Bed rest for treating pressure ulcers (bed sores) among wheelchair users

Background

Pressure ulcers (also known as bed sores) are wounds that occur on the skin or underlying tissues as a result of unrelieved pressure on bony, weight-bearing points of the body, such as the hips, heels or lower back. People at risk include those with reduced mobility. Wheelchair users are therefore at risk because they remain seated for long periods. Pressure ulcers can be difficult to heal and are prone to infection and other complications. When these wounds occur among wheelchair users, bed rest is considered important to relieve pressure on part of the body that bear weight in a seated position. This change from a sitting to a lying position is thought to improve wound healing.

Review question

We wanted to discover the impact of bed rest on the healing of pressure ulcers among people confined to a wheelchair. Eligible studies could involve wheelchair users of any age with a pressure ulcer in any setting (hospital, nursing home, person’s own home etc).

What we found

In October 2016 we searched widely through the medical literature for randomised controlled trials comparing bed rest with no bed rest for the healing of pressure ulcers in wheelchair users. We did not find any trials that had been conducted in this area. This means that we cannot say whether bed rest improves the healing of pressure ulcers in wheelchair users, or what the harms and benefits of this treatment might be. Trials are needed that compare pressure ulcer healing with and without bed rest among wheelchair users.

This plain language summary is up-to-date as of October 2016.

Authors' conclusions: 

We set out to evaluate the research evidence, from randomised controlled trials, of the impact of bed rest on pressure ulcer healing in wheelchair users. No study met the inclusion criteria. It is uncertain whether bed rest makes a difference to the healing of pressure ulcers in wheelchair users. Well-designed trials addressing important clinical, quality of life and economic outcomes are required.

Read the full abstract...
Background: 

Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, and impact negatively on the individual's quality of life. International guidelines suggest bed rest as a component of the treatment strategy to manage pressure ulcers among wheelchair users. The potential benefits and risks need to be considered when assessing the effectiveness of bed rest as an intervention for treating pressure ulcers in this population. Therefore, it was important to search and appraise existing research evidence in order to determine the impact of bed rest on the healing of pressure ulcers in wheelchair users.

Objectives: 

To assess the impact of bed rest on pressure ulcer healing, in wheelchair users, of any age, who are living or being cared for in any setting.

Search strategy: 

In October 2016 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trials registries and conference proceedings and for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting.

Selection criteria: 

We considered randomised controlled trials (RCTs) and cluster-RCTs that evaluated the impact of bed rest on healing pressure ulcers in wheelchair users.

Data collection and analysis: 

Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for their eligibility.

Main results: 

We identified no studies that met the inclusion criteria.

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