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A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers

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  • Zena Moore
  • Seamus Cowman
  • Ronán M Conroy

Abstract

Background. Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required. Design. A pragmatic, multi‐centre, open label, prospective, cluster‐randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. Method. Ethical approval was received. Study sites (n = 12) were allocated to study arm using cluster randomisation. The experimental group (n = 99) were repositioned three hourly at night, using the 30° tilt; the control group (n = 114) received routine prevention (six‐hourly repositioning, using 90° lateral rotation). Data analysis was by intention to treat; follow‐up was for four weeks. Results. All participants (n = 213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p = 0·035; 95% CI 0·031–0·038; ICC = 0·001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (β = −0·246, 95% CI = −0·319 to −0·066; p = 0·003); (β = 0·227, 95% CI = 0·041–0·246; p = 0·006). Conclusion. Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines. Relevance to clinical practice. An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one.

Suggested Citation

  • Zena Moore & Seamus Cowman & Ronán M Conroy, 2011. "A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers," Journal of Clinical Nursing, John Wiley & Sons, vol. 20(17‐18), pages 2633-2644, September.
    • Handle: RePEc:wly:jocnur:v:20:y:2011:i:17-18:p:2633-2644
    DOI: 10.1111/j.1365-2702.2011.03736.x
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    Cited by:

    1. Aglecia Moda Vitoriano Budri & Zena Moore & Declan Patton & Tom O’Connor & Linda Nugent & Aisling Mc Cann & Pinar Avsar, 2020. "Impaired mobility and pressure ulcer development in older adults: Excess movement and too little movement—Two sides of the one coin?," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(15-16), pages 2927-2944, August.
    2. Soo-Yeon Kim & Yong-Soon Shin, 2021. "A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler’s Position," IJERPH, MDPI, vol. 18(19), pages 1-14, September.
    3. Sirpa Mäki‐Turja‐Rostedt & Minna Stolt & Helena Leino‐Kilpi & Elina Haavisto, 2019. "Preventive interventions for pressure ulcers in long‐term older people care facilities: A systematic review," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(13-14), pages 2420-2442, July.
    4. Beáta Grešš Halász & Anna Bérešová & Ľubomíra Tkáčová & Dagmar Magurová & Ľubomíra Lizáková, 2021. "Nurses’ Knowledge and Attitudes towards Prevention of Pressure Ulcers," IJERPH, MDPI, vol. 18(4), pages 1-9, February.
    5. May Stinson & Rachel Schofield & Cathy Gillan & Julie Morton & Evie Gardner & Stephen Sprigle & Alison Porter-Armstrong, 2013. "Spinal Cord Injury and Pressure Ulcer Prevention: Using Functional Activity in Pressure Relief," Nursing Research and Practice, Hindawi, vol. 2013, pages 1-8, April.
    6. Dorothy Li Bai & Tsai-Wen Liu & Hsiu-Ling Chou & Yeh-Liang Hsu, 2020. "Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-14, November.
    7. Heidrun M. Pickenbrock & Antonia Zapf & Dirk Dressler, 2015. "Effects of therapeutic positioning on vital parameters in patients with central neurological disorders: a randomised controlled trial," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(23-24), pages 3681-3690, December.

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