Nonpharmacologic Interventions to Heal Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The SENATOR-ONTOP Series)

Journal of the American Medical Directors Association

Volumn 16, Issue 6, 2015, Pages 448-469

  Vélez Díaz Pallarés, Manuel ^a   Lozano Montoya, Isabel ^a   Abraha, Iosief ^b   Cherubini, Antonio ^b   Soiza, Roy L ^c   O'Mahony, Denis ^d   Montero Errasquín, Beatriz ^a   Cruz Jentoft, Alfonso J ^a  

^a HOSPITAL RAMÓN Y CAJAL   (Spain)

^b INRCA   (Italy)

^c NHS GRAMPIAN   (United Kingdom)

^d UNIVERSITY COLLEGE CORK   (Ireland)

Author keywords

Meta analysis; Overview of reviews; Pressure ulcer treatment; Pressure ulcers; Systematic reviews

Indexed keywords

ALTERNATIVE MEDICINE; CLINICAL EVALUATION; COCHRANE LIBRARY; COMPARATIVE STUDY; CONTROLLED CLINICAL TRIAL (TOPIC); DECUBITUS; DELPHI STUDY; EARLY INTERVENTION; ELECTROSTIMULATION THERAPY; EMBASE; EVIDENCE BASED PRACTICE; EXPERIMENTAL DESIGN; EXTRACORPOREAL LITHOTRIPSY; HEALTH CARE; HUMAN; HYDROTHERAPY; IMMOBILIZATION; LOW LEVEL LASER THERAPY; MEDLINE; META ANALYSIS; MULTICENTER STUDY (TOPIC); NUTRITIONAL SUPPORT; OUTCOME ASSESSMENT; PATIENT POSITIONING; PHOTOTHERAPY; PRACTICE GUIDELINE; QUALITY CONTROL; RADIOFREQUENCY; RADIOFREQUENCY RADIATION; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK ASSESSMENT; RISK FACTOR; SHAM PROCEDURE; SYSTEMATIC REVIEW; THERAPY EFFECT; ULCER HEALING; ULTRASOUND THERAPY; VACUUM ASSISTED CLOSURE; WOUND HEALING; AGED; PRESSURE ULCER; VERY ELDERLY;

AGED; AGED, 80 AND OVER; HUMANS; PRESSURE ULCER; WOUND HEALING;

EID: 84929951893     PISSN: 15258610     EISSN: 15389375     Source Type: Journal    
DOI: 10.1016/j.jamda.2015.01.083     Document Type: Review

References (77)

