Pressure ulcers remain a serious problem for patients and providers in healthcare. When a pressure ulcer develops, it can inflict pain and cause untoward complications such as severe infections, surgery, prolonged hospital stay and even death.
The objective of this review was to establish whether using the Braden subscale mobility assessment is comparable to using the full Braden pressure ulcer risk assessment scale. However, due to lack of research studies, the focus of this review was extended to include the use of other assessment tools for hospital acquired pressure ulcer risk.
Types of Studies
Quantitative studies that reported data on mobility and pressure ulcer development or preventive interventions, irrespective of their design were included in the review.
Types of Participants
The review focused on adult patients admitted to an acute care facility, who underwent a pressure ulcer risk assessment, and had no pressure ulcers on admission.
Types of Interventions
This review considered studies that use Braden mobility subscale assessment
Types of Comparator
This review compared the use of full Braden risk assessment scale where available only when it was included within the same study,
Types of Outcome Measures
This review considered:
- Incidence of hospital acquired pressure ulcers
- Endorsement or initiation of preventive interventions
- Reliability of Braden mobility subscale assessment to identify patients at risk of developing pressure ulcer with or without Braden assessment. For the purposes of this systematic review, reliability of the mobility scale means predictive validity.
- Frequency of using Braden mobility subscale assessment
A search for published and unpublished studies from 2000 to 2010 of major healthcare related electronic databases was conducted. Studies in other languages that were translated into English were included in the review.
Assessment of Quality
The papers that were selected for possible inclusion were assessed by two independent reviewers for methodological validity using standardised critical appraisal instruments from the Joanna Briggs Institute.
Data Collection and Analysis
Data from included studies were extracted and analysed using Revman5 software.
Results and Conclusions
Eighteen studies were included in this review. The findings suggest that the risk of pressure ulcer development was higher when the patient was identified as having impaired mobility, as assessed using the Braden subscale mobility or other similar mobility scales. However, there is little conclusive evidence to indicate that using mobility assessment alone is comparable to using Braden or other risk assessment scales in reducing the incidence of pressure ulcer. Evidence for association between assessment of mobility and endorsement of preventive interventions was significant. However, this finding was based on only one study. No evidence found on the reliability of mobility assessment as a tool to predict pressure ulcer risk. Nor was there evidence on the frequency of assessment using the mobility assessment tool.
Implications for Practice
Assessment of mobility may be a useful measure in an acute care setting in relation to assessing the risk of developing pressure ulcer. However, there is not enough evidence to conclude that mobility assessment alone can replace the more common risk assessment scales such as Braden scale in predicting incidence of pressure ulcer.
Implications for Research
Further research is required to:
- Compare the use of Braden mobility subscale assessment against the use of the full Braden scale or other risk assessment scales in acute care settings on incidence of pressure ulcer.
- Ascertain the effect of using Braden mobility subscale assessment on endorsement or initiation of preventive interventions and in comparison to Braden risk assessment scale in acute care settings.
- Ascertain the reliability of the Braden mobility subscale assessment as a predictor of pressure ulcer risk
- Ascertain the optimum frequency of assessment