Are strategies, including mechanical and traditional repositioning, effective for pressure ulcer prevention?

Abstract

Pressure ulcers represent a debilitating condition for patients and present a significant challenge for healthcare professionals. To determine the risk of pressure ulcer development, patients are typically assessed with pressure ulcer risk assessment scales. Bedbound patients deemed at risk of pressure ulcers may receive a range of interventions, including regular repositioning by nursing staff. However, this is resource intensive and could be augmented by
mechanical lateral rotation systems, although there is a paucity of research examining these systems.

Several experimental studies were conducted, utilising physical output parameters and comfort assessments to examine the efficacy and acceptability of two lateral rotation systems, when compared to traditional repositioning, in cohorts of healthy participants. In addition, a study sought to determine the inter-practitioner variability of traditional repositioning. An integrative
review of pressure ulcer risk assessments scales was further undertaken, to update and extend previous reviews.
A number of differences were observed in the physical and comfort data, some ofwhich were device dependent. A trend towards fewer instances of compromised tissue viability was observed during traditional repositioning, although some participants preferred turning by means of a lateral rotation system. Considerable variation was noted in the repositioning technique employed by practitioners, even after written guidance, and offloading of vulnerable areas was not always achieved. Ninety-four risk assessment scales were identified, but only 15% of these scales were assessed for inter-rater reliability. The methodological quality of such studies was often poor.

Lateral rotation systems may provide an adjunct to repositioning by traditional methods, but the design is important, both in terms of efficacy and acceptability. Practitioners should be provided with practical training, focusing on the procedural aspects of repositioning. Further high-quality primary research is required to evaluate existing riskassessment scales.

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Identifiers

ORCID for Daniel Bader: orcid.org/0000-0002-1208-3507

ORCID for David Voegeli: orcid.org/0000-0003-3457-7177

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