Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: A systematic review
A total of 1,589 articles were screened and 15 randomised control trials with 4,724 participants were included in the review.
Greenwood C, Nelson EA, Nixon J, Vargas-Palacios A, McGinnis E, view paper on the JTV website.
This review of randomised control trials concludes that from the low-quality evidence available offloading devices may reduce pressure heel ulceration, but there is insufficient evidence to support the idea that dressings reduce incidence. This indicates that offloading needs to be a component of care when a patient is at risk of pressure ulcer development and further high-quality research is necessary within this area and a consensus of suitable outcomes measures to use is necessary to ensure fair comparisons between various offloading devices.
Heel pressure ulcers predominantly occur in those with limited mobility or those with reduced tissue perfusion. Those who remain in supine positions are at risk of posterior heel ulceration, an area of the heel which has little sub-cutaneous tissue for protection. The International guidelines published in 2019 by the European Pressure Ulcer Advisory Panel recommend that those with a high potential for shear and frictional forces should also be considered as at risk of pressure ulcer development. The authors undertook a systematic review to determine the evidence base for the use heel-specific items such as dressings, heel cushioning and offloading devices when attempting to prevent ulceration occurring.
A total of 1,589 articles were screened and 15 randomised control trials with 4,724 participants were included in the review. The review indicated that there was there a scarcity of good quality research to determine the role of dressings in ulcer prevention. The analysis of the data from studies which examined offloading devices such as heel suspension boots or suspension wedges indicated that these may be effective at reducing incidence of pressure ulceration, but that there were issues around patient compliance and acceptance.
The authors conclude that future medical device development should consider patient input in terms of the acceptability of the device and impact to quality of life.
