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Abstract

INTRODUZIONE. Il regime di riposizionamento è un intervento raccomandato dalle linee guida e tradizionalmente impiegato nella pratica assistenziale quotidiana ma il suo beneficio per prevenire le lesioni da pressione (LDP) non è clinicamente provato. Obiettivo. Determinare l'effetto del regime di riposizionamento per prevenire le LDP.

METODI. E' stata condotta in data 23 marzo 2017 una ricerca su cinque database elettronici (The Cochrane Library, Medline, Embase, CINAHL, Web of Science). I record restituiti dalla strategia di ricerca sono stati analizzati in modo indipendente e quelli che rispettavano i criteri di inclusione sono stati reperiti in versione integrale. Sono state incluse nella sinossi revisioni sistematiche di sperimentazioni cliniche controllate o di studi quasi sperimentali che confrontassero il regime di riposizionamento con le cure usuali. Per la valutazione di qualití  è stata impiegata la AMSTAR checklist.

RISULTATI. Cinque revisioni sistematiche hanno rispettato i criteri di inclusione. La qualití  metodologica degli studi inclusi è stata molto eterogenea. Rispetto alle cure usuali, l'intervento non è associato ad una riduzione statisticamente significativa di LDP.

DISCUSSIONE. I pochi e piccoli studi disponibili non consentono di accertare un beneficio dall'intervento, qualora ci sia. Attualmente l'applicazione di un regime di riposizionamento individualizzato sembra una soluzione ragionevole. Occorrono ulteriori ricerche per confermare che una maggiore frequenza di riposizionamento e l'assunzione del decubito laterale di 30° contribuiscono a prevenire le LDP. E' necessario inoltre valutare l'impatto economico, l'accettabilití  e i rischi connessi all'intervento.

CONCLUSIONI. Ancora non è chiaro il ruolo del regime di riposizionamento per prevenire le LDP.

Is repositioning regimen effective to prevent pressure injuries? Synopsis of systematic reviews.

PAROLE CHIAVE. Efficacia, regime di riposizionamento, lesioni da pressione, sinossi. abstract

INTRODUCTION. Repositioning regimen is an intervention recommended by guidelines and traditionally used in daily care practice but its benefit for preventing pressure injuries (PI) is not clinically proved. Objective. To determine the effect of repositioning regimen to prevent PI.

METHOD. A research on five electronic databases (The Cochrane Library, Medline, Embase, CINAHL, Web of Science) was conducted on March 23, 2017. Records returned by the search strategy were independently analyzed and those that respected inclusion criteria have been found in full text. In synopsis have been included systematic reviews of controlled clinical trials or quasi-experimental studies that compare repositioning regimen with usual care. The AMSTAR checklist has been used for quality evaluation.

RESULTS. Five systematic reviews met inclusion criteria. The methodological quality of included studies have been very heterogeneous. Compared to usual cares, intervention is not associated with a statistically significant reduction of PI.

DISCUSSION. A few and small available studies do not allow to ascertain a benefit from the intervention, if any. At the moment, the application of an individualized repositioning regimen seems a reasonable solution. Further researches are needed to confirm that a more frequent repositioning and a 30° lateral decubitus intake help to prevent PI. It is also necessary to evaluate the economic impact, the acceptability and risks associated with the intervention.

CONCLUSIONI. It is still unclear the role of repositioning regimen to prevent PI. Keywords. Effectiveness, repositioning regimen, pressure injuries, synopsis.

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Re, L. G., Fusetti, V., & Lusignani, M. (2017). Il regime di riposizionamento è efficace per la prevenzione di lesioni da pressione? Sinossi di revisioni sistematiche. PROFESSIONI INFERMIERISTICHE, 70(3). Recuperato da https://www.profinf.net/pro3/index.php/IN/article/view/424
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Riferimenti

