Shi C, Dumville JC, Cullum N, et al.
PloS one. Date of publication 2018 Feb 23;volume 13(2):e0192707.
1. PLoS One. 2018 Feb 23;13(2):e0192707. doi: 10.1371/journal.pone.0192707.
eCollection 2018.
Support surfaces for pressure ulcer prevention: A network meta-analysis.
Shi C(1), Dumville JC(1), Cullum N(1)(2).
Author information:
(1)Division of Nursing, Midwifery & Social Work, School of Health Sciences,
Faculty of Biology, Medicine & Health, University of Manchester, Manchester
Academic Health Science Centre, Manchester, United Kingdom.
(2)Research and Innovation Division, Manchester University NHS Foundation Trust,
Manchester Academic Health Science Centre, Manchester, United Kingdom.
BACKGROUND: Pressure ulcers are a prevalent and global issue and support surfaces
are widely used for preventing ulceration. However, the diversity of available
support surfaces and the lack of direct comparisons in RCTs make decision-making
difficult.
OBJECTIVES: To determine, using network meta-analysis, the relative effects of
different support surfaces in reducing pressure ulcer incidence and comfort and
to rank these support surfaces in order of their effectiveness.
METHODS: We conducted a systematic review, using a literature search up to
November 2016, to identify randomised trials comparing support surfaces for
pressure ulcer prevention. Two reviewers independently performed study selection,
risk of bias assessment and data extraction. We grouped the support surfaces
according to their characteristics and formed evidence networks using these
groups. We used network meta-analysis to estimate the relative effects and
effectiveness ranking of the groups for the outcomes of pressure ulcer incidence
and participant comfort. GRADE was used to assess the certainty of evidence.
MAIN RESULTS: We included 65 studies in the review. The network for assessing
pressure ulcer incidence comprised evidence of low or very low certainty for most
network contrasts. There was moderate-certainty evidence that powered active air
surfaces and powered hybrid air surfaces probably reduce pressure ulcer incidence
compared with standard hospital surfaces (risk ratios (RR) 0.42, 95% confidence
intervals (CI) 0.29 to 0.63; 0.22, 0.07 to 0.66, respectively). The network for
comfort suggested that powered active air-surfaces are probably slightly less
comfortable than standard hospital mattresses (RR 0.80, 95% CI 0.69 to 0.94;
moderate-certainty evidence).
CONCLUSIONS: This is the first network meta-analysis of the effects of support
surfaces for pressure ulcer prevention. Powered active air-surfaces probably
reduce pressure ulcer incidence, but are probably less comfortable than standard
hospital surfaces. Most prevention evidence was of low or very low certainty, and
more research is required to reduce these uncertainties.
DOI: 10.1371/journal.pone.0192707
PMCID: PMC5825032
PMID: 29474359 [Indexed for MEDLINE]
