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Evidence based practice

Can the repositioning of patients with pressure ulcers contribute to wound healing?


A Cochrane review searched for evidence on the effects of repositioning on pressure ulcers but discovered a lack of high quality research on this area of care

Keywords Pressure ulcer, repositioning, position, wound healing

  • This article has been double-blind peer-reviewed

Review question

What is the effect of patient repositioning on the healing of pressure ulcers?

Nursing implications

Pressure ulcers, caused by excess pressure, shearing or friction forces, are a serious health issue for patients in all kinds of settings, including those being cared for at home.

Repositioning involves moving the individual into a different position to remove or redistribute pressure from a part of the body. Its purpose is to contribute to wound healing.

Analysing the evidence on the effectiveness of repositioning can promote the development of treatment strategies for pressure ulcers to:

  • Reduce the suffering of patients and improve their quality of life;
  • Reduce the financial burden on the health service;
  • Lighten the workload of nursing staff.

Study characteristics

Randomised controlled trials and controlled clinical trials that evaluated the following comparisons were eligible for inclusion into the review:

  • Repositioning compared with no repositioning;
  • Comparisons between different frequencies of repositioning;
  • Comparisons between different positions for repositioning.

The review intended to include studies involving people of any age, in any healthcare setting, who had existing pressure ulcers.

The primary outcomes were objective measures of pressure ulcer healing and included:

  • Time to complete healing;
  • Absolute or percentage change in pressure ulcer area or volume;
  • Proportion of pressure ulcers healed;
  • Healing rate.

Secondary outcomes included:

  • Procedural pain;
  • Assessment of quality of life;
  • Ease of use of the method of repositioning;
  • Adverse events such as falls, length of hospital stay or death.

Summary of key evidence

The initial search identified 91 titles; however, the review authors identified not studies that met the inclusion criteria.

Best practice recommendations

The lack of high quality evidence makes it difficult to draw conclusions about the effectiveness of repositioning patients on the healing of pressure ulcers.

Although repositioning is an integral component of pressure ulcer management strategies and is widely used in clinical practice, there are no available RCTs or CCTs that provide specific guidance for practice.

High quality comparative research of repositioning on pressure ulcer healing is needed.

For the full review report, including references, can be accessed at click here

AUTHORS Chenling Luoa, PhD, RN, is associate professor, School of Southern Medical University, Guangzhou, China; Jing Chub, MSN Nursing, is lecturer, Nursing School of Second Military Medical University, Shanghai, China; both are members of the Cochrane Nursing Care Field


Readers' comments (11)

  • I'm a student nurse. Would someone explain what are 'RCT' and 'CCT'?

    I want to read the full review report, so I clicked the sign 'click here' but there was an error. Is it my pc's error or this site's error?

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  • eileen shepherd

    Thank you Sujin
    RCT stands for randomised controlled trial and CCT is controlled clinical trial. I will check the link with our web team. Thank you for letting us know it is not working.

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  • I am a nurse working in dementia nursing home and quite a few of the resident where i am working, who has a pressure sore has been on the regular turning chart i.e. two hourly or four hourly.

    I can certainly say that frequent repositioning of the resident who has pressure sore help in the healing process of the wound.

    Plus using the appropriate dressing for the wound type also contribute in healing process of the pressure sore.

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  • We should be concentrating on prevention, in the first instance. Before the advent of pressure relieving mattresses, regular positioning was key to prevention. It didn't always result in the ideal, but attempts were made to prevent pressure damage. I will admit there were other practices, eg. rubbing spirit on potential vulnerable areas wasn't the best idea. Research is going to, hopefully, provide the answers, but that will be with the knowledge \resources we only have at that time. I was a bit disappointed that students, who are taught evidence-based practice were not aware how RCTs and CCTs influenced this.

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  • Was a bit disappointed as I hoped the article would identify somethign I did nto already know. It is very difficult to do trials for this, as which patient do you NOT change position so that you can see if this has an effect on healing?
    It is well known, and easy to see that a patient who is at risk and does NOT have their position changed WILL develop a pressure sore. A bit like asking if a patient is unable to walk to the loo will they become incontinent.

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  • The Cochrane reviews are an excellent source of information on clinical trials. But of course as stated above, it would be impossible to conduct any sort of controlled trial on patients with pressure sores because it would be unethical to not reposition patients. So how do we know that relieving pressure on a sore helps it to heal? Because us nurses have clinical evidence - we have witnessed it and know it to be true. But of course, as all nurses know, there are multiple factors involved in wound healing and these all need to be considered to enable optimum wound healing. Research does of course have its place in wound care; the choice of dressing used is one example.

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  • Pauline Beldon

    Anonymous above has the nub of the matter, how can repositioning be robustly examined as a preventative means, when not repositioning patients would be unethical.
    Perhaps Cochrane should be examining other means of recognising/evaluating some aspects of Tissue Viability practice instead of producing a document, which tells us what we already know?

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  • I agree wholeheartedly with the above comment from Pauline Beldon that such research would be unethical. However apparently we need evidence on which to base our clinical practice these days, regardless of clinical experience and judgement.

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  • I hope that piece of research was undertaken at no cost. I agree with Anon and Pauline - time and energy could be best spent else where.

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  • Richard White

    There is no RCT evidence for plaster of paris stabilisation of fractures.

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