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Practice question

Does massage help to prevent pressure ulcers?

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The simple answer is there is no evidence to suggest massage helps prevent pressure ulcers. In fact, there is limited evidence to suggest it actually causes harm, and several national guideline groups advise against it (Diemel-Peeters et al, 2006, 2005; Dyson, 1978).

Guy H (2011) Does massage help to prevent pressure ulcers? Nursing Times; 107, 32/33,

  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article
  • There is no evidence to suggest massage helps to prevent pressure ulcers
  • The potential for interpreting what constitutes a massage could mean there is no standard approach
  • Massage on patients at risk of developing pressure ulcers who have inflamed skin could exacerbate existing damage

 

There are many different techniques of massage, and therapeutic masseurs are fully trained in the art. As nurses, we need to ask whether we are simply referring to rubbing the skin in a circular motion, typically over the buttocks or the heels. This potential for misinterpretation could mean that massage is not applied in a standardised way.

Massage can relax patients and assist with their emotional wellbeing. However, it is contraindicated in certain circumstances, for instance if the skin is inflamed or if there is a possibility that blood vessels are damaged.

Patients at risk of developing pressure ulcers may have skin inflammation presenting as a blanching erythema; this may be difficult to observe, particularly in those with a darker skin tone. These are the patients nurses may believe would benefit from massage to prevent pressure damage and yet, in carrying it out, they could well be exacerbating any existing damage.

The National Institute for Health and Clinical Excellence (2005) guidelines for pressure ulcer prevention and management do not include any reference to massage. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (2009) guidance states neither massage nor vigorous rubbing should be used to prevent pressure ulcers.

Given the potential difficulty around recognising when not to use massage, a lack of clarity about technique of massage delivery, and a lack of evidence to support any effectiveness, it is safer practice to advise against its use. 

Heidi Guy is a tissue viability clinical nurse specialist, East and North Hertfordshire Trust, and an honorary fellow, University of Hertfordshire

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