Preventing pressure injuries in individuals with impaired mobility: Best practices and future directions

Abstract

Pressure injuries, also known as decubitus ulcers or bedsores, are a major source of preventable morbidity among individuals with impaired mobility, particularly those recovering from spinal cord injury, stroke, or traumatic brain injury. These wounds not only prolong hospital stays and increase healthcare costs but also significantly impair rehabilitation outcomes and quality of life. This paper provides a comprehensive review of the pathophysiology and risk factors underlying pressure injury development, emphasizing the unique vulnerabilities of patients with sensory loss, malnutrition, obesity, and incontinence. It synthesizes current best practices in prevention, including repositioning schedules, the use of pressure-redistributing support surfaces, moisture control, and nutritional optimization. The role of risk assessment tools such as the Braden Scale is examined alongside newer technologies like pressure mapping systems, Artificial intelligence-based prediction algorithms and biofeedback tools enhance individualization of care. Pharmacologic strategies and wound management principles, including debridement and antimicrobial use, are discussed in the context of multidisciplinary rehabilitation. Implementation challenges such as staffing constraints, variability across care settings, and financial limitations are addressed, and future directions are proposed to better integrate skin integrity metrics into functional outcome measures. Ultimately, this review advocates for a proactive, interdisciplinary approach that aligns preventive strategies with personalized care and emerging technology, positioning pressure injury prevention as a core component of high-quality, value-based medicine.

Keywords: Assistive technology; Impaired mobility; Incontinence-associated dermatitis; Nutritional support; Pressure injury; Pressure mapping; Preventive care; Rehabilitation medicine; Risk assessment; Skin integrity.

Figure 1:

Mechanisms of Pressure Injury Formation: Sustained external pressure exceeding capillary filling pressure leads to microcirculatory occlusion, ischemia, and tissue necrosis. Shear and friction forces, such as those from immobility or poorly fitted devices, further compromise tissue perfusion and contribute to ulcer development.

Figure 2:

Contributing Factors in Pressure Injury Development. Multiple intrinsic and extrinsic factors contribute to pressure ulcer development, including mechanical forces, patient characteristics, and environmental exposures that impair tissue integrity and perfusion.

Figure 3:

Comprehensive Management of Pressure Injuries in limited Mobility Patients. Effective pressure injury management involves both prevention and treatment, targeting biomechanical stressors, wound environment, systemic health, and caregiver competency to promote healing and prevent recurrence.