Repositioning and Pressure Ulcer in Geriatric Population: A Systematic Review

Wednesday, 1 August 2012: 8:50 AM

Yueh-Lih Li, BSN, RN1
Yueh-Yen Fang, PhD, RN2
Chia-Hua Tsai, BSN, RN1
Yu-Pei Li, BSN, RN1
Li-Chen Sun, MSN, RN3
Li-Chin Chen, MSN, RN3
(1)Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital-An affiliation of Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
(2)School of Nursing, Fooyin University, Kaohsiung, Taiwan
(3)Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital-An affiliation of Kaohsiung Medical University Hospital and Kaohsiun, Kaohsiung, Taiwan

Learning Objective 1: The learner will be able to understand the knowledge gap in prevention of pressure ulcers between present practice and current evidence.

Learning Objective 2: The learner will be able to describe the limitations of current repositioning studies.

Purpose: The purpose of this study was to identify the relationship between repositioning and the development of pressure ulcers (PUs) in geriatric population from current research evidence. 

Methods:  A systematic review was conducted to respond the study purpose. Six English and three Chinese databases were used to search English and Chinese literature published up to August, 2011. Search terms used were ‘turning’, ‘position’, ‘reposition’, ‘pressure ulcer’, ‘erythema’, ‘pressure sore’, and ‘decubitus ulcer.’ Data were extracted by two researchers independently. Disagreement among data extraction was resolved by complete consensus between researchers. Study quality was evaluated by the Johns Hopkins Nursing Evidence-based practice Quality Rating Scale.

Results:  Four randomized controlled trials (RCTs) that met the inclusion criteria were located from 1312 articles. The total subjects involved were 1332 geriatric patients. Study quality of included studies ranged from high to median level. However, a combination of different mattress and position used made the integration of study results difficult. Attrition and protection of patient’s right became major concerns of study quality. Though, the quantitative integration of study results was impossible because of different protocols used between studies. Grouping of same or similar manipulations across studies revealed a combined effect of mattress type and position. Pressure-reduction mattresses did bring a positive effect in either first-grade or second-grade PU development. Patients who received Semi-Flower position presented a higher rate of PU incidence than those who did not use this position.

Conclusion: Variations in repositioning protocols made the validation of research evidence difficult. Varied capability in mobility of research subjects across studies and short intervention time impeded study validity. Prevention of pressure ulcers may bring a significant impact on healthcare cost and patient’s mortality and quality of life. It is suggested that future studies include a standard control to make cross study comparison possible.