Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: a systematic review

Clare Greenwood*, E. Andrea Nelson, Jane Nixon, Armando Vargas-Palacios, Elizabeth McGinnis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Pressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown. Systematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate. Fifteen RCTs (4724 participants) were identified. Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01). Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67). Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence. In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively). Off-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence. [Abstract copyright: Copyright © 2022. Published by Elsevier Ltd.]
Original languageEnglish
JournalJournal of Tissue Viability
Early online date3 Oct 2022
DOIs
Publication statusE-pub ahead of print - 3 Oct 2022

Keywords

  • Heel
  • Pressure ulcer
  • Systematic review
  • Prevention
  • Devices

ASJC Scopus subject areas

  • Health Professions(all)
  • Nursing(all)

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