Table 3.

Uncertain risk factors

Uncertain risk factors	Key discussion points
Friction and shear	• Important concept in relation to biomechanics and tissue loading • Debate about whether a patient characteristic • Difficult to measure in practice • Different definition of terms (e.g. nurses and bioengineers) • Interlinked with immobility • Should to be minimized in care
Acute illness Infection Body temperature (elements of general health status)	• Felt to be important clinically • Links between the 3 elements recognized • Impact on mobility, perfusion and moisture acknowledged
Chronic wound	• Did not emerge as a strong risk factor in the systematic review • Link to other factors including nutritional depletion, moisture(exudate), oedema, diabetes and general skin condition recognized • Would be captured by other key risk factors e.g. general ‘skin status’, nutrition, moisture and diabetes
Pitting oedema	• Relatively unexplored area in the literature • Leads to changes in the mechanical properties of the tissues • May result in reduced mobility due to heavy oedematous legs • Some felt that oedema should be considered under the skin status umbrella
Medication	• Acknowledged that the systematic review evidence associated with medication was weak. • Links between specific medications and risk factors were made, e.g. the effects of sedation, epidurals and analgesia on sensation and movement and steroids on skin condition (tissue paper skin) • Use of vasoconstrictors in specialist areas important • Complicated by dose-dependent effects • Difficult to measure
Age	• Some felt that age formed an important element of assessment • Others felt it was a proxy for other measures e.g. skin condition and immobility