Background
Methods
Study design
Ethics approval and consent to participate
Setting
Participants
Variables
Data sources and measurement
Bias
Study size
Quantitative variables
Statistical methods
Results
Participants
Responders (n = 223) | Non-Responders (n = 29) | |
---|---|---|
Female, n (%) | 151/223 (67.7) | 16/29 (55.2) |
Age [years] | ||
Mean (SD) | 83.6 (8.0) | 83.1 (11.1)a
|
Median (IQR) | 84 (78–89) | 81 (73–95)a
|
BMI [kg/m2] | ||
Mean (SD) | 25.3 (5.1)b
| 24.0 (4.4)c
|
Median (IQR) | 24.6 (21.9–28.3)b
| 23.5 (20.6–26.8)c
|
Descriptive data
Gender n (%) | Care dependency (Barthel – Index)d n (%) | Total (n = 223) | ||||
---|---|---|---|---|---|---|
Female 151 (67.7) | Male 72 (32.3) | Score: 100–60 71 (31.8) | Score: 59–20,116 (52.0) | Score: 19–0 35 (15.7) | ||
Demographic characteristics | ||||||
Age [years] | ||||||
Mean (SD) | 84.9 (8.0) | 80.7 (7.3) | 83.0 (7.8) | 83.9 (8.1) | 83.3 (8.2) | 83.6 (8.0)a
|
Median (IQR) | 85 (78.0–91.0) | 80 (76.0–86.0) | 84.0 (77.0–89.0) | 85.0 (78.0–90.0) | 80.0 (78.0–89.0) | 84.0 (78.0–89.0)a
|
BMI [kg/m2] | ||||||
Mean (SD) | 25.5 (5.5)q
| 24.9 (4.3)k
| 25.3 (4.9)x
| 25.6 (5.1)z
| 24.6 (5.5) | 25.3 (5.1)b
|
Median (IQR) | 25.0 (21.8–28.4)q
| 24.5 (21.8–28.3)k
| 24.7 (21.6–28.7)x
| 25.3 (21.9–28.3)z
| 24.1 (21.7–26.9) | 24.6 (21.9–28.3)b
|
Functional assessments | ||||||
Braden Total score | ||||||
Mean (SD) | 17.0 (3.7)o
| 17.9 (3.6) | 20.7 (1.8) | 16.5 (2.9) | 13.0 (3.0) | 17.3 (3.7)d
|
Median (IQR) | 17.0 (14.0–20.0)o
| 18.5 (15.0–21.0) | 21.0 (20.0–22.0) | 16.0 (14.3–18.0) | 12.0 (12.0–14.0) | 18.0 (14.0–21.0)d
|
6-CIT score | ||||||
Mean (SD) | 21.9 (10.4) | 18.4 (11.4) | 16.8 (11.9) | 21.7 (10.4) | 25.6 (6.5) | 20.8 (10.8)a
|
Median (IQR) | 28.0 (18.0–28.0) | 28.0 (6.0–28.0) | 25.0 (4.0–28.0) | 28.0 (16.5–28.0) | 28.0 (28.0–28.0) | 28.0 (10.0–28.0)a
|
≥ 8, n (%) | 123 (81.5) | 51 (70.8) | 48 (67.6) | 92 (79.3) | 33 (94.3) | 172 (77.1)a
|
Skin conditions | ||||||
Xerosis cutis, Overall Dry Skin Score (arms) | ||||||
Mean (SD) | 1.7 (0.8) | 1.8 (0.9) | 1.7 (0.9) | 1.8 (0.8) | 1.7 (0.9) | 1.8 (0.8) |
Median (IQR) | 2.0 (1.0–2.0) | 2.0 (1.0–2.0) | 2.0 (1.0–2.0) | 2.0 (1.0–2.0) | 2.0 (1.0–2.0) | 2.0 (1.0–2.0) |
Xerosis cutis, Overall Dry Skin Score (legs) | ||||||
Mean (SD) | 2.1 (1.0)l
| 2.1 (1.0)m
| 2.1 (1.0)3
| 2.1 (1.0)15
| 1.9 (1.0) | 2.1 (1.0)n
|
Median (IQR) | 2.0 (1.0–3.0)l
| 2.0 (1.5–3.0)m
| 2.0 (1.9–3.0)3
| 2.0 (1.0–3.0)15
| 2.0 (1.0–2.5) | 2.0 (1.0–3.0)n
|
Pressure ulcer (I-V/DTI) n, % | 14 (9.3) | 6 (8.3) | 4 (5.6) | 9 (7.8) | 6 (17.1) | 20/223 (9.0) |
Pressure ulcer (II-V/DTI) n, % | 4 (2.6) | 4 (5.6) | 1 (1.4) | 3 (2.6) | 3 (8.6) | 8/223 (3.6) |
Skin tears (n, %) | 8 (5.3) | 6 (8.3) | 5 (7.0) | 6 (5.2) | 3 (8.6) | 14/223 (6.3) |
Incontinence associated dermatitis (n, %) | 51 (33.8) | 28 (38.9) | 24 (33.8) | 47 (40.5) | 8 (22.9) | 79/223 (35.4) |
Biophysical skin measurements (Mean, SD) | ||||||
Midvolar forearm | ||||||
Transepidermal water loss, temperature adjusted, g/m2/h | 11.3 (8.1)o
| 11.1 (7.6) | 11.3 (7.8) | 11.9 (9.0)13
| 9.0 (2.2) | 10.4 (7.2) |
Stratum corneum hydration (a.u.) | 41.7 (9.8)o
| 40.1 (8.7) | 41.3 (8.8) | 41.4 (9.5)13
| 40.1 (10.8) | 41.2 (9.5) |
Skin surface pH | 5.1 (0.6)o
| 5.0 (0.7)k
