Immobilization Discomfort During Prolonged Emergency Stretcher Use: An Exploratory Qualitative Descriptive Study.

Abstract

Background: Accurate pain assessment in trauma care is challenged by the coexistence of multiple forms of discomfort. Recognizing and differentiating these experiences is essential to improve assessment accuracy and guide appropriate early interventions. However, immobilization discomfort remains poorly defined.

Purpose: Explore the experiences of healthy volunteers subjected to immobilization on an ambulance stretcher, and develop a preliminary conceptual definition of immobilization discomfort.

Design: Exploratory qualitative descriptive study.

Method: This exploratory qualitative descriptive study involved healthy volunteers who participated in two 1-hour immobilization sessions using the same stretcher, with a resting interval of 2 weeks. Data collection was carried out through a structured questionnaire with sociodemographic data, closed questions (such as discomfort [numeric-rating scale], comparison of discomfort between sessions, body location of main discomfort) and open-ended questions to characterize discomfort. All qualitative responses were analyzed using Bardin's content analysis technique.

Results: A total of 21 participants (mean age = 20.8 years; SD = 3.99; 76.2% female) were enrolled. Global discomfort was higher in Session 1 (6.9 ± 1.9 vs 6.3 ± 2.4), but the paired difference was not statistically significant (p = .168). Discomfort was most frequently localized in the occipital region, heels, and shoulders, often intensifying with time. Thematic analysis revealed nine main categories: immobility and feelings of claustrophobia; pressure points on bony prominences; temporal progression of discomfort often evolving into pain; distinction between discomfort and pain; habituation effect across sessions; psychological components such as anxiety, stress, and distraction; environmental factors including heat, restricted visibility, itching, and breathing difficulties; immediate relief upon release; and sensations of paresthesia, numbness, or tingling.

Conclusion: Immobilization discomfort is a subjective, multidimensional experience involving physical, psychological, and environmental components, and is distinct from pain in most volunteers. A preliminary conceptual definition was formulated, which may serve as a foundation for improving patient assessment and care protocols in emergency and transport settings. The findings are preliminary and require validation in trauma populations before clinical generalization.

Clinical implications: Prolonged immobilization on a stretcher can cause significant physical and psychological discomfort, a phenomenon not yet well characterized. Immobilization discomfort on a stretcher was characterized as a multidimensional experience involving physical, psychological, and environmental factors, distinct from pain.