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List of 12 priorities for pressure ulcer study identified by UK researchers


There remain substantial areas of “doubt and uncertainty” about the prevention and treatment of pressure ulcers, warn UK researchers.

More studies are needed to guide practice on how to prevent and treat pressure ulcers, according to the James Lind Alliance Pressure Ulcer Priority Setting Partnership.

As a result, the partnership has drawn up a short-list of 12 most important research questions in wound care that need further study.

It held a stakeholder event in March at which around 30 patients, service users, carers and health professionals chose their top 12 pressure ulcer prevention and treatment research questions from a shortlist of 30.

The list, which has been shared exclusively with Nursing Times, will now be provided to organisations that fund research about pressure ulcer treatment and prevention.

The partnership’s members include Leeds Community Healthcare Trust, the University of York’s department of health sciences and the University of Manchester’s school of nursing, midwifery and social work as well as a range of charities and other groups.

Professor Nicky Cullum, from Manchester’s school of nursing, said: “Research funds are precious so it is essential that we use them wisely to address the uncertainties that matter most to patients, carers and the clinicians who deliver care.

“This James Lind partnership has been focused on ensuring we get these priorities right.”

Nikki Stubbs, clinical team leader in tissue viability at Leeds Community Healthcare Trust, said: “Uncertainties around pressure ulcer prevention and treatment can make conversations with patients and carers about managing risk really challenging. 

“Developing answers through research is vital for everyone. The next stage is to encourage funders and researchers to rise to the challenge of addressing the agreed priorities.”

Research fellow Dr Mary Madden, from York University, added: “We planned to produce a top 10 but after some tough negotiations between service users, carers and clinicians we settled on a top 12.”


 Top 12 Pressure Ulcer Uncertainties
1How effective is repositioning in the prevention of pressure ulcers?
2How effective at preventing pressure ulcers is involving patients, family and lay carers in patient care?
3Does the education of health and social care staff on prevention lead to a reduction in the incidence of pressure ulcers and, if so, which are the most effective education programmes (at organisational and health/social care level)?
4What is the relative effectiveness of the different types of pressure relieving beds, mattresses, overlays, heel protectors and cushions (including cushions for electric and self-propelling wheelchairs) in preventing pressure ulcers?
5What impact do different service models have on the incidence of pressure ulcers including staffing levels, continuity of care [an on-going relationship with same staff members] and the current organisation of nursing care in hospitals? 
6What are the best service models (and are they sufficiently accessible) to ensure that patients with pressure ulcers receive the best treatment outcomes (including whether getting people with pressure ulcers and their carers more involved in their own pressure ulcer management improves ulcer healing and if so, the most effective models of engagement)?
7For wheelchair users sitting on a pressure ulcer, how effective is bed rest in promoting pressure ulcer healing?
8How effective are wound dressings in the promotion of pressure ulcer healing?
9Does regular turning of patients in bed promote healing of pressure ulcers?
= 10Does improving diet (eating) and hydration (drinking) promote pressure ulcer healing?
= 10How effective are surgical operations to close pressure ulcers?
12How effective are topical skin care products and skin care regimes at preventing pressure ulcers?


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Readers' comments (3)

  • It is very telling that the list was to be 10 but expanded to 12 variables. The nature of ulcers is complex and thorough research into practices purported to be effective is most necessary.

    This has been a very important area of focus so that the best evidence based practice can be used by all.

    I wonder if the degree of oedema in foot/leg ulcers in particular should be on that list. Reduction in leg oedema can help expotentially in the healing process.

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  • What makes this top 12 so important is that JLAPUP is a partnership of patients, service users, clinicians and carers working with researchers to identify the questions about pressure ulcer prevention and treatment that matter most to the people directly affected.

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  • Foot and leg ulcers were beyond the scope of the James Lind Alliance Pressure Ulcer Partnership. Partners from the JLAPUP are intending (subject to funding) to build a James Lind style leg ulcer priority setting partnership. If you are interested please send your contact details to to be kept informed of developments.

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