Sitting pressure during wheelchair propulsion and handcycling: effects of backrest angle, movement intensity and cushion type

Purpose: The main aim of this study was to compare sitting pressure (peak pressure index (PPI) and peak pressure gradient (PPG)) between a daily wheelchair and fixed-frame handcycle, thereby assessing the effect of handcycle backrest angle, movement intensity and cushion type. Materials and methods: Twenty able-bodied participants performed static and dynamic (two intensities) tests in a wheelchair and handcycle. A honeycomb wheelchair cushion and standard foam handcycle cushion were used. Handcycle backrest angles were 45° and 60°. The PPI and PPG at the sacro-coccygeal (SC) and ischial tuberosity (IT) regions were determined with a pressure mat. Results: PPI at the IT-region was higher in the 60° handcycle condition than in the wheelchair ( p  = 0.04), while PPG at the IT-region did not differ significantly between the wheelchair and handcycle conditions ( p  > 0.05). PPI and PPG were higher at the 45° handcycle SC-region compared to the wheelchair IT-region ( p  < 0.03). PPI and PPG at the IT-region were higher with the 60° than with the 45° backrest angle ( p  < 0.01), while at the SC-region PPI was higher with the 45° backrest angle ( p  = 0.047). No clear influence of movement intensity was found. PPI and PPG at the IT-region and PPI of the SC-region in the handcycle were significantly lower with the wheelchair cushion than with the handcycle cushion ( p  < 0.01). Conclusion: Overall, sitting pressure was higher in the handcycle compared to the daily wheelchair. For handcyclists using an upright position, it is recommended to use a cushion designed to redistribute pressure, thereby reducing internal tissue pressure and shear.