Mike Fray

Introduction: This study evaluated the repeatability of a heating and pressure protocol using laser Doppler flowmetry to measure the full dynamic range of skin microvascular responses at the sacrum and heel – key sites for pressure injury risk. Methods: Twelve healthy participants (10 male, 2 female; mean age 28 ± 4 years; stature 1.77 ± 0.11 m; body mass 72.6 ± 11.9 kg; body mass index 23 ± 3 kg/m2) completed sacrum assessments. Eleven participants (9 male, 2 female; mean age 28 ± 4 years; stature 1.77 ± 0.57 m; body mass 79.5 ± 9.8 kg; body mass index 20.4 ± 4.5 kg/m2) completed heel assessments. Each participant underwent three identical experimental sessions comprising four phases: baseline, local heating, loading, and pressure release. Skin blood flow was measured continuously. Repeatability was assessed using intraclass correlation coefficients (ICC), with an ICC of 0.75 as a minimum threshold for acceptable repeatability. Four methods were tested to identify the pressure at which blood flow ceased: segmental regression, visual analysis of the initial plateau in blood flow, visual analysis of the final cessation of blood flow, and the plateau that corresponds the final-minute mean. Results: The protocol showed good to excellent repeatability for baseline flow, settled flow at 42°C, and post direct-pressure reactive hyperaemia. Maximum combined thermal and reactive hyperaemia demonstrated excellent repeatability at the sacrum (ICC = 0.93) and heel (ICC = 0.91), while the area under the curve showed good repeatability at the sacrum (ICC = 0.81) and excellent at the heel (ICC = 0.90). Segmental regression showed the strongest repeatability (ICC = 0.90 at the sacrum; ICC = 0.84 at the heel). Visual inspection of the initial plateau in blood flow and absolute cessation of blood flow also exceeded the threshold for acceptable repeatability. Conclusion: This study presents a reproducible protocol for assessing pressure-induced microvascular compromise, capturing responses from complete vascular occlusion to peak thermal-pressure hyperaemic vasodilation. Applied at the sacrum and heel, it offers a quantifiable, non-invasive tool to investigate pressure injury risk in vulnerable populations. It also supports future evaluations of support surfaces, offloading strategies, and novel therapeutic interventions to improve tissue pressure tolerance.

Objective: This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices. Introduction: The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices. Method: The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices. Results: The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes. Conclusion: There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated. Practical Application: Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

Background: Sedentary behaviour (sitting) is a highly prevalent negative health behaviour, with individuals of all ages exposed to environments that promote prolonged sitting. The school classroom represents an ideal setting for environmental change through the provision of sit–stand desks.Objectives: The aim of this study was to undertake a pilot cluster randomised controlled trial of the introduction of sit–stand desks in primary school classrooms, to inform a definitive trial. Objectives included providing information on school and participant recruitment and retention, acceptability of the intervention, and outcome measures. A preliminary estimate of the intervention’s effectiveness on the proposed primary outcome (change in weekday sitting time) for inclusion in a definitive trial was calculated, along with a preliminary assessment of potential cost-effectiveness. A full process evaluation was also undertaken.Design: A two-armed pilot cluster randomised controlled trial with economic and qualitative evaluations. Schools were randomised on a 1 : 1 basis to the intervention (n = 4) or control (n = 4) trial arms.Setting: Primary schools in Bradford, West Yorkshire, UK.Participants: Children in Year 5 (i.e. aged 9–10 years).Intervention: Six sit–stand desks replaced three standard desks (sitting six children) in the intervention classrooms for 4.5 months. Teachers were encouraged to ensure that all pupils were exposed to the sit–stand desks for at least 1 hour per day, on average, using a rotation system. Schools assigned to the control arm continued with their usual practice.Main outcome measures: Trial feasibility outcomes included school and participant recruitment and attrition, acceptability of the intervention, and acceptability of and compliance with the proposed outcome measures [including weekday sitting measured using activPAL™ (PAL Technologies Ltd, Glasgow, UK) accelerometers, physical activity, adiposity, blood pressure, cognitive function, musculoskeletal comfort, academic progress, engagement and behaviour].Results: Thirty-three per cent of schools approached and 75% (n = 176) of eligible children took part. At the 7-month follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63% to 97%. A preliminary estimate of intervention effectiveness, from a weighted linear regression model (adjusting for baseline sitting time and wear time) revealed a mean difference in change in sitting of –30.6 minutes per day (95% confidence interval –56.42 to –4.84 minutes per day) between the intervention and control trial arms. The process evaluation revealed that the intervention, recruitment and evaluation procedures were acceptable to teachers and children, with the exception of minor issues around activPAL attachment. A preliminary within-trial economic analysis revealed no difference between intervention and control trial arms in health and education resource use or outcomes. Long-term modelling estimated an unadjusted incremental cost-effectiveness ratio of Stand Out in Class of £78,986 per quality-adjusted life-year gained.Conclusion: This study has provided evidence of the acceptability and feasibility of the Stand Out in Class intervention and evaluation methods. Preliminary evidence suggests that the intervention may have a positive direction of effect on weekday sitting time, which warrants testing in a full cluster randomised controlled trial. Lessons learnt from this trial will inform the planning of a definitive trial.Trial registration: Current Controlled Trials ISRCTN12915848.Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 8, No. 8. See the NIHR Journals Library website for further project information.