Fifty-nine RCTs (n=13,845) were included in the review.
Interventions targeting impaired mobility (51 RCTs, n=11,551).
The quality of the RCTs was generally poor: 25 adequately described randomisation procedures, while only 14 gave information that indicated that patients were randomly allocated with concealed allocation; only 10 RCTs described having a blinded outcome assessment.
Support surfaces.
Forty-eight RCTs assessed the role of support surfaces in preventing pressure ulcers. Out of 16 studies investigating a static support surface, eight showed a reduction in pressure ulcer incidence compared with a standard support surface.
Fourteen RCTs compared dynamic and static support surfaces. Only three found that dynamic support surfaces were better than static support surfaces (one of which did not report the statistical significance).
Three RCTs compared beds that turn and rotate the patient with standard hospital beds or standard intensive care unit beds. Rotating beds offered no advantage in reducing pressure ulcer incidences.
Repositioning.
Two RCTs assessed the role of repositioning in preventing pressure ulcers. One poor-quality RCT found that turning patients every 4 hours combined with the use of specialised foam mattresses reduced the incidence of pressure ulcers compared with turning every 2 hours on standard hospital mattresses. The other RCT compared patients lying at a 30 degree tilt position with standard patient positioning (90 degree side lying), but found no significant difference between the two groups.
Incontinence exercises and treatment.
One RCT assessed the role of exercise and treatment of incontinence on preventing pressure ulcers. No difference was found between the exercise and incontinence care group and the usual care group.
Interventions targeting impaired nutrition (5 RCTs, n=1,475).
The quality of the RCTs was poor: none gave information that indicated that patients were randomly allocated with concealed allocation; only one described blinding of the patients and outcome assessors.
The largest trial found that nutritional supplementation was beneficial for the prevention of pressure ulcers. Four smaller, poorer quality trials found no benefit.
Interventions targeting impaired skin health (3 RCTs, n=819).
The quality of the RCTs was poor: none indicated that patients were randomly allocated with concealed allocation. However, all three described blinding of the patients and outcome assessors.
Hyperoxygenated fatty acid compound (1 RCT) and hexachlorophene, squalene and allantoin-containing lotion (1 RCT) were both found to be superior to placebo for reducing the incidence of pressure ulcers. Topical nicotinate-containing lotion was not found to reduce the incidence of pressure ulcers compared with hexachlorophene, squalene and allantoin-containing lotion (1 RCT).