1. Prevention and treatment of pressure ulcers: quick reference guide 2009, European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP), National Pressure Ulcer Advisory Panel, Washington DC.
2. Thomas D.R. Does pressure cause pressure ulcers? An inquiry into the etiology of pressure ulcers. JAm Med Dir Assoc 2010, 11:397-405.
3. Lyder C.H., Wang Y., Metersky M., et al. Hospital-acquired pressure ulcers: Results from the national Medicare Patient Safety Monitoring System study. JAm Geriatr Soc 2012, 60:1603-1608.
4. Vanderwee K., Clark M., Dealey C., et al. Pressure ulcer prevalence in Europe: A pilot study. JEval Clin Pract 2007, 13:227-235.
5. Landi F., Russo A., Danese P., et al. Anemia status, hemoglobin concentration, and mortality in nursing home older residents. JAm Med Dir Assoc 2007, 8:322-327.
6. Meesterberends E., Halfens R.J., Spreeuwenberg M.D., et al. Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study. JAm Med Dir Assoc 2013, 14:605-610.
7. Ronda L., Falce R.L. Skin care in older people. Primary Health Care 2002, 12:51-57.
8. Spoelhof G.D. Management of pressure ulcers in the nursing home. Ann Long-Term Care 2000, 8:69-77.
9. Berlowitz D.R., Wilkin S.V. Risk factors for pressure sores: A comparison of cross-sectional and cohort derived data. JAm Geriatr Soc 1989, 37:1043-1050.
10. Allman R.M. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med 1997, 13:421-436.
11. Casey G. The importance of nutrition in wound healing. Nurs Stand 1998, 13:51-54. 56.
12. Gerardo M.P., Teno J.M., Mor V. Not so black and white: Nursing home concentration of Hispanics associated with prevalence of pressure ulcers. JAm Med Dir Assoc 2009, 10:127-132.
13. Krause T., Anders J., von Renteln-Kruse W. [Urinary incontinence as a risk factor for pressure sores does not withstand a critical examination]. Pflege 2005, 18:299-303.
14. Gallagher S.M. Morbid obesity: A chronic disease with an impact on wounds and related problems. Ostomy Wound Manage 1997, 43:18-24. 26-7.
15. Bergstrom N., Horn S.D., Smout R.J., et al. The National Pressure Ulcer Long-Term Care Study: Outcomes of pressure ulcer treatments in long-term care. JAm Geriatr Soc 2005, 53:1721-1729.
16. Scott J.R., Gibran N.S., Engrav L.H., et al. Incidence and characteristics of hospitalized patients with pressure ulcers: State of Washington, 1987 to 2000. Plast Reconstr Surg 2006, 117:630-634.
17. Rolland Y., Resnick B., Katz P.R., et al. Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference. JAm Med Dir Assoc 2014, 15:313-325.
18. Abraha I., Cruz-Jentoft A.J., Soiza R.L., et al. Evidence of and recommendations for nonpharmacological interventions for common geriatric conditions. The SENATOR-ONTOP Systematic Review Protocol. BMJ Open 2015, 5:e007488.
19. GRADE handbook for grading quality of evidence and strength of recommendations 2013, The GRADE Working Group, Updated October 2013. Available at:, Accessed April 21, 2014. http://www.guidelinedevelopment.org/handbook, H. Schünemann, J. Broz˙ek, G. Guyatt, A. Oxman (Eds.).
20. Montori V.M., Wilczynski N.L., Morgan D., Haynes R.B. Optimal search strategies for retrieving systematic reviews from Medline: analytical survey. BMJ 2005, 330:68. Hedges Team.
21. Higgins J.P.T., Altman D.G. Chapter 8: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 2011, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group, The Cochrane Collaboration, [updated March 2011]. J.P.T. Higgins, S. Green (Eds.).
22. National Pressure Advisory Panel. Support Surfaces Standard Initiative. Terms and definitions relate to support surfaces. Version 01/29/2007. Available at:. Accessed April 21, 2014. http://www.npuap.org/wp%13content/uploads/2012/03/NPUAP_S3I_TD.pdf.
23. Cullum N., Nelson E.A., Flemming K., Sheldon T. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 2001, 5:1-221.
24. Allman R.M., Walker J.M., Hart M.K., et al. Air-fluidized beds or conventional therapy for pressure sores. A randomized trial. Ann Intern Med 1987, 107:641-648.
25. Branom R., Rappl L.M. 'Constant force thechnology' versus low-air-loss therapy in the treatment of pressure ulcers. Ostomy Wound Manage 2001, 46:38-46.
26. Cassino R., Ippolito A.M., Cuffaro C., et al. Acontrolled, randomised study on the efficacy of two overlays in the treatment of decubitus ulcers. Minerva Chir 2013, 68:105-116.
