The effect of pressure‐relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta‐analysis

Abstract

This meta-analysis investigated the effectiveness of a pressure-relieving intervention on the incidence of heel pressure ulcers in a variety of settings. Literature searches of Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE and Cochrane databases were conducted for English-language articles that investigated the effect of pressure relief interventions with or without concurrent prevention programs on the number of heel ulcers occurring on adult humans in a controlled clinical design. Full articles were selected from citations based upon consensus between at least two independent reviewers. Methodological quality of each study was assessed using the Jadad and PEDro scales. A quantitative analysis was performed to determine and compare relative risk (RR) between pressure relief programs/devices that were classified according to similarity of interventions. Fourteen studies that involved a total of 1457 subjects were selected from a total of 105 full articles reviewed. Pressure-reducing/relieving surfaces were associated with a significantly lower incidence of heel ulcers compared with standard hospital mattresses (RR = 0.50, 95% CI = 0.26-0.93, P < 0.03). Foam mattresses also significantly reduced the risk of developing heel ulcers. There is evidence to support the use of certain air or foam mattresses/overlays in the prevention of heel pressure ulcers when compared with a standard hospital mattress. There is insufficient research available at this time to determine if heel-protective devices can prevent heel pressure ulcers. These results need to be interpreted with caution given the relatively low number and poor quality of research articles available to date.

Spatial resolution in plantar pressure measurement revisited

“…However, Davis's (1996) results show that much lower spatial frequencies dominate the power spectrum, and the general literature shows that a study's focus may not be on single high-frequency pulses. Examples include those which focus on the heel (Nicosia et al, 2007), which is spatially broader than other foot structures, those which focus on changes in local maxima, for example: following orthotic intervention (Spencer, 2000), and those which focus on wholefoot distribution patterns (De Cock et al, 2005). If different plantar pressure phenomena indeed have different spatial frequencies, then from the Nyquist-Shannon sampling theorem (Shannon, 1949) it follows that a specific device will measure different phenomena with different accuracies.…”

Heel ulceration – An exploration of the issues

“…The vulnerable patient should be nursed on a pressure redistributing mattress. A metaanalysis of research considering the effectiveness of pressure reducing or relieving mattresses in preventing heel ulcers demonstrated that pressure reducing/relieving surfaces were associated with a significantly lower incidence of heel ulcers (Nicosia et al, 2007). It is important to note that interface pressures between the heels and support surfaces are particularly high and that pressure redistributing mattresses must never be relied upon to reduce this pressure sufficiently to protect the heels from ulceration.…”

Pressure Ulcer Prevention: Effectiveness of Heel Off-Loading Methodologies

“…The prevalence of PUs in patients with a fractured hip was found to be 21.3% [8]. An older study by Nicosia, Giliatta, Woodbury, and Houghton [9] reported an annual rate of 1.6 million PUs in acute care settings in the United States. The incidence of PU development is higher for patients treated in the ICU.…”