Cushions can be confusing! Of the hundreds of cushions available on the market made with different materials and different designs … how do you know which one is right for you or your participant? Understanding marketing claims and the engineering behind each cushion adds to the challenge. Choosing a cushion can be overwhelming … but you can now use ISO Testing results in addition to evidence-based practice and your own clinical experience to guide cushion selection and prescription.
Contributing elements of evidence-based practice include material science, the client perspective, clinical expertise and decision making, research evidence and clinical practice guidelines. ISO testing and performance metrics serve as a crucial bridge between manufacturers and clinicians, providing a common language for understanding cushion effectiveness. This shared framework supports informed decision-making, aligns clinical recommendations with manufacturing innovations.
• Standardised tests developed in accordance with ISO
• Indenters (buttock models) are evaluated in a lab test
• These tests provide a baseline for cushion performance
• There are not any pass/fail criteria (except immersion)
• Performance metrics make up one consideration when prescribing cushions
The National Pressure Injury Advisory Panel's (NPIAP) Clinical Practice Guideline (CPG) for the prevention and treatment of pressure injuries was published in 2019. Over 250 international experts reviewed evidence of over 3500 peer reviewed research studies.
CPG offers a clinical perspective that informs the development and application of ISO tests. It includes recommendations on the role of support surfaces, which are crucial for deriving performance metrics.
Based on the CPG, Permobil created The Pressure Management Guide, an extensive resource to better understand the role of support surfaces and wheelchair systems for pressure management. Short on time? Check out the The Wheelchair Seating Pocket Guide, a condensed resource to help select wheelchair seating components for pressure injury management.
You can find more resources at the bottom of the page.
Performance metrics assist in cushion selection by aligning with individual goals and needs, helping clinicians focus on the user without bias. These lab-based metrics should complement personal requirements and are not pass/fail tests or for ranking except immersion. Instead, they identify key cushion characteristics to meet individual priorities and functions.
To accurately interpret the dataset of 50 cushions from RERC, a Scientific Report has been released to enhance your understanding of the statistics. Cushions are categorised into lower, typical, and higher priority based on statistical thresholds such as median and percentiles, ensuring consistent representation from various manufacturers and designs. If you have specific goals in mind, you can refer to the relevant tests and consider trialing cushions that fall into the higher priority category.
The full report is available at the bottom of the page.
💡 Individual Remains at the Center
When using cushion performance metrics to determine a seating solution, the individual remains central to the prescription process. While these metrics primarily address skin protection and stability, a user-centric approach requires considering many other factors. One performance test or measure should never be used as a cushion selector tool. Remember, the results are the starting point, not the final answer!
Contact area
Immersion
Offloading IT
Lateral Stability
Immersion
Contact area
Immersion
Contact area
Offloading IT
Lateral stability
Offloading IT
Lateral stability
Immersion
Contact area
Horizontal stiffness/
forward stability
Immersion
Contact area
Offloading IT
Horizontal stiffness/
forward stability
Offloading IT
Horizontal stiffness/
forward stability
Immersion
Contact area
Lateral stability
Contact area
Immersion
Offloading IT
Lateral Stability