Pressure Injuries and Orthotic Devices: Prevalence, Incidence, Risk Factors, and Preventive Measures; A Systematic Literature Review

Abstract

ABSTRACT:

Background: The National Pressure Injury Advisory Panel states that pressure injuries can be medical devices-related pressure injuries. As orthotic devices are medical devices, there is a gap in the literature covering orthotic devices-related pressure injuries. Objective: To determine the extent to which the use of orthotic devices contributes to the development of pressure injuries. Study design: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Methods: A search strategy was conducted using six databases: Embase, Medline, Biotechnology research abstract, Cinahl, Compendex, and Scopus to capture peer-reviewed studies published in English between 2015 and May 2024. Key inclusion criteria were studies reported orthotic devices-related pressure injuries. Exclusion criteria were studies reported abrasion/maceration, and case studies. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the included studies. Results: Twenty-two articles were included, most of them lacked clarity of adequate sample size with insufficient coverage of subgroup. The prevalence of medical device-related pressure injuries ranged from 0.60% to 38.10%. Of these 0.83% to 53.4% were reported orthotic devices-related pressure injuries. Of the overall reported incidence of medical devices-related pressure injuries, 1.2% to 70.73% were orthotic devices-related pressure injuries. Prolonged hospitalizations and low Braden score, which include elements of mobility, activity, nutrition, sensory, moisture, and shear force/friction, were commonly identified as risk factors for the development of medical device-related pressure injuries. Preventive measures recommended by most studies were skin assessment and offloading, reflecting that the studies were more focused on medical devices than orthotic devices. Conclusion: Due to methodological issues identified in the included studies, such as orthotic and pressure injury characteristics, prevent establishing that orthoses directly cause pressure injuries. However, there is a clear relationship between orthotic devices and pressure injuries.