Short abstract
Linked Article: Lechner et al. Br J Dermatol 2022; 187:743–752.
Pressure ulcers result from unrelieved local pressure and shear forces, usually over a bony prominence. 1 Interventions to prevent these are focused on reducing mechanical load (repositioning, mobility improvement, support surfaces, offloading, prophylactic dressings, friction‐reducing textiles) and enhancing tissue tolerance (preventive skincare, malnutrition correction, electrical stimulation, modulating heat and moisture). 1 , 2 Many of these strategies have been extensively investigated. However, the study quality is often low and a plethora of different outcome measures and measurement instruments are reported. 1 Such heterogeneity limits study comparability and eligibility for data synthesis. Thus, it impedes the development of systematic reviews, meta‐analyses and clinical guidelines. Consequently, the quality of evidence for interventions such as pressure ulcer prevention remains limited. 2
To decrease this lack of uniformity in research, core outcome sets (COSs) are increasingly being developed. A COS defines what should be measured and reported for a certain condition. 3 In the latest issue of BJD, Lechner et al. report the development of a consensus‐derived COS for pressure ulcer prevention trials. 4 They relied on standardized methodology and involved different stakeholder groups, including practitioners, patients and informal caregivers, researchers, and industry representatives. 5 , 6 Firstly, they identified 68 different outcomes reported in the literature 2 and complemented these with patient suggestions. After merging overlapping outcomes, this list was condensed into 36 outcomes and their descriptions. Next, three rounds of voting using the Delphi method and a final consensus meeting were held, after which the stakeholders agreed on six core outcomes: (i) pressure ulcer occurrence, (ii) pressure ulcer precursor signs and symptoms, (iii) mobility, (iv) acceptability and comfort of intervention, (v) adherence/compliance and (vi) adverse events/safety. The development and implementation of COSs such as these bring uniform data collection closer, thereby enabling better assessment of quality of care. Moreover, COSs are generally developed in collaboration with patients, which ensures a set of relevant, patient‐centred outcomes.
Researchers who consider developing a COS themselves may reach out to the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. 7 COMET provides COS development guidelines, maintains a database of COS studies, and facilitates the exchange of ideas and methodological research to enhance the quality and uptake of COSs by researchers and clinicians. 7 Furthermore, developers and users of COSs for skin conditions may also refer to the CHORD COUSIN Collaboration (C3). 6 C3 provides methodological support for all development steps, from protocol writing to COS implementation.
COSs are becoming increasingly important, in an attempt to guarantee the quality of both clinical practice and research. Consequently, their implementation may soon become a necessary step of clinical trial design and reporting. 8 Therefore, we recommend that clinicians and trialists involved in research and care of a skin condition consult the database of COMET to find out whether a COS is available for their condition of interest. 7
In conclusion, we would like to congratulate Lechner et al. for reaching an important step in the harmonization of research on pressure ulcer prevention and look forward to the next step: finding suitable measurement instruments for each of these six core outcomes.
Author contributions
Anne Fledderus: Conceptualization (equal); validation (equal); visualization (equal); writing – original draft (equal); writing – review and editing (equal). H. Antoine Gout: Conceptualization (equal); validation (equal); visualization (equal); writing – original draft (equal); writing – review and editing (equal).
Acknowledgments
the authors thank Dr Oren Lapid for his review of and feedback on this commentary.
Conflicts of interest: The authors declare they have no conflicts of interest.
Data availability statement: Data sharing not applicable – no new data generated.
References
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