  • Arnold, M.C. (2003) Pressure ulcer prevention and management: the current evidence for care. AACN Clin Issues, 14 (4), 411-428.
  • Ayello, E.A., & Lyder, C.H. (2007) Protecting patients from harm: preventing pressure ulcers in hospital patients. Nursing, 37 (10), 36-40.
  • Bergstrom, N., Horn, S.D., Rapp, M.P., Stern, A., Barrett, R., & Watkiss, M. (2013) Turning for Ulcer ReductioN: a multisite randomized clinical trial in nursing homes. J Am Geriatr Soc, 61 (10), 1705-1713.
  • Bernabei, R., Manes-Gravina E., & Mammarella F. (2011) Epidemiology of pressure ulcers. G Gerontol, 59, 237-243.
  • Bradford, N.K. (2016) Repositioning for pressure ulcer prevention in adults. A Cochrane review. Int J Nurs Pract, 22 (1), 108-109.
  • Buss, I.C., Ruud, J.G., Halfens, R.J.G., & Abu-Saad H.H. (2002) The most effective time interval for repositioning subjects at risk of pressure sore development: a literature review. Rehabil Nurs, 27 (2), 59-77.
  • Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A.J., Reitel, K., et al. (2013) Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review. Ann Intern Med, 159 (1), 28-38.
  • Clark, M. (1998) Repositioning to prevent pressure sores--what is the evidence? Nurs Stand, 13 (3), 58-60, 62, 64.
  • Cooper, H., & Koenka, A.C. (2012) The overview of reviews: unique challenges and opportunities when research syntheses are the principal elements of new integrative scholarship. Am Psychol, 67 (6), 446-462.
  • Cullum, N., Deeks, J.J., Fletcher, A.W., Sheldon, T.A., & Song, F. (1995) Preventing and treating pressure sores. Qual Health Care, 4 (4), 289-297.
  • Defloor, T. (1999) The risk of pressure sores: a conceptual scheme. J Clin Nurs, 8 (2), 206-216.
  • Defloor, T., De Bacquer, D., & Grypdonck, M.H. (2005) The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. Int J Nurs Stud, 42 (1), 37-46.
  • Gillespie, B.M., Chaboyer, W.P., McInnes, E., Kent, B., Whitty, J.A., & Thalib, L. (2014) Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev, (4), CD009958.
  • Griffiths, H., & Gallimore, D. (2005) Positioning critically ill patients in hospital. Nurs Stand, 19 (42), 56-64.
  • Hagisawa, S., & Ferguson-Pell, M. (2008) Evidence supporting the use of two-hourly turning for pressure ulcer prevention. J Tissue Viability, 17 (3), 76-81.
  • Krapfl, L.A., & Gray, M. (2008) Does regular repositioning prevent pressure ulcers? J Wound Ostomy Continence Nurs, 35 (6), 571-577.
  • Jadad, A.R., Moore, R.A., Carroll, D., Jenkinson, C., Reynolds, D.J., Gavaghan, D.J., et al. (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials, 17, 1-12.
  • Lozano-Montoya, I., Vélez-Dí­az-Pallarés, M., Abraha, I., Cherubini, A., Soiza, R.L., O'Mahony, D., et al. (2016) Nonpharmacologic Interventions to Prevent Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The Software ENgine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons [SENATOR] Definition of Optimal Evidence-Based Non-drug Therapies in Older People [ONTOP] Series). J Am Med Dir Assoc, 17 (4), 370.e1-10.
  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & PRISMA Group. (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8 (5), 336-341.
  • Moore, Z., Cowman, S., & Conroy, R.M. (2011) A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. J Clin Nurs, 20 (17-18), 2633-2644.
  • Phillips, S., Seiverling, E., & Silvis, M. (2015) Pressure and Friction Injuries in Primary Care. Prim Care, 42 (4), 631-644.
  • Robinson, K.A., Saldanha, I.J., & McKoy, N.A. (2011) Development of a framework to identify research gaps from systematic reviews. J Clin Epidemiol, 64 (12), 1325-1330.
  • Reddy, M., Gill, S.S., & Rochon, P.A. (2006) Preventing pressure ulcers: a systematic review. JAMA, 296 (8), 974-984.
  • Ryan, R., Santesso, N., Lowe, D., Hill, S., Grimshaw, J., Prictor, M,, et al. (2014) Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev, (4), CD007768.
  • Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C., et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 7 (10), 1-7.
  • Sprigle, S., & Sonenblum, S. (2011) Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: a review. J Rehabil Res Dev, 48 (3), 203-213.
  • Vanderwee, K., Grypdonck, M.H., De Bacquer, D., & Defloor, T. (2007) Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions. J Adv Nurs, 57 (1), 59-68.
  • Walker Sewill, D.K., Van Sell, S., & Kindred, C. (2010) Pressure ulcer prevention: utilizing unlicensed assistive personnel. Crit Care Nurs Q, 33 (4), 348-355.
  • Young, T. (2004) The 30 degree tilt position vs the 90 degree lateral and supine positions in reducing the incidence of non-blanching erythema in a hospital inpatient population: a randomised controlled trial. J Tissue Viability, 14 (3), 88, 90, 92-96.