Repositioning for Pressure Ulcer Prevention in Adults

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 502 subjects. Three RCTs and one economic study representing a total of 502 randomised participants from acute and long-term care settings were included. Two trials compared the 30° and 90° tilt positions using similar repositioning frequencies (there was a small difference in frequency of overnight repositioning in the 90° tilt groups between the trials). The third RCT compared alternative repositioning frequencies.All three studies reported the proportion of patients developing PU of any grade, stage or category. None of the trials reported on pain, or quality of life, and only one reported on cost.

The two trials of 30° tilt vs. 90° were pooled using a random effects model (I² = 69%) (252 participants). The risk ratio for developing a PU in the 30° tilt and the standard 90° position was very imprecise (pooled RR 0.62, 95% CI 0.10 to 3.97). This comparison is underpowered and at risk of a Type 2 error (only 21 events).In the third study, a cluster randomised trial, participants were randomised between 2-hourly and 3-hourly repositioning on standard hospital mattresses and 4 hourly and 6 hourly repositioning on viscoelastic foam mattresses. This study was also underpowered and at high risk of bias. The risk ratio for pressure ulcers (any category) with 2-hourly repositioning compared with 3-hourly repositioning on a standard mattress was imprecise (RR 0.90, 95% CI 0.69 to 1.16). The risk ratio for pressure ulcers (any category) was compatible with a large reduction and no difference between 4-hourly repositioning and 6-hourly repositioning on viscoelastic foam (RR 0.73, 95% CI 0.53 to 1.02).

Clinical comments

Although there is sparse data on effectiveness, repositioning is an integral component of pressure ulcer prevention and treatment; it has a sound theoretical rationale, and is widely recommended and used in practice.