Effectiveness of interventions to prevent pressure injury in adults admitted to acute hospital settings: A systematic review and meta-analysis of randomised controlled trials
Section snippets
What is already known
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While hospital-acquired pressure injuries are predominately preventable with the use of preventative interventions, they continue to occur within acute hospital settings.
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Clinical practice recommendations and evidence syntheses for pressure injury prevention are available to guide practice across settings.
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The body of randomised controlled trials testing pressure injury preventative interventions in adults admitted to acute hospital settings alone has not yet been synthesised.
What this paper adds
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Included studies investigated nine different types of intervention. Six types of intervention were pooled for meta-analyses; however, most pooled samples were heterogeneous.
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In intention-to-treat meta-analyses, only one intervention demonstrated a statistically significant effect: Australian medical sheepskin overlay. All trials were judged to be at unclear or high risk-of-bias.
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Further acute care trials with large sample sizes are recommended for all intervention types and should be undertaken
Design
This systematic review and meta-analysis of randomised controlled trials was guided by the Cochrane Handbook (Higgins et al., 2019c). The protocol was registered a priori with PROSPERO (Lovegrove et al., 2019).
Eligibility criteria
PICOS criteria:
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Population: adults in acute hospital settings
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Intervention: pressure injury preventative interventions (single/bundled)
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Comparator: inactive control (e.g. standard care, placebo, none) or active (e.g. variation of experimental intervention, other interventions outside of
Study selection
Overall, 45 acute hospital setting studies were included (Fig. 1), including nine with intensive care sub-settings. Two articles were excluded as they were duplicate reports (Nixon et al., 2006a; Nixon et al., 2019b), with more detailed reports of the same studies retained for inclusion (Nixon et al., 2019a; Nixon et al., 2006b).
Study characteristics
Study characteristics and outcomes are presented in Table 1. The earliest study was reported in 1961. Of the included studies, over half were European (n = 24), with
Meta-analyses
Where sufficient studies with intention-to-treat incidence data were available, meta-analyses were performed according to intervention type. Forest plots are shown in Fig. 3, with heterogeneity and effect size statistics shown in Table 2.
Discussion
This systematic review and meta-analysis identified a sizeable evidence base. However, all included trials were judged to be at unclear or high risk-of-bias. While randomised controlled trials are the highest level of evidence for an individual study (National Health and Medical Research Council, 2000), the validity of results may be jeopardised when bias has potentially been introduced (Higgins et al., 2019b). By extracting both intention-to-treat and per-protocol data, this review and
CRediT authorship contribution statement
Josephine Lovegrove: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing – original draft, Writing – review & editing, Project administration. Paul Fulbrook: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing – original draft, Writing – review & editing, Project administration, Supervision. Sandra J. Miles: Conceptualization, Methodology, Validation, Investigation, Writing – review & editing,
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Funding
This study was part-funded by a PhD scholarship awarded by The Prince Charles Hospital Foundation to the first author (ref: PhD2019–01).
Acknowledgements
The authors would like to acknowledge specialist health services librarian Virginia Corfield (Australian Catholic University, Brisbane, Australia) for her assistance with search strategy development and database searching.
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