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Permobil Blog / April 26, 2023

The Relationship Between Standards & Clinical Practice

The relationship between standards & clinical practice

Editor's note: This post was originally published in February 2020 and has been updated for accuracy and comprehensiveness. 

This is the 3rd in our blog series on understanding cushion properties with the help of ANSI/RESNA and ISO standards. See part 1, part 2, part 3part 4, blog 5, and blog 6.


Previously we’ve been focusing on the process of developing ISO and ANSI/RESNA standards, along with the benefits and limitations of these test methods. Today’s blog focuses on the relationship between the standards and clinical practice.

How do standards tie to clinical practice? We have ISO and RESNA standards which are mechanical testing methods, and we currently have the Prevention and Treatment of Pressure Ulcers / Injuries: Clinical Practice Guideline (CPG) published in 2019 by the National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP), and the Pan Pacific Pressure Injury Alliance (PPPIA). The CPG offers guidance about the best clinical practices, informed by the current understanding of the etiology of pressure injury, published scientific literature, and expert opinion. Using the guidelines and the standards together can help narrow the field of cushion choices for trialing with a client. These tools, in combination with clinical reasoning, can help identify a solution that best meets the individual’s needs.


The Clinical Practice Guideline (CPG) on the Prevention and Treatment of Pressure Ulcers / Injuries is a remarkable accomplishment, published in 2019 as a collaboration among more than 250 pressure injury experts worldwide. They assessed over 3500 research studies and received feedback from over 1000 stakeholders to establish a global consensus on the latest understanding of pressure injury prevention and treatment. Let's delve into the CPG's perspective on pressure injury, which is crucial to developing standardized tests that help understand cushion performance.

This document is key to us as we develop standards, and we take our guidance and input from this clinical practice and level of understanding that exists today in 2023. The guidelines have extensive definitions, especially for pressure injury. To paraphrase, a pressure injury is localized damage to the skin and/or underlying tissue as a result of pressure or pressure in combination with shear. Tolerance may be affected by microclimate, perfusion, age, health conditions, co-morbidities, and conditions of the soft tissue. Pressure, shear, and microclimate can all be measured in a laboratory environment, so developing these standardized test methods is important to help us better understand cushion performance.

The CPG talks specifically about the role of support surfaces in the prevention and treatment of pressure injuries. The guideline describes support surfaces as devices for pressure redistribution, designed for management of tissue loads, microclimate, and/or other therapeutic functions. The characteristics of the surface include immersion, envelopment, and microclimate.

The CPG notes that the way these properties are achieved and the level they achieve does vary substantially between devices within and across categories. Not all support surfaces are designed the same way, and they don’t perform the same way. Having standardized tests that can quantify those performance characteristics is extremely helpful in understanding how the surfaces are different. As a complement to your clinical reasoning, when you know the properties, you’re looking for your individual, the results of standardized tests can help you find a solution to meet their needs.

Join us next time as we take a closer look at the specific ISO and RESNA standard test methods for wheelchair seating and positioning.

Trust & Transparency

For more information on the CPG, ANSI/RESNA Wheelchair and Related Seating Standards Committee, and the ISO standards for Wheelchairs and Wheelchair Seating, please visit:




Images provided by the University of Pittsburgh Tissue Integrity Management Laboratory


Kara Kopplin HeadshotKara Kopplin, B.Sc.Eng,
Chair of the ANSI/RESNA Wheelchair and Related Seating Committee, Director of Regulatory Science for Permobil

Kara Kopplin holds a B.Sc. in Ceramic Engineering from the University of Missouri-Rolla, U.S.A., bringing a unique and complementary materials engineering perspective to seating solutions. In her role as Director of Regulatory Science for Permobil, Inc., Ms. Kopplin actively contributes to the efforts of the International Organization for Standardization (ISO) and European Committee for Standardization (CEN) to develop object test methods for wheelchair systems and components. She is honored to chair the ANSI/RESNA Standards Committee on Wheelchair and Related Seating (WRS) in the US and encourages everyone to contribute to the development of these critical evaluation tools.



Categories: Complex Rehab, Seating and Positioning, Therapists

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