Main Study Findings and Author’s Conclusions

Main Study Findings

Author’s Conclusions

Systematic review

Liu, 2014⁹

Preventive studies (n=16):

4 types of ES devices were identified: conventional surface electrodes (10 studies); custom-made garment with built-in electrodes (one study); electrical current delivered through a sacral anterior nerve root stimulator (SARS) implant (2 studies); and electrical current delivered via implanted intramuscular electrodes (3 studies).
Of 11 studies examining dynamic effect of ES, 8 studies demonstrated a reduction of pressure under the ischial tuberosities; 3 of 5 studies which measured local tissue oxygenation or blood flow reported an increase in regional tissue oxygenation or blood flow during the stimulation, and 2 studies reported an increase of tissue oxygenation in some participants (unclear if observed differences reached statistical significance).
Of 5 studies examining long-term effects of ES, 4 studies demonstrated positive changes including reduced seating pressure or incidence of PrUs, increased muscle thickness, ischial tissue oxygenation, and sitting tolerance; one study reported no change in gluteal thickness or pressure distribution after a 12-week follow-up
Of 4 studies which reported on adverse events (two studies delivered ES using surface electrodes and two studies sued a SARS implant), no adverse events were experienced by the participants.

“The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I [strong] evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention.” (p.703)

Randomized controlled trials

Dutra, 2015¹⁰

Incidence of PrUs

Incidence of PrUs was significantly lower (P = 0.038) in the PF group (8.7%) than in the HD group (15%).

Mean number of dressing changes per body region

Significant between-group differences were found in mean number of dressing changes in the sacral region (HD 2.50±0.871 changes; PF 2.05±0.825; P = 0.001), with PF requiring significantly fewer changes than the HD group.

Total number of dressing changes during the study period

Significant between-group differences were found in the mean total number of dressing changes (HD 6.09±1.66 chnages; PF 5.59±2.04 changes; P = 0.010)

Reasons for dressing changes

Most common reasons for changing dressings in both groups were moisture (PF 51.1%; HD 47.9%) and shear (HD 43%; PF 38.9%), with a significant between-group difference in shear (P = 0.048).

“The results suggest that the transparent polyurethane film had a better performance and was more effective than the hydrocolloid dressing in preventing PU development.” (p.268)

Findings and Recommendations

Grade/Strength of Recommendation

Haesler (Ed.), 2014¹¹ – National Pressure Ulcer Advisory Panel (NPUAP) European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA)

Microclimate control

Consider the need for additional features such as ability to control moisture and temperature when selecting a support surface or support surface cover.
Do not apply heating devices (e.g., hot water bottles, heating pads, built-in bed warmers) directly on skin surfaces or pressure ulcers.

Prophylactic dressings

Consider applying a polyurethane foam dressing to bony prominences (e.g., heels, sacrum) for the prevention of pressure ulcers in anatomical areas frequently subjected to friction and shear.
When selecting a prophylactic dressing consider:
- ability of the dressing to manage microclimate;
- ease of application and removal;
- ability to regularly assess the skin;
- anatomical location where the dressing will be applied; and
- the correct dressing size.
Continue to use all other preventive measures necessary when using prophylactic dressings.
Assess the skin for signs of pressure ulcer development at each dressing change or at least daily, and confirm the appropriateness of the current prophylactic dressing regimen.
Replace the prophylactic dressing if it becomes damaged, displaced, loosened or excessively moist.

Fabrics and textiles

Consider using silk-like fabrics rather than cotton or cotton-blend fabrics to reduce shear and friction.

Electrical Stimulation of the Muscles

Consider the use of electrical stimulation for anatomical locations at risk of pressure ulcer development in spinal cord injury patients.

Microclimate control

Strength of Evidence = C; Strength of Recommendation = Weak positive recommendation (probably do it)
Strength of Evidence = C; Strength of Recommendation = Weak positive recommendation (probably do it)

Prophylactic dressings

Strength of Evidence = B; Strength of Recommendation = Weak positive recommendation (probably do it)
Strength of Evidence = C; Strength of Recommendation = Weak positive recommendation (probably do it)
Strength of Evidence = C; Strength of Recommendation = Weak positive recommendation (probably do it)
Strength of Evidence = C; Strength of Recommendation = Weak positive recommendation (probably do it)
Strength of Evidence = C; Strength of Recommendation = Strong positive recommendation (definitely do it)

Fabrics and textiles

Strength of Evidence = B; Strength of Recommendation = Weak positive recommendation (probably do it)

Electrical Stimulation of the Muscles

Strength of Evidence = C; Strength of Recommendation = No specific recommendation

Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner.

Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK395746

Contents

< PrevNext >

Bookshelf

Emerging Technologies for the Prevention of Pressure Ulcers in Acute Care Settings: A Review of Clinical and Cost-Effectiveness and Guidelines [Internet].

APPENDIX 4Main Study Findings and Author’s Conclusions

Table A7Summary of Findings of Included Studies

Table A8Summary of Recommendations in Included Guidelines

Views

Other titles in this collection

Recent Activity

Main Study Findings	Author’s Conclusions
Systematic review
Liu, 2014⁹
Preventive studies (n=16): 4 types of ES devices were identified: conventional surface electrodes (10 studies); custom-made garment with built-in electrodes (one study); electrical current delivered through a sacral anterior nerve root stimulator (SARS) implant (2 studies); and electrical current delivered via implanted intramuscular electrodes (3 studies). Of 11 studies examining dynamic effect of ES, 8 studies demonstrated a reduction of pressure under the ischial tuberosities; 3 of 5 studies which measured local tissue oxygenation or blood flow reported an increase in regional tissue oxygenation or blood flow during the stimulation, and 2 studies reported an increase of tissue oxygenation in some participants (unclear if observed differences reached statistical significance). Of 5 studies examining long-term effects of ES, 4 studies demonstrated positive changes including reduced seating pressure or incidence of PrUs, increased muscle thickness, ischial tissue oxygenation, and sitting tolerance; one study reported no change in gluteal thickness or pressure distribution after a 12-week follow-up Of 4 studies which reported on adverse events (two studies delivered ES using surface electrodes and two studies sued a SARS implant), no adverse events were experienced by the participants.	“The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I [strong] evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention.” (p.703)
Randomized controlled trials
Dutra, 2015¹⁰
Incidence of PrUs Incidence of PrUs was significantly lower (P = 0.038) in the PF group (8.7%) than in the HD group (15%). Mean number of dressing changes per body region Significant between-group differences were found in mean number of dressing changes in the sacral region (HD 2.50±0.871 changes; PF 2.05±0.825; P = 0.001), with PF requiring significantly fewer changes than the HD group. Total number of dressing changes during the study period Significant between-group differences were found in the mean total number of dressing changes (HD 6.09±1.66 chnages; PF 5.59±2.04 changes; P = 0.010) Reasons for dressing changes Most common reasons for changing dressings in both groups were moisture (PF 51.1%; HD 47.9%) and shear (HD 43%; PF 38.9%), with a significant between-group difference in shear (P = 0.048).	“The results suggest that the transparent polyurethane film had a better performance and was more effective than the hydrocolloid dressing in preventing PU development.” (p.268)