Pressure ulcer research: where do we go from here?

The physiology and pathology of pressure defence mechanisms have been little studied and are not understood. No critical risk factors have been identified and populations of patients identified as being 'at risk' by risk calculators and clinical impression often have small numbers of patients who are really susceptible to pressure ulcers (PUs). Prevention trials must therefore have large sample sizes to enable significant results to be observed, or must be carried out in patient populations with a high PU incidence. Many trials have been carried out in orthopaedic patients but results may not be generalizable. Measurement of physical parameters (e.g. interface pressure), useful for adapting support surfaces for individual patients and designing new support systems, is unlikely to identify the aetiology of PUs and, without validation from clinical trials, predict the efficacy of interventions. In future it may be better to sample other groups, such as critical care patients for trials, as the findings might prove more generalizable. The effects of interventions should also be researched at the healthcare system level rather than that of product or risk factor. However, only the physiological study of PU aetiology is likely to advance our knowledge and ability to prevent PUs more effectively.