Understanding clinical decision making and perspectives on wheelchair seating

Pressure injuries (PIs) impact individuals with limited mobility, including wheelchair users, and can lead to serious health issues. PIs occur when localized pressure and shear forces slow blood flow, create wounds, and raise infection risk. During wheelchair consultations, clinicians recommend seat cushions to users. Seat cushions are often the primary PI prevention tool for wheelchair users, but PIs remain a prevalent clinical concern. Most existing cushions alleviate pressure with inactive materials that necessitate frequent manual repositioning. A qualitative study with clinicians, an important stakeholder in the seating ecosystem, was conducted toward development of a new seat cushion design to better address PIs. Clinicians know cushion features that promote positive health outcomes, practical considerations for usefulness, and can provide insight into how cushion designs impact multiple wheelchair users' experiences. Clinician interview analysis revealed two key themes: (1) cushion selection process is influenced by clinical context and cushion attributes and (2) tradeoffs between cushion features exist when choosing among existing cushion designs. Relative importance of cushion features is also explored. Key insights into clinicians' experiences sourcing, recommending, and using wheelchair seat cushions were developed into technical design criteria which may serve as a guide for assistive technology innovators developing next-generation seat cushions.