The Essential Role of Specialist Seating in Comprehensive Care

The Essential Role of Specialist Seating in Comprehensive Care

In our modern society, we often take for granted our ability to sit comfortably. It is something most of us do without thinking, whether we’re at work, at home, or in our cars. However, for some individuals, particularly those with physical disabilities, complex needs, or chronic conditions, sitting comfortably isn’t as straightforward. In fact, inadequate postural care can result in physical, psychological, and emotional effects that can severely impact an individual’s overall health and well-being.¹

In this blog, we will explore the significant role of specialist seating in postural care, how it can enhance a person’s quality of life, and why investing in it can save on long-term health and social care costs. 

Associated Costs – Human, Health, and Social

The lack of consideration towards optimum postural care can lead to body shape distortion, with severe and life-threatening consequences.¹ The inability to sit upright can cause a decline in overall health, primarily reflecting altered physiological function.² Individuals may present with an increased risk of infections, choking episodes, constipation, and pressure injuries. Although postural care can be an expensive service, it can significantly reduce the need for invasive and more costly interventions, including emergency department visits, hospital admissions, surgical procedures, home adaptations, enteral feeding, and pain management.³ If better provision of equipment resulted in even a modest reduction in the need for treatment, medication and surgery, the costs of the equipment could be recuperated.⁴

If a person becomes unwell due to physiological dysfunction and subsequently requires hospital admission, this non-elective inpatient stay costs the NHS an average of £1,603.⁵ A hospital admission in itself can pose a risk to the health and well-being of a person with deconditioning syndrome gaining increased recognition among the medical community. During hospitalisation, between 30% and 55% of older patients show a decline in the ability to perform routine personal care activities, and up to 65% of hospitalised older adults experience a decline in ambulatory function.⁶

Deconditioning and muscle weakness in older people is associated with significant excess annual costs for health and social care in the UK of around £2.5 billion.⁷ These costs are projected to increase in the future due to the ageing population. Furthermore, generalised weakness, or the presence of a long-term condition, can increase the risk of falls. 30% of people aged 65 and over will fall at least once a year; for those aged 80 and over, it is a staggering 50%.⁸ Annual costs to the NHS from falls among older people are estimated at £2.3 billion.⁹ Interventions to reduce the prevalence of deconditioning among individuals are likely to have a substantial beneficial impact on the economy; specialist seating should be utilised to enable sitting out of bed, encourage functional movement, allow safe transfers, and promote continued activity.

When pressure injuries occur, they can have a profound impact on overall wellbeing and can be both painful and debilitating.¹⁰ Alarmingly, pressure injuries in older persons are associated with a fivefold increase in mortality.¹¹ Treating them costs the NHS more than £3.8 million every day.¹² Specialist seating can support pressure care by encouraging equal weight distribution over the maximum support surface. Chair functions can also promote regular changes in positioning, which is a fundamental practice in reducing the risk of pressure injuries.¹³

Prolonged destructive positioning and inattention to optimal postural care can also lead to the development of contractures, which are not only costly to the individual but also the wider economy; the estimated cost for inpatient treatment and surgery for a single contracture is £18,000.¹⁴ Conservative approaches to preventing and managing contractures are needed; when used for corrective purposes, a specialist seating system can be utilised as an orthotic device.¹⁵

The psychological and emotional effects of body shape distortion cannot be underestimated either. Being unable to sit out comfortably can result in individuals becoming confined to their beds with limited interaction and engagement. This isolation can lead to loneliness, which is twice as harmful as obesity to physical and mental health.¹⁶ Specialist seating allows an individual to engage with loved ones and interact with the world around them away from the four walls of their bedroom.

Specialist Seating Considerations

Evidently, specialist seating is a critical element of postural care. When assessing for and prescribing specialist seating, there are six key principles to consider to maximise outcomes for individuals:

1. Comfort

The main objective should always be for the individual to be comfortable. Regardless of the clinical benefits, the chair may not be utilised if the user is not comfortable.¹⁷ Thus, promoting comfort is crucial to encouraging compliance with the chair and consistency with its use.

2. Postural support

The chair must offer appropriate postural support at all body segments to encourage pelvic stability, trunk alignment, head control, and upper and lower limb support. It must also work in combination with all other postures adopted and equipment used across the total 24 hours of daily life.

3. Pressure care

An integrated pressure redistributing system is critical for those at risk of pressure injury. The opportunity to sit out can offer a much-needed change of position to encourage blood flow and redistribute pressure.

