Can the repositioning of patients with pressure ulcers contribute to wound healing?

Can the repositioning of patients with pressure ulcers contribute to wound healing?
22 November, 2010

A Cochrane review searched for evidence on the effects of repositioning on pressure ulcers but discovered a lack of high quality research on this area of care

Keywords Pressure ulcer, repositioning, position, wound healing

This article has been double-blind peer-reviewed
Review question

What is the effect of patient repositioning on the healing of pressure ulcers?

Nursing implications

Pressure ulcers, caused by excess pressure, shearing or friction forces, are a serious health issue for patients in all kinds of settings, including those being cared for at home.

Repositioning involves moving the individual into a different position to remove or redistribute pressure from a part of the body. Its purpose is to contribute to wound healing.

Analysing the evidence on the effectiveness of repositioning can promote the development of treatment strategies for pressure ulcers to:

Reduce the suffering of patients and improve their quality of life;
Reduce the financial burden on the health service;
Lighten the workload of nursing staff.
Study characteristics

Randomised controlled trials and controlled clinical trials that evaluated the following comparisons were eligible for inclusion into the review:

Repositioning compared with no repositioning;
Comparisons between different frequencies of repositioning;
Comparisons between different positions for repositioning.
The review intended to include studies involving people of any age, in any healthcare setting, who had existing pressure ulcers.

The primary outcomes were objective measures of pressure ulcer healing and included:

Time to complete healing;
Absolute or percentage change in pressure ulcer area or volume;
Proportion of pressure ulcers healed;
Healing rate.
Secondary outcomes included:

Procedural pain;
Assessment of quality of life;
Ease of use of the method of repositioning;
Adverse events such as falls, length of hospital stay or death.
Summary of key evidence

The initial search identified 91 titles; however, the review authors identified not studies that met the inclusion criteria.

Best practice recommendations

The lack of high quality evidence makes it difficult to draw conclusions about the effectiveness of repositioning patients on the healing of pressure ulcers.

Although repositioning is an integral component of pressure ulcer management strategies and is widely used in clinical practice, there are no available RCTs or CCTs that provide specific guidance for practice.

High quality comparative research of repositioning on pressure ulcer healing is needed.

For the full review report, including references, click here

AUTHORS Chenling Luoa, PhD, RN, is associate professor, School of Southern Medical University, Guangzhou, China; Jing Chub, MSN Nursing, is lecturer, Nursing School of Second Military Medical University, Shanghai, China; both are members of the Cochrane Nursing Care Field

References:
Moore ZEH, Cowman S (2009) Repositioning for treating pressure ulcers. Cochrane Database of Systematic Reviews; Issue 2, Art No: CD006898. DOI: 10.1002/14651858.CD006898.pub2.

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