Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 4

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Methods (Second Edition)

pecific to this clinical practice guideline, a
systematic search of the medical literature was
conducted in MEDLINE (via PubMed) and
Embase to identify relevant English-language
publications describing pressure ulcers in patients
with spinal cord injuries. The search identified
publications using specific keywords and Index
Medicus subheadings (MeSH subheadings) in
MEDLINE, or equivalent Emtree terms in Embase
related to pressure ulcer or synonyms such as
bedsores, and terms related to spinal cord injury
or types of paralysis, such as paraplegia or
quadriplegia. Keywords had to be located in the
title or abstract of full-length publications, and
studies had to be conducted in humans and
published from January 1997 to October 2010.
Articles were included if they reported on
patients aged 13 or older with spinal cord
injuries. Publications reporting the results of
randomized or non-randomized clinical trials,
observational cohort studies, case-control
studies, and case series were included. Included
publications described studies of pressure ulcers
of all categories/stages and any anatomical
location, and at any stage of treatment. Articles
were excluded if they did not report on an adult
population with spinal cord injuries, or if they
did not report studies conducted in humans.
Articles also were excluded if they did not report
on a patient population with pressure ulcers,
or if they reported results for patients with nontraumatic paralysis. Letters, reviews, case reports,
commentaries, "n-of-one" studies, editorials, and
publications without abstracts also were excluded.
Articles were included in the final review if
they did not meet any of the exclusion criteria
during full-text review. Subsequent to the
systematic search conducted for literature
published through October 2010, additional
articles were recommended for inclusion in
the clinical practice guidelines by the expert
panel members.
Several guidelines exist to inform an
evaluation of the quality of published research.
Generally, these guidelines suggest a hierarchy of
evidence based on study design, with systematic

reviews of randomized controlled trials (RCT)
presenting the highest quality evidence, followed
by individual RCTs, observational cohort studies,
and case-series, with editorials/expert opinions
representing the lowest-quality evidence.
A single researcher evaluated the level of
evidence for each study using criteria from the
University of Oxford's Centre for Evidence-Based
Medicine (CEBM) Levels of Evidence guidelines
(2009).1,2 The guidelines from 2009 were used to
grade articles recommended by the panel
members in 2010; when the CEBM guidelines for
determining the levels of evidence were updated
in 2011, these guidelines were used to grade
subsequent articles recommended for inclusion by
the panel members. The 2011 levels of evidence
guidelines were designed to be simpler to use
than the previous version (from 2009), and to be
more closely aligned with the process of clinical
decision-making.2,3 The grading of the evidence
focused on study design, but also was influenced
by other measures of study quality, such as
sample size, statistical analyses, imprecision, bias,
and how well the analyses aligned with the
research question of the study. Some publications
were not graded according to these guidelines;
these included websites, handbooks, and studies
reporting the results of pre-clinical investigations,
in vitro analyses, instrument validation, and
guidelines or consensus statements.
REFERENCES

1. OCEBM Levels of Evidence Working Group, Badenoch D,
Ball C, et al. OCEBM Levels of Evidence 1 (March 2009).
Oxford Centre for Evidence-based Medicine (OCEBM);
2009. Available at: http://www.cebm.net/index.
aspx?o=1025. Accessed May 2014.
2. OCEBM Levels of Evidence Working Group, Howick J,
Chalmers I, et al. The Oxford Levels of Evidence 2 (2011).
Oxford Centre for Evidence-Based Medicine (OCEBM);
2011. Available at: http://www.cebm.net/index.
aspx?o=5653. Accessed May 2014.
3. OCEBM Table of Evidence Working Group, Howick J,
Chalmers I, et al. The Oxford 2011 Levels of Evidence
Table. Oxford Centre for Evidence-Based Medicine
(OCEBM); 2011. Available at: http://www.cebm.net/mod_
product/design/files/CEBM-Levels-of-Evidence-2.1.pdf.
Accessed May 2014.

http://www.cebm.net/index.aspx?0=1025 http://www.cebm.net/index.aspx?0=1025 http://www.cebm.net/index.aspx?o=5653 http://www.cebm.net/index.aspx?o=5653 http://www.cebm.net/mod_product/design/files/CEBM-Levels-of-Evidence-2.1.pdf http://www.cebm.net/mod_product/design/files/CEBM-Levels-of-Evidence-2.1.pdf

Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

Table of Contents for the Digital Edition of Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury