Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews.

Humans Pressure Ulcer / prevention & control
Pressure injury Prevention Recommendations Systematic meta-review Treatment

Journal

Journal of tissue viability
ISSN: 0965-206X
Titre abrégé: J Tissue Viability
Pays: England
ID NLM: 9306822

Informations de publication

Date de publication:
Nov 2020
Historique:
received: 07 01 2020
revised: 13 04 2020
accepted: 29 05 2020
pubmed: 7 7 2020
medline: 17 8 2021
entrez: 7 7 2020
Statut: ppublish

Résumé

There are many high-quality systematic reviews to inform practice around pressure injury (PI) prevention and treatment. However, they are often unable to provide recommendations for practice and research due to low quality trials. To evaluate current systematic review evidence on the prevention and treatment of PI. This meta-synthesis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only Cochrane Reviews were included. Evidence from reviews was independently screened and assessed for risk of bias and certainty using Grading of Recommendations, Assessment, Development and Evaluations by two authors, with a third resolving discrepancies. Methodological quality of included reviews was assessed using the second version of A Measurement Tool to Assess Systematic Reviews, and a narrative synthesis undertaken. Twenty-five Cochrane Reviews were included; eight for PI prevention and 19 for PI treatment. Prevention reviews included 102 studies (27,933 participants). Treatment reviews included 154 studies (over 16,936 participants). Three prevention reviews and nine treatment reviews reported risk of bias, judging the included trials as having low or very low certainty evidence. Two reviews reported moderate certainty evidence. Methodological quality of the systematic reviews was rated as high for eight reviews (7/19 for treatment and 1/6 for prevention). Recommendations for prevention included repositioning, nutrition and support surfaces. Recommendations for treatment focused on nutrition and repositioning. This meta-synthesis confirms the low-certainty of PI prevention and treatment trials, resulting in few recommendations to inform clinical practice. Generation of high-quality evidence on PI prevention and treatment is imperative.

Sections du résumé

BACKGROUND BACKGROUND
There are many high-quality systematic reviews to inform practice around pressure injury (PI) prevention and treatment. However, they are often unable to provide recommendations for practice and research due to low quality trials.
OBJECTIVES OBJECTIVE
To evaluate current systematic review evidence on the prevention and treatment of PI.
METHODS METHODS
This meta-synthesis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only Cochrane Reviews were included. Evidence from reviews was independently screened and assessed for risk of bias and certainty using Grading of Recommendations, Assessment, Development and Evaluations by two authors, with a third resolving discrepancies. Methodological quality of included reviews was assessed using the second version of A Measurement Tool to Assess Systematic Reviews, and a narrative synthesis undertaken.
RESULTS RESULTS
Twenty-five Cochrane Reviews were included; eight for PI prevention and 19 for PI treatment. Prevention reviews included 102 studies (27,933 participants). Treatment reviews included 154 studies (over 16,936 participants). Three prevention reviews and nine treatment reviews reported risk of bias, judging the included trials as having low or very low certainty evidence. Two reviews reported moderate certainty evidence. Methodological quality of the systematic reviews was rated as high for eight reviews (7/19 for treatment and 1/6 for prevention). Recommendations for prevention included repositioning, nutrition and support surfaces. Recommendations for treatment focused on nutrition and repositioning.
CONCLUSIONS CONCLUSIONS
This meta-synthesis confirms the low-certainty of PI prevention and treatment trials, resulting in few recommendations to inform clinical practice. Generation of high-quality evidence on PI prevention and treatment is imperative.

Identifiants

DOI: 10.1016/j.jtv.2020.05.004 PMID: 32624289
pubmed: 32624289
pii: S0965-206X(20)30078-4
doi: 10.1016/j.jtv.2020.05.004
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Pagination

227-243

Informations de copyright

Copyright © 2020 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Auteurs

Rachel M Walker (RM)

School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University & Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia. Electronic address: r.walker@griffith.edu.au.

Brigid M Gillespie (BM)

School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University & Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia. Electronic address: https://twitter.com/bgillespie6.

Elizabeth McInnes (E)

Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia. Electronic address: https://twitter.com/McInnesLiz.

Zena Moore (Z)

School of Nursing & Midwifery, Royal College of Surgeons (RCSI), Dublin, Ireland; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, United Kingdom. Electronic address: https://twitter.com/ZenaMoore5.

Anne M Eskes (AM)

Department of Surgery, Amsterdam UMC, University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; School of Nursing and Midwifery, Griffith University, Ireland. Electronic address: https://twitter.com/Anne_Eskes.

Declan Patton (D)

School of Nursing & Midwifery, Royal College of Surgeons, Dublin, Ireland; Faculty of Science, Medicine and Health, University of Wollongong, Australia; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia. Electronic address: https://twitter.com/DeclanPatton3.

Emma L Harbeck (EL)

Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.

Codi White (C)

Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.

Ian A Scott (IA)

Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia.

Wendy Chaboyer (W)

School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. Electronic address: https://twitter.com/WChaboyer.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prevention and treatment of pressure injuries:...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Ulcère cutané › Escarre › Prevention and treatment of pressure injuries:...