Abstract
BackgroundPressure ulcers are a prevalent and global issue and support surfaces are widely used for preventing ulceration. However, the diversity of available support surfaces and the lack of direct comparisons in RCTs make decision-making difficult.ObjectivesTo determine, using network meta-analysis, the relative effects of different support surfaces in reducing pressure ulcer incidence and comfort and to rank these support surfaces in order of their effectiveness.MethodsWe conducted a systematic review, using a literature search up to November 2016, to identify randomised trials comparing support surfaces for pressure ulcer prevention. Two reviewers independently performed study selection, risk of bias assessment and data extraction. We grouped the support surfaces according to their characteristics and formed evidence networks using these groups. We used network meta-analysis to estimate the relative effects and effectiveness ranking of the groups for the outcomes of pressure ulcer incidence and participant comfort. GRADE was used to assess the certainty of evidence.Main resultsWe included 65 studies in the review. The network for assessing pressure ulcer incidence comprised evidence of low or very low certainty for most network contrasts. There was moderate-certainty evidence that powered active air surfaces and powered hybrid air surfaces probably reduce pressure ulcer incidence compared with standard hospital surfaces (risk ratios (RR) 0.42, 95% confidence intervals (CI) 0.29 to 0.63; 0.22, 0.07 to 0.66, respectively). The network for comfort suggested that powered active air-surfaces are probably slightly less comfortable than standard hospital mattresses (RR 0.80, 95% CI 0.69 to 0.94; moderate-certainty evidence).ConclusionsThis is the first network meta-analysis of the effects of support surfaces for pressure ulcer prevention. Powered active air-surfaces probably reduce pressure ulcer incidence, but are probably less comfortable than standard hospital surfaces. Most prevention evidence was of low or very low certainty, and more research is required to reduce these uncertainties.
Highlights
Pressure ulcers are localised injuries to the skin and/or underlying tissue, which are known as pressure injuries, pressure sores, decubitus ulcers and bedsores [1]
Pressure ulcers are caused by localised pressure and shear [1], intervention to alleviate pressure and shear is an important part of pressure ulcer prevention
Our primary outcome was pressure ulcer incidence. We considered this outcome as either the proportion of participants developing a new ulcer at the latest trial follow-up point or time-to-pressure ulcer incidence
Summary
Pressure ulcers are localised injuries to the skin and/or underlying tissue, which are known as pressure injuries, pressure sores, decubitus ulcers and bedsores [1]. Pressure ulcers represent a serious heath burden with a point prevalence of approximately 3.1 per 10,000 in the United Kingdom (UK) [2]. Pressure ulcers are caused by localised pressure and shear [1], intervention to alleviate pressure and shear is an important part of pressure ulcer prevention. Support surfaces (e.g. mattresses, overlays, integrated bed systems) are designed to work towards preventing pressure ulcers primarily in this way [4]. Identification of the optimum support surface from the diverse options available requires evidence on their relative effectiveness in terms of how well they prevent the incidence of new pressure ulcers [2]. Pressure ulcers are a prevalent and global issue and support surfaces are widely used for preventing ulceration. The diversity of available support surfaces and the lack of direct comparisons in RCTs make decision-making difficult
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