27. Ferrell B.A., Osterweil D., Christenson P. Arandomized trial of low air loss beds for treatment of pressure ulcers. JAMA 1993, 269:494-497.
28. Nixon J., Cranny G., Iglesias C., et al. Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial. BMJ 2006, 332:1413.
29. Rosenthal M.J., Felton R.M., Hileman D.L., et al. Awheelchair cushion designed to redistribute sites of sitting pressure. Arch Phys Med Rehabil 1996, 77:278-282.
30. Russell L., Reynolds T.M., Carr J., et al. Randomised controlled trial of two pressure-relieving systems. JWound Care 2000, 9:52-55.
31. Bennett R.G., Baran P.J., DeVone L.V., et al. Low air-loss hydrotherapy versus standard care for incontinent hospitalized patients. JAm Geriatr Soc 1998, 46:569-576.
32. Evans D., Land L., Geary A. Aclinical evaluation of the Nimbus 3 alternating pressure mattress replacement system. JWound Care 2000, 9:181-186.
33. Munro B.H., Brown L., Heitman B.B. Pressure ulcers: One bed or another?. Geriatr Nurs 1989, 10:190-192.
34. Russell L., Reynolds T.M., Towns A., et al. Randomized comparison trial of the RIK and the Nimbus 3 mattresses. Br J Nurs 2003, 12:254. 256-259.
35. Strauss M.J., Gong J., Gary B.D., et al. The cost of home air-fluidized therapy for pressure sores. A randomized controlled trial. JFam Pract 1991, 33:52-59.
36. Izutsu T., Matsui T., Satoh T., et al. Effect of rolling bed on decubitus in bedridden nursing home patients. Tohoku J Exp Med 1998, 184:153-157.
37. Chernoff R. The effect of a high protein formula (Replete) on decubitus ulcer healing in long-term tube fed institutionalized patients. JAm Diet Assoc 1990, 90:A130.
38. Benati G., Delvecchio S., Cilla D., Pedone V. Impact on pressure ulcer healing of an arginine-enriched nutritional solution in patients with severe cognitive impairment. Arch Gerontol Geriatr 2001, 7:43-47.
39. Ek A.C., Unosson M., Larsson J., et al. The development and healing of pressure sores related to the nutritional state. Clin Nutr 1991, 10:245-250.
40. Cereda E., Gini A., Pedrolli C., Vanotti A. Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: A randomized controlled trial. JAm Geriatr Soc 2009, 57:1395-1402.
41. Lee S.K., Posthauer M.E., Dorner B., et al. Pressure ulcer healing with a concentrated, fortified, collagen protein hydrolysate supplement: A randomized controlled trial. Adv Skin Wound Care 2006, 19:92-96.
42. Ohura T., Nakajo T., Okada S., et al. Evaluation of effects of nutrition intervention on healing of pressure ulcers and nutritional states (randomized controlled trial). Wound Repair Regen 2011, 19:330-336.
43. van Anholt R.D., Sobotka L., Meijer E.P., et al. Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients. Nutrition 2010, 26:867-872.
44. Breslow R.A., Hallfrisch J., Guy D.G., et al. The importance of dietary protein in healing pressure ulcers. JAm Geriatr Soc 1993, 41:357-362.
45. Vu T., Harris A., Duncan G., Sussman G. Cost-effectiveness of multidisciplinary wound care in nursing homes: A pseudo-randomized pragmatic cluster trial. Fam Pract 2007, 24:372-379.
46. Ameis A., Chiarcossi A., Jimenez J. Management of pressure sores. Comparative study in medical and surgical patients. Postgrad Med 1980, 67:177-184.
47. Moore Z.E.H., Cowman S. Repositioning for treating pressure ulcers. Cochrane Database Syst Rev 2012, CD006898.
48. McDiarmid T., Burns P.N., Lewith G.T., Machin D. Ultrasound in the treatment of pressure sores. Physiotherapy 1985, 71:66-70.
49. ter Riet G., Kessels A.G., Knipschild P. Arandomized clinical trial of ultrasound in the treatment of pressure ulcers. Phys Ther 1996, 76:1301-1311.
50. Maeshige N., Fujiwara H., Honda H., et al. Evaluation of the combined use of ultrasound irradiation and wound dressing on pressure ulcers. JWound Care 2010, 19:63-68.
51. Ubbink D.T., Westerbos S.J., Evans D., et al. Topical negative pressure for treating chronic wounds. Cochrane Database Syst Rev 2008, CD001898.
52. Wild T., Stremitzer S., Budzanowski A., et al. Definition of efficiency in vacuum therapy-A randomized controlled trial comparing with V.A.C. Therapy. Int Wound J 2008, 5:641-647.
