A Systematic Review Lateral Repositioning for Preventing Pressure Ulcers in Stroke Patients
Lateral Repositioning for Preventing Pressure Ulcers in Stroke Patients: A Systematic Review
DOI:
https://doi.org/10.35654/ijnhs.v7i6.843Keywords:
Lateral Repositioning, Nursing Interventions, Pressure Ulcers, StrokeAbstract
Introduction: Pressure ulcers (PU) are a common complication among stroke patients, especially those with limited mobility. Proper nursing interventions, such as regular lateral repositioning, play a crucial role in preventing these injuries. However, the optimal angle and frequency of repositioning remain subjects of ongoing research.
Objective: This systematic review aims to synthesize evidence on the effectiveness of various lateral positions and repositioning intervals in reducing the risk of PU in stroke patients.
Method: This review follows PRISMA guidelines. Literature searches were conducted using databases such as PubMed, ScienceDirect, and Google Scholar, focusing on studies investigating lateral positioning interventions for stroke patients. Inclusion criteria consisted of studies published in English and Indonesian, with no publication year restrictions, covering any stroke subtype. We framed the research questions using PICO elements and analyzed the selected articles with the CASP checklist, classifying them based on levels of evidence and recommendation strength.
Results: Seven studies were included in the final analysis, with four conducted in Indonesia and three from international sources. The findings indicate that a 30° lateral tilt is more effective than a 90° angle in preventing PU. Additionally, repositioning every 2–3 hours significantly reduces the risk, while repositioning every 3–4 hours presents a cost-effective alternative without increasing risk. An economic analysis highlighted substantial savings with repositioning every 3 hours compared to every 2 hours.
Recommendation: Lateral repositioning at a 30° angle and 3–4-hour intervals provides an optimal balance between effectiveness and cost-efficiency in preventing PU among stroke patients. Further research with larger sample sizes and robust designs is recommended to strengthen the evidence base.
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(1) Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795–820.
(2) World Health Organization (WHO). Stroke, Cerebrovascular accident. 2024 [cited 2024 Oct 11]; Available from: emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html
(3) Kementerian Kesehatan RI. Kenali Stroke dan Penyebabnya. 2023 [cited 2024 Oct 11]; Available from: https://ayosehat.kemkes.go.id/kenali-stroke-dan-penyebabnya
(4) Cramer SC, Sur M, Dobkin BH, O’Brien C, Sanger TD, Trojanowski JQ, et al. Harnessing neuroplasticity for clinical applications. Brain. 2011 Jun 1;134(6):1591–609.
(5) Huang L, Yi L, Huang H, Zhan S, Chen R, Yue Z. Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta Neurol Belg. 2024 Feb 13;124(1):25–36.
(6) Maljuliani D, Harun H, Ulfah Rifa S, Fitri atul. Latihan Range Of Motion (ROM) Terhadap Kekuatan Otot Pasien Stroke Hemoragik: Studi Kasus [Internet]. Vol. 2, Jurnal Riset Ilmiah. 2023 [cited 2024 Oct 12]. Available from: https://www.google.com/url?sa=i&url=https%3A%2F%2Fejournal.nusantaraglobal.or.id%2Findex.php%2Fsentri%2Farticle%2Fdownload%2F1558%2F1576&psig=AOvVaw2_RaCfxJI9Ro7N_b5dU4Hx&ust=1728749926433000&source=images&cd=vfe&opi=89978449&ved=0CAQQn5wMahcKEwiwlpe33oaJAxUAAAAAHQAAAAAQBA
(7) Chen YC, Chen TL, Cheng CC, Yang YC, Wang JH, Yip HT, et al. High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study. Medicina (B Aires). 2022 Mar 8;58(3):402.
(8) Tervo-Heikkinen T, Heikkilä A, Koivunen M, Kortteisto T, Peltokoski J, Salmela S, et al. Nursing interventions in preventing pressure injuries in acute inpatient care: a cross-sectional national study. BMC Nurs. 2023 Jun 12;22(1):198.
(9) Ka??kç? M, Aksoy M, Ay E. Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study. J Tissue Viability. 2018 Aug;27(3):135–40.
(10) Wahyuni ED, Dewi YS, Laili NR, Kurniawati ND, Wulandari S, Gunawan G, et al. A Systematic Review of Pressure Ulcers Prevention. Fundamental and Management Nursing Journal. 2023 Apr 1;6(1):7–17.
(11) Engelen M, van Dulmen S, Vermeulen H, de Laat E, van Gaal B. The content and effectiveness of self-management support interventions for people at risk of pressure ulcers: A systematic review. Int J Nurs Stud. 2021 Oct;122:104014.
(12) Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021 Jun;134:178–89.
(13) Frandsen TF;, Eriksen MB. The impact of PICO as a search strategy tool on literature search quality: A systematic review. Journal of the Medical Library Association. 2018;106(In press):420–31.
(14) Critical Appraisal Skills Programme. CASP 2018: Checklist for critical appraisal of Studies. 2018; Available from: https://casp-uk.net/casp-tools-checklists/
(15) Burns PB, Rohrich RJ, Chung KC. The Levels of Evidence and Their Role in Evidence-Based Medicine. Plast Reconstr Surg. 2011 Jul;128(1):305–10.
(16) Paulden M, Bergstrom N, Horn SD, Rapp M, Stern A, Barrett R, et al. Turning for Ulcer Reduction (TURN) Study: An Economic Analysis. Ont Health Technol Assess Ser. 2014;14(12):1–24.
(17) Sujatmiko, Sri Hastuti W. Positioning Techniques for Stroke Infarction Patients to Prevent Decubitus Wounds. Health and Technology Journal (HTechJ). 2023 Dec 23;1(6):682–91.
(18) Meliza SC, Ritarwa K, Sitohang NA. The Prevention of Ulcers Decubitus with Mobilization and The Usage of Olive Oil on Stroke Patients. Elkawnie. 2020 Dec 30;6(2):189.
(19) Latipah S, Sofiani Y, Yunitri N, Mulyatsih ME, Sulistyorini CI. Comparison of the Effectiveness Lateral Position 30 Degrees and 90 Degrees on Decubitus Events in Stroke Patients. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2024 Jul 29;10(3).
(20) Sulistiyawati A, Cahyati Y. Comparison of the effect of 30° and 90° sloping position on pressure ulcer incident on stroke patients. Indonesian Journal of Global Health Research [Internet]. 2020;2(1):73–82. Available from: http://jurnal.globalhealthsciencegroup.com/index.php/IJGHR
(21) Moore Z, Cowman S, Posnett J. An economic analysis of repositioning for the prevention of pressure ulcers. J Clin Nurs. 2013 Aug 5;22(15–16):2354–60.
(22) Moore Z, Cowman S, Conroy RM. A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. J Clin Nurs. 2011 Sep;20(17–18):2633–44.
(23) Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic Reviews. 2014 Apr 3;
(24) Su P, Lun Q, Lu D, Wu Q, Liu T, Zhang L. Biomechanical Changes on the Typical Sites of Pressure Ulcers in the Process of Turning Over from Supine Position: Theoretical Analysis, Simulation, and Experiment. Ann Biomed Eng. 2022 Jun 8;50(6):654–65.
(25) Kim SY, Shin YS. A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler’s Position. Int J Environ Res Public Health. 2021 Sep 23;18(19):9992.
(26) Gillespie BM, Walker RM, Latimer SL, Thalib L, Whitty JA, McInnes E, et al. Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews. 2020 Jun 2;2020(6).
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