baseline levels by Month 8 (4.26±5.78 s/h). Recorded sitting time also dropped significantly (5.62±3.30 h/day at Baseline vs. 1.81±2.08 h/day at Months 6-8, p=0.013). Thirty-six out of 40 questionnaire items scored above the acceptability threshold (>5/7). The system demonstrated good acceptability and effectively promoted short-term increases in pressure relief activity. Its greatest value may be as a short-term training tool during rehabilitation or re-training. Future iterations of the system must address limitations associated with promoting long-term adherence.