Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M Turning for Ulcer ReductioN: a multisite randomized clinical trial in nursing homes. J Am Geriatr Soc.. 2013; 61:(10)1705-1713

Defloor T, De Bacquer D, Grypdonck MH The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. Int J Nurs Stud.. 2005; 42:(1)37-46

Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system. J Wound Ostomy Continence Nurs.. 2016; 43:(6)585-597

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Quick reference guide. 2019.

Galhardo VA, Garroni Magalhaes M, Blanes L, Juliano Y, Masako Ferreira L Healthrelated quality of life and depression in older patients with pressure ulcers. Wounds.. 2010; 22:(1)20-26

Gillespie BM, Walker RM, Latimer SL, Thalib L, Whitty JA, McInnes E, Lockwood I, Chaboyer WP Repositioning for pressure injury prevention in adults: an abridged Cochrane systematic review and meta-analysis. Int J Nurs Stud.. 2021; 120

Kim J, Lee JY, Lee E Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. J Nurs Manag.. 2022; 30:(5)O1-O9

Lala D, Dumont FS, Leblond J, Houghton PE, Noreau L Impact of pressure ulcers on individuals living with a spinal cord injury. Arch Phys Med Rehabil.. 2014; 95:(12)2312-2319

Langemo D, Anderson J, Hanson D, Thompson P, Johnson E The conundrum of turning/repositioning frequency, sleep surface selection, and sleep disruption in preventing pressure injury in healthcare settings. Adv Skin Wound Care.. 2022; 35:(5)252-259

National Institute for Health and Care Excellence. Pressure ulcers: prevention and management. 2014.

Office for Health Improvement and Disparities. Pressure ulcers: applying All Our Health. 2015.

Song YP, Shen HW, Cai JY, Zha ML, Chen HL The relationship between pressure injury complication and mortality risk of older patients in follow-up: a systematic review and meta-analysis. Int Wound J.. 2019; 16:(6)1533-1544

Theisen S, Drabik A, Stock S Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study. J Clin Nurs.. 2012; 21:(3-4)380-387

Weiner C, Alperovitch-Najenson D, Ribak J, Kalichman L Prevention of nurses’ work-related musculoskeletal disorders resulting from repositioning patients in bed: comprehensive narrative review. Workplace Health Saf. 2015; 63:(5)226-232

Yap TL, Horn SD, Sharkey PD Effect of varying repositioning frequency on pressure injury prevention in nursing home residents:TEAM-UP trial results. Adv Skin Wound Care.. 2022; 35:(6)315-325

Repositioning for pressure injury prevention in adults: a commentary on a Cochrane review

01 September 2023


Repositioning is regarded as an important intervention to prevent the development of pressure injuries in patients who are immobile. However, there is uncertainty as to the optimal regimen in terms of frequency and method of repositioning. This commentary summarises and critically appraises a Cochrane systematic review that assessed the clinical and costeffectiveness of different repositioning regimens on the prevention of pressure injuries in adults in any setting.

A pressure injury is defined as a soft tissue injury to a localised body part, which is caused by prolonged pressure and/or friction to the skin and is often caused by extended periods spent in bed or by using a medical device (Edsberg et al, 2016). Pressure injuries have an impact on both the physical and mental health of patients (Galhardo et al, 2010; Lala et al, 2014). Having a pressure injury has been shown to be a predictor of longer hospital stays in elderly patients (Theisen et al, 2012) and patients with pressure injuries have a higher risk of mortality compared to those who do not (Song et al, 2019). Elderly patients and those with mobility problems are at particular risk of developing pressure injuries (Kim et al, 2022). Repositioning—where patients are regularly turned or moved into different positions to relieve pressure on one area of the body—is regarded as a key intervention to prevent pressure injury development and is recommended in clinical guidelines such as the National Institute for Health and Care Excellence (NICE) guidance on pressure ulcer prevention and management (NICE, 2014). However, the optimum regimen for frequency (how often patients are repositioned) and method of repositioning (for example, using tilt and/or lateral, supine, prone body position) is uncertain (Yap et al, 2022). Repositioning is also not without negative consequences. For patients, frequent repositioning has the potential to cause discomfort and to disrupt sleep (Langemo et al, 2022). For healthcare staff, repositioning requires substantial time to deliver and may result in musculoskeletal injuries (Weiner et al, 2015). It is therefore important to establish the optimal repositioning regimens that will be clinically effective whilst minimising negative effects on patients and staff. This Cochrane systematic review aimed to assess the clinical efficacy and cost-effectiveness of different repositioning regimens on the prevention of pressure injuries in adults in any setting.

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