Author interview: Suite of reviews on pressure ulcers

Pressure ulcers, also known as pressure sores or bed sores, are wounds to the skin and underlying tissue caused by prolonged pressure or rubbing. People who have mobility problems or who lie in bed for long periods are at risk of developing pressure ulcers.

Cochrane Wounds has recently published a suite of reviews on this topic, lead author Chunhu Shi tells us about these reviews.

How did this suite of reviews come about?
The relative effectiveness of different types of beds and mattresses (support surfaces) for preventing pressure ulcers, came out as a “top uncertainty” in a priority setting exercise involving patients, carers and health care professionals. We were awarded funding from the National Institute for Health Research to review the research on this topic.

In the beginning, we thought we would update an existing, large Cochrane review, Support surfaces for pressure ulcer prevention. This review was one of our most downloaded, with 11,835 downloads in 2019. However, we were concerned that the existing review was too large and difficult for readers to navigate. Furthermore, its size and complexity made it difficult to update. We therefore decided to split the review into four new review titles plus an overview that would include a network meta-analysis, to pull all comparisons together.

Before embarking on the splitting and restructure of the review, we consulted users of our reviews via an online survey. In the survey we explained the rationale for splitting the review and outlined our suggested new review titles and comparisons. Our stakeholders were positive about the plan so we proceeded to split the original review into four new reviews plus an overview.

Whilst addressing the evidence for pressure ulcer prevention we decided to also update our review of the effects of support surfaces for the treatment of pressure ulcers and include these data in the overview. In doing this we hoped to create a “one-stop-shop” on the evidence for support surfaces.  

What led to these topics being picked?
Support surfaces such as beds and mattresses are widely-used and the focus of recommendations in pressure injury guidelines globally. However, decision-makers are faced with a confusing array of devices to choose from and consequent uncertainty. In splitting the review, we aimed to ensure each new review was as clinically comprehensive and relevant as possible. We used the support surface classification of the (US) National Pressure Injury Advisory Panel to structure our reviews, ensuring international, as well as national relevance.

Tell us about the prioritisation exercise
Full details about the priority setting exercise can be found here. Briefly, The James Lind Alliance approach is open and participatory. Patients, carers and health care professionals worked together to identify and rank the key ‘uncertainties’ that would benefit from research (including systematic reviews). More than 450 uncertainties were submitted to the Pressure Ulcer Partnership and these were crystallised into a top 12. Support surfaces for pressure ulcer prevention was ranked at number four.

Who are the reviews particularly useful for? Does any of the evidence stand out as useful for those caring for people with pressure ulcers, or those who have ulcers themselves?
We think these Cochrane reviews plus the overview are relevant to anyone making choices about using support surfaces to prevent and treat pressure ulcers, including carers and people at risk of (or who already have) pressure ulcers.

Friday, June 4, 2021