4. Functional independence

Function is necessary for individuals to participate in the activities important to them. It is critical to independence and important to living a fulfilling life.  Postural control and stability within the chair are fundamental to freedom of movement.¹⁸

5. Health and Safety

Protection of the body structure and promoting optimum physiological function is critical to a person’s health. It is also vital that the individual user achieves security within the chair while transferring into and out of the chair safely without injury.

6. Wellbeing

Engagement in daily life is important for a sense of well-being. Using chair functions and accessories can promote energy management, allowing social interaction and participation in activities, hobbies, and occupations.

A special thank you to the Laffoley Family for this article’s beautiful picture; we are so happy you are delighted with your new CareFlex chair.

Professional Education Opportunities

If you are involved in specialist seating and interested in deepening your understanding and expertise, various training opportunities are available. CareFlex offers free specialist seating study days and virtual webinars for Health & Social Care Professionals working in the field of postural care. We also share regular blogs and case studies and develop comprehensive educational material to complement our range of specialist seating solutions.

Conclusion

Investing in specialist seating and postural care services is about recognising the physical, psychological, and emotional benefits they bring to an individual’s life. It is also about acknowledging the long-term cost savings that could be made in health and social care through a proactive approach, prevention, and improved quality of life.

References

1. Public Health England (2018) Postural care and people with learning disabilities: guidance Available from: gov.uk/government/publications/postural-care-services-making-reasonable-adjustments/postural-care-and-people-with-learning-disabilities#fn:2
2. Healy A, Ramsey C, Sexsmith E (1997) Postural support systems: their fabrication and functional use Developmental Medicine and Children Neurology 39:706-710
3. Hill S, Goldsmith J (2010) Biomechanics and prevention of body shape distortion Tizard Learning Disability Review 15:15-32
4. Centre for Economics and Business Research (2014) The economic benefits of better provision of equipment for disabled and terminally ill children Available from: pmguk.co.uk/data/page_files/publications%20and%20reports/2014/BHTA%20paper%20-%20benefits%20of%20better%20provision%20of%20childrens%20equipment.pdf
5. Department of Health (2018) Reference costs 2017/18: highlights, analysis and introduction to the data Available from: improvement.nhs.uk/resources/reference-costs/#rc1718
6. British Geriatrics Society (2020) Sit Up, Get Dressed and Keep Moving! Available from: bgs.org.uk/policy-and-media/%E2%80%98sit-up-get-dressed-and-keep-moving%E2%80%99
7. Pinedo‑Villanueva R, Westbury LD, Syddall HE, Sanchez‑Santos M, Dennison E, Robinson S, Cooper C (2019) Health Care Costs Associated With Muscle Weakness: A UK Population-Based Estimate Calcified Tissue International 104:137–144
8. National Institute for Health and Care Excellence (2013) Falls in older people: assessing risk and prevention Available from: Introduction | Falls in older people: assessing risk and prevention | Guidance | NICE
9. National Institute for Health and Care Excellence (NICE) (2018) NICEimpact falls and fragility fractures Available from: nice.org.uk/media/default/about/what-we-do/into-practice/measuring-uptake/nice-impact-falls-and-fragility-fractures.pdf
10. Moore ZE, Webster J, Samuriwo R (2015) Wound-care teams for preventing and treating pressure ulcers Cochrane Database Syst Rev16(9)
11. Grey JE, Harding KG (2006) Pressure ulcers BMJ 332(7539):472–475
12. NHS England/Improvement (2020) National Pressure Ulcer Prevalence and Quality of Care Audit – Cohorts 1 and 2 National Stop the Pressure Programme: Audit Report Available from: ahsnnetwork.com/app/uploads/2020/11/PU-audit-final.pdf
13. NHS (2017) Overview:Pressure ulcers (pressure sores) Available from: https://www.nhs.uk/conditions/pressure-sores/
14. Chartered Society of Physiotherapy (2015) Clinical update: guideline on splinting Available from: csp.org.uk/frontline/article/clinical-update-guideline-splinting
15. Herman JH, Lange ML (1999) Seating and positioning to manage spasticity after brain injury Neurorehabilitation 12(2):105-117
16. Holt-Lunstad J, Smith T, Baker M, Harris T, Stephenson D (2015) Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review Perspectives on Psychological Science 10(2):227-237
17. Bartley C, Stephens M (2017) Evaluating the impact of WaterCell® Technology on pressure redistribution and comfort/discomfort of adults with limited mobility Journal of Tissue Viability 26(2):144-149
18. Green EM & Nelham RL (1991) Development of sitting ability, assessment of children with a motor handicap and prescription of appropriate seating systems Prosthetics and Orthotics International 15:203-216