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Il regime di riposizionamento è efficace per la prevenzione di lesioni da pressione? Sinossi di revisioni sistematiche

Luca Giuseppe Re, Viviana Fusetti, Maura Lusignani

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 qualità è stata impiegata la AMSTAR checklist.

RISULTATI. Cinque revisioni sistematiche hanno rispettato i criteri di inclusione. La qualità 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’accettabilità 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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