Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: A systematic review |
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| Affiliation: | 1. Clinical Nurse Specialist, Leeds Teaching Hospitals, NHS Trust, Leeds, UK;2. Glasgow Caledonian University, Glasgow, UK;3. Tissue Viability and Clinical Trials Research, University of Leeds, Leeds, UK;4. University of Leeds, Leeds, UK |
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| Abstract: | BackgroundPressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown.MethodsSystematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate.ResultsFifteen RCTs (4724 participants) were identified.Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01).Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67).Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence.In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively).ConclusionsOff-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence. |
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| Keywords: | Heel Pressure ulcer Systematic review Prevention Devices CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" Confidence Interval CLP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" Constant Low Pressure HPU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" Heel Pressure Ulcer HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" Hazard Ratio ITT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" Intention to treat MD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" Mean Difference NPIAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0091" }," $$" :[{" #name" :" text" ," _" :" National Pressure Injury Advisory panel NPUAP/EPUAP/PPPIA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" National Pressure Ulcer Advisory Panel/ European Pressure Ulcer Advisory Panel/Pan Pacific Pressure Injury Alliance PAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" Peripheral Arterial Disease PRISMA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" Preferred Reporting Items for Systematic Reviews and Meta-analyses PU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" Pressure Ulcer RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" Randomised Controlled Trial RR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" Risk Ratio SMD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" Standard Mean Difference |
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