Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews

Abstract

Background: There are many high-quality systematic reviews to inform practice around pressure injury (PI) prevention and treatment. However, they are often unable to provide recommendations for practice and research due to low quality trials. Objectives: To evaluate current systematic review evidence on the prevention and treatment of PI. Methods: This meta-synthesis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only Cochrane Reviews were included. Evidence from reviews was independently screened and assessed for risk of bias and certainty using Grading of Recommendations, Assessment, Development and Evaluations by two authors, with a third resolving discrepancies. Methodological quality of included reviews was assessed using the second version of A Measurement Tool to Assess Systematic Reviews, and a narrative synthesis undertaken. Results: Twenty-five Cochrane Reviews were included; eight for PI prevention and 19 for PI treatment. Prevention reviews included 102 studies (27,933 participants). Treatment reviews included 154 studies (over 16,936 participants). Three prevention reviews and nine treatment reviews reported risk of bias, judging the included trials as having low or very low certainty evidence. Two reviews reported moderate certainty evidence. Methodological quality of the systematic reviews was rated as high for eight reviews (7/19 for treatment and 1/6 for prevention). Recommendations for prevention included repositioning, nutrition and support surfaces. Recommendations for treatment focused on nutrition and repositioning. Conclusions: This meta-synthesis confirms the low-certainty of PI prevention and treatment trials, resulting in few recommendations to inform clinical practice. Generation of high-quality evidence on PI prevention and treatment is imperative.