Article

OBJECTIVES: To evaluate the literature on the effectiveness of bed and wheelchair
positioning and repositioning in the prevention of pressure ulcers (PUs) in both
the spinal cord injury (SCI) and non-SCI populations. DESIGN: Systematic review.
METHODS: PubMed, CINAHL, PsycINFO, and EMBASE were queried with the subject
heading terms "pressure sore," "pressure ulcer," "position or turn in bed,
wheelchair," "pressure relief," and "pressure release." All study design types
that assessed the effectiveness of bed and wheelchair positioning and pressure
relief maneuvers in any patient group and in any setting were sought. Three
independent reviewers extracted and summarized details of eligible trials using a
standardized method. Two independent reviewers assessed the methodological
quality of each trial using the American Academy of Neurology guidelines. When
reviewers were not able to reach consensus, a third independent reviewer served
as tiebreaker. RESULTS: We identified 2820 publications, of which 49 met
inclusion criteria. Of these publications, the subject population was 2834 (923
persons with SCI, 717 persons without SCI, and 1194 healthy control subjects).
Among studies examining pressure related to position or repositioning in bed or
sitting, procedures for measuring skin pressure and metabolism were highly
variable by anatomic location, measurement technique, outcome measure, study
site, participant characteristics, and description of position/turning for bed
and seated interventions. Numerous factors can influence tissue interface
pressures, and no prospective studies had been performed to determine a causal
relationship between interface pressure and skin breakdown. Several studies
suggest that skin response to pressure differs between subjects with and without
SCI. Conflicting results and insufficient evidence for optimal bed and seated
positioning and turning and pressure relief maneuvers to prevent PUs in both SCI
and non-SCI populations were limiting factors. CONCLUSIONS: Although there is no
clear optimal positioning or turning frequency in bed, the evidence suggests
avoiding the 90 degrees lateral position because of high pressures and PU risk
over the trochanters. During sitting, pressures are linearly redistributed from
the sitting area during recline and tilt; however, reclining carries with it an
increased risk of shear forces on this skin. The evidence does not support
conclusive guidelines on positioning or repositioning techniques for PU
prevention in bed or during sitting. We conclude that PU risk is highly
individualized, with the SCI population at a higher risk, which demands flexible
PU prevention strategies for bed/seated positioning and pressure relief
maneuvers. Education has and will remain our most powerful ally to thwart this
pervasive public health problem.
CI - Copyright (c) 2015. Published by Elsevier Inc.

Langue : ANGLAIS