Bed rest for pressure ulcer healing in wheelchair users

BACKGROUND: Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, and impact negatively on the individual's quality of life. International guidelines suggest bed rest as a component of the treatment strategy to manage pressure ulcers among wheelchair users. The potential benefits and risks need to be considered when assessing the effectiveness of bed rest as an intervention for treating pressure ulcers in this population. Therefore, it was important to search and appraise existing research evidence in order to determine the impact of bed rest on the healing of pressure ulcers in wheelchair users.

OBJECTIVES: To assess the impact of bed rest on pressure ulcer healing, in wheelchair users, of any age, who are living or being cared for in any setting.

SEARCH METHODS: In October 2016 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trials registries and conference proceedings and for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting.

SELECTION CRITERIA: We considered randomised controlled trials (RCTs) and cluster-RCTs that evaluated the impact of bed rest on healing pressure ulcers in wheelchair users.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for their eligibility.

MAIN RESULTS: We identified no studies that met the inclusion criteria.

AUTHORS' CONCLUSIONS: We set out to evaluate the research evidence, from randomised controlled trials, of the impact of bed rest on pressure ulcer healing in wheelchair users. No study met the inclusion criteria. It is uncertain whether bed rest makes a difference to the healing of pressure ulcers in wheelchair users. Well-designed trials addressing important clinical, quality of life and economic outcomes are required.