Discussion
Fromthestudiescritiqued,itisclearthatmore
research is needed in to the efficacy of barrier
products on the market, especially in clinical
settings (which have not been substantially
investigatedincurrentliterature).
Onesetbacktoselectingaleadingbarrier
productfromthesestudiesisthattheyalldate
backto2006orearlierandnewerproducts
havebeenintroducedsince.Coughlanetal
(2007) suggest that research critiqued in a
literaturereviewshouldbelessthanfiveyears
old.However,therehasbeenaconsiderable
lackofresearchsince2006soearlierstudies
wereusedforthisreview.
These studies have made headway in
providing a greater understanding of the
aetiology,pathophysiologyandpreventionand
treatmentofIADinolderpeople.However
moreresearchisneededintheuseofmore
recent barrier products, in other clinical
settings and addressing a greater variety of
ages.Researchwouldbenefitpracticeifstudies
unanimouslyagreedonebarrierproductwas
the most effective in the prevention and
treatmentofIAD,asitwouldsimplifychoice
fornon-expertsinwoundcare.
It might also be useful to differentiate
between barriers products that protect
vulnerable skin and those for improving
IADwhereskinintegrityhasalreadybeen
lost.Furthermore,guidelinesidentifyingthe
properties, indications for use and brand
nameexamplesofbarrierproductscontaining
themostcommonactiveingredientsmight
provebeneficialforhealthcareprofessionals.
Currentreviewsdisagreeontheproperties
andeffectivenessofsomeproducts(Beldon
2012;Grayetal,2012)andarecentstudyby
Doughtyandcolleagues(2012)confirmsthat,
whilerecommendationscanbemadeforthe
moisturisingstepofaskincareregimen,more
researchneedstobeconductedifthesameis
tobedoneforbarrierproducts.
Basedonthefindingsofthisreview,there
is insufficient evidence to recommend one
barrier product over another for elderly
residentslivinginlong-termcarefacilities.Two
outofthefivestudiesthattestedtheCavilon
film favoured it over the other products
(BaatenburgdeJongandAdmiraal,2004;Bale
etal,2004)andBaleetal(2004)saidthatit
dramaticallyreducedtheincidenceofpressure
ulcers, although this was not an outcome
ofthisreview.However,Zehreretal(2004)
stated that Cavilon showed no significant
differencetotheotherproductstested.
Allofthestudies(exceptHoggarthetal,
2005)areatahighriskofbiasasnoneofthem
comparedthebarrierproductstoacontrol.It
thereforecannotbedeterminedwhetherthe
useofabarrierproductisbetterthanusing
noneatall.
AstandardisedassessmenttoolforIADis
alsoneededtoprovidecongruencewithinthe
methodologyoffutureresearchinthisfield.
Withonlyalimitedconcurrencebetweenthesixstudiesoverall,theresponsibilityofproduct
choicestillfallsontheindividualcarefacility
andontheindividualhealthcareprofessional