Progressive Mobility to Promote Healing of a Sacral Pressure Injury in an Acute Care Setting: A Case Study.

Abstract

Background: This case study describes progressive sitting in a hospitalized patient with chronic full thickness wounds. Promoting patient mobility is often a challenge. Patient adherence, logistics of progressive sitting, and potential threats to wound healing must be addressed to optimize wound healing.

Case: Ms. B was a 49-year-old obese female admitted to an acute care hospital with a worsening stage 4 sacral pressure injury. She became progressively deconditioned and was not adherent to recommended repositioning in bed due to pain and poor respiratory status. A physical therapist (PT) created a structured program to encourage out of bed sitting that included detailed instructions on transfer method, weight shift type, and sitting surface to address Ms. B's adherence and mobility impairments. The PT partnered with a certified WOC nurse and performed weekly wound treatments, provided recommendations on sitting time based on wound assessments, and addressed additional modifiable risk factors such as nutrition. Ms. B progressively increased the time spent sitting in an appropriate seating system. Upon discharge, she achieved her goal of sitting up daily in her own wheelchair for at least 4 hours with a 92% decrease in wound volume.

Conclusion: This case highlights the importance of a collaborative and structured approach to promoting mobility while managing chronic wounds. The case also demonstrates how to progressively increase out of bed sitting time without negatively impacting the healing of a stage 4 sacral pressure injury.