53. Lucas C., Coenen C.H.M., de Haan R.J. The effect of low level laser therapy (LLLT) on stage III decubitus ulcers (pressure sores): A prospective randomized single blind, multicentre pilot study. Lasers Med Sci 2000, 14:94-100.
54. Lucas C., van Gemert M.J., de Haan R.J. Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomized clinical trial. Lasers Med Sci 2003, 18:72-77.
55. Comorosan S., Vasilco R., Arghiropol M., et al. The effect of Diapulse therapy on the healing of decubitus ulcer. Rom J Physiol 1993, 30:41-45.
56. Ozdemir F., Kasapoglu M., Oymak F., Murat S. Efficiency of magnetic field treatment on pressure sores in bedridden patients. Balkan Med J 2011, 28:274-278.
57. Cooper-Vastola S.A., Salzberg C.A., Viehbeck M.G., Pérez F.J. Arandomized, double-blind study on the effects of Diapulse on wound healing in pressure ulcers. JAm Paraplegia Soc 1983, 16:263-264.
58. Adunsky A., Ohry A. Decubitus direct current treatment (DDCT) of pressure ulcers: Results of a randomized double-blinded placebo controlled study. Arch Gerontol Geriatr 2005, 41:261-269. DDCT Group.
59. Kloth L.C., Feedar J.A. Acceleration of wound healing with high voltage, monophasic, pulsed current. Phys Ther 1988, 68:503-508.
60. Gentzkow G.D., Pollack V.P., Kloth L.C., Stubbs H.A. Improved healing of pressure ulcers using Dermapulse, a new electrical stimulation device. Wounds 1991, 3:158-170.
61. Feedar J.A., Kloth L.C., Gentzkow G.D. Chronic dermal ulcer healing enhanced with monophasic pulsed electrical stimulation. Phys Ther 1991, 71:639-649.
62. Mulder G.D. Treatment of open-skin wounds with electric stimulation. Arch Phys Med Rehab 1991, 72:375-377.
63. Wood J.M., Evans P.E., Schallreuter K.U., et al. Amulticenter study on the use of pulsed low-intensity direct current for healing chronic stage II and stage III decubitus ulcers. Arch Dermatol 1993, 129:999-1009.
64. Asbjornsen G., Hernaes B., Molvaer G. The effect of transcutaneous electrical nerve stimulation on pressure sores in geriatric patients. JClin Exp Gerontol 1990, 12:209-214.
65. Durovic A., Maric D., Brdareski Z., et al. The effects of polarized light therapy in pressure ulcer healing. Vojnosanit Pregl 2008, 65:906-912.
66. Iordanou P., Baltopoulos G., Giannakopoulou M., et al. Effect of polarized light in the healing process of pressure ulcers. Int J Nurs Pract 2002, 8:49-55.
67. Wills E.E., Anderson T.W., Beattie B.L., Scott A. Arandomized placebo-controlled trial of ultraviolet light in the treatment of superficial pressure sores. JAm Geriatr Soc 1983, 31:131-133.
68. Schubert V. Effects of phototherapy on pressure ulcer healing in elderly patients after a falling trauma. A prospective, randomized, controlled study. Photodermatol Photoimmunol Photomed 2001, 17:32-38.
69. Larking A.M., Duport S., Clinton M., et al. Randomized control of extracorporeal shock wave therapy versus placebo for chronic decubitus ulceration. Clin Rehabil 2010, 24:222-229.
70. Burke D.T., Ho C.H., Saucier M.A., Stewart G. Effects of hydrotherapy on pressure ulcer healing. Am J Phys Med Rehabil 1998, 77:394-398.
71. Ritz M.C., Gallegos R., Canham M.B., et al. PROVANT wound-closure system accelerates closure of pressure wounds in a randomized, double-blind, placebo-controlled trial. Ann N Y Acad Sci 2002, 961:356-359.
72. Arashi M., Sugama J., Sanada H., et al. Vibration therapy accelerates healing of stage I pressure ulcers in older adult patients. Adv Skin Wound Care 2010, 23:321-327.
73. Pressure ulcers: Prevention and management of pressure ulcers. NICE clinical guideline 179. Available at: . Issued in April2014. Accessed July 22, 2014. http://guidance.nice.org.uk/cg179.
74. Saha S., Smith M.E.B., Totten A., et al. Pressure Ulcer Treatment Strategies: Comparative Effectiveness. Comparative Effectiveness Review No. 90. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC003-EF 2013, Agency for Healthcare Research and Quality, Rockville, MD, Available at:, Accessed April 21, 2014. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm.
75. McInnes E., Dumville J.C., Jammali-Blasi A., et al. Support surfaces for treating pressure ulcers. Cochrane Database Syst Rev 2011, CD009490.
76. Volkert D., Berner Y.N., Berry E., et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 2006, 25:330-360.
77. Langer G., Fink A. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2014, CD003216.