To systematically review published randomized controlled trials (RCTs) evaluating therapies for pressure ulcers.
A total of 103 RCTs met inclusion criteria. Of these, 83 did not provide sufficient information about authors' potential financial conflicts of interest. Methodological quality was variable. Most trials were conducted in acute care (38 [37%]), mixed care (25 [24%]), or long-term care (22 [21%]) settings.
Then these were categorized into 3 groups to mirror the way wound specialist approach pressure ulcer management:
- RCT investigated the management of underlying contributing factors (first: reduce or eliminate underlying contributing factors – support surfaces and nutritional supplementation)
- RCT investigated the effects of local wound care (second: provide local wound care – wound dressings and biological agents)
- RCT investigated adjunctive therapies (third: consider adjunctive therapies – ie vacuum therapy, surgery)
Here are their conclusions:
Relatively few RCTs evaluating pressure ulcer treatments follow standard criteria for reporting non-pharmacological interventions.High-quality studies are needed to establish the efficacy and safety of many commonly used treatments.There is little evidence from RCTs to justify the use of 1 support surface or dressing over alternatives.Similarly, there is little evidence to justify the routine use of nutritional supplements, biological agents, and adjunctive therapies compared with standard care.Clinicians should make decisions regarding pressure ulcer therapy based on fundamental wound care principles, cost, ease of use, and patient preference.