| 5.1 (0.6)3
| 5.1 (0.6)13
| 5.1 (0.6) | 5.1 (0.6) |
Skin surface temperature | 30.8 (1.3)p
| 31.2 (1.2) | 31.2 (1.2) | 30.8 (1.3)14
| 30.9 (1.3) | 30.9 (1.3) |
Lower leg | ||||||
Transepidermal water loss, temperature adjusted, g/m2/h | 8.7 (6.9)p
| 8.8 (7.2) | 9.6 (8.7) | 8.7 (6.8)13
| 7.1 (2.1)12
| 8.3 (6.2) |
Stratum corneum hydration (a.u.) | 35.3 (10.2)o
| 32.8 (10.1) | 32.5 (9.9) | 35.2 (10.6)13
| 36.3 (9.4) | 34.5 (10.2) |
Skin surface pH | 5.4 (0.6)l
| 5.1 (0.6) | 5.2 (0.6)3
| 5.4 (0.6)6
| 5.4 (0.6) | 5.3 (0.6) |
Skin surfaces temperature | 30.4 (1.4)i
| 30.8 (1.4) | 30.7 (1.2)3
| 30.4 (1.5)14
| 30.5 (1.5) | 30.5 (1.4) |
Main results
Variables (mean) | Age | Gender (1/0) | 6-CIT score > 8 | Barthel Index | Braden score | TEWL arm | TEWL leg | SCH arm | SCH leg | pH arm | pH leg | Skin surface temperature arm | Skin surface temperature leg | ODS arm | ODS leg | IAD | Skin tears(1 = yes/0 = no) | Pressure ulcers (1 = yes/ 0 = no) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | 1 | |||||||||||||||||
Gender (1 = female/0 = male) |
0.285
| 1 | ||||||||||||||||
6-CIT score > 8 | −0.003 | 0.110 | 1 | |||||||||||||||
Barthel Index | −0.085 | −0.119 |
−0.262
| 1 | ||||||||||||||
Braden score | −0.038 | −0.115 |
−0.278
|
0.814
| 1 | |||||||||||||
TEWL arm | −0.165 | 0.034 | 0.103 | 0.021 | −0.016 | 1 | ||||||||||||
TEWL leg | −0.080 | 0.012 | 0.079 | 0.072 | 0.040 |
0.800
| 1 | |||||||||||
SCH arm | 0.143 | 0.075 | −0.057 | −0.002 | 0.012 | 0.145 | 0.190 | 1 | ||||||||||
SCH leg |
0.205
| 0.112 | 0.024 | −0.145 | −0.173 | 0.065 | −0.087 |
0.427
| 1 | |||||||||
pH arm | 0.070 | 0.101 | 0.116 | −0.024 | −0.042 | −0.025 | 0.031 | −0.006 | 0.036 | 1 | ||||||||
pH leg | 0.011 | 0.194 | 0.084 |
−0.204
|
−0.222
| −0.025 | 0.007 | −0.115 | −0.003 |
0.574
| 1 | |||||||
Skin surface temperature arm | 0.126 | −0.134 | −0.093 | 0.044 | 0.097 | −0.036 | 0.000 | 0.187 | 0.120 | −0.026 | −0.105 | 1 | ||||||
Skin surface temperature leg | 0.024 | −0.125 | 0.062 | 0.083 | 0.094 | 0.079 | 0.057 | 0.061 | 0.018 | −0.098 | −0.197 |
0.522
| 1 | |||||
ODS arm | 0.168 | −0.027 | −0.077 | −0.016 | 0.017 |
−0.228
| −0.117 | −0.152 |
−0.242
| 0.069 | 0.016 | −0.011 | −0.020 | 1 | ||||
ODS leg | 0.084 | −0.011 | −0.143 | 0.050 | 0.046 | −0.143 | −0.086 | −0.066 |
−0.281
| 0.078 | −0.012 | −0.025 | −0.019 |
0.614
| 1 | |||
IAD | 0.035 | −0.063 | −0.017 | 0.003 | −0.015 | 0.078 | 0.137 | 0.040 | −0.009 | 0.031 | −0.029 | −0.086 | 0.024 | 0.065 | −0.001 | 1 | ||
Skin tears (1 = yes/0 = no) | 0.154 | −0.059 | 0.048 | −0.056 | −0.154 | −0.195 |
0.212
| 0.164 |
0.207
| −0.061 | −0.038 | 0.082 | 0.105 | 0.097 | 0.048 | 0.057 | 1 | |
Pressure ulcers (1 = yes/0 = no) | 0.064 | 0.045 | 0.081 | −0.092 | −0.089 | 0.169 |
−0.209
| −0.027 | 0.065 | 0.086 | 0.119 | 0.040 | 0.069 | 0.042 | 0.046 | 0.072 | 0.054 | 1 |
Skin barrier parameters
Clinical outcomes
Independent variables | Dependent variable: SCH leg (mean) | ||
---|---|---|---|
Standardized Beta coefficient (95% CI) |
P value | VIF | |
Demography | |||
Age (years) | 0.159 (0.052 to 0.352) | 0.009 | 1.1 |
Skin physiology | |||
SCH (arm) | 0.352 (0.255 to 0.514) | <0.001 | 1.1 |
ODS (arm) | −0.098 (−2.968 to 0.611) | 0.195 | 1.7 |
ODS (leg) | −0.225 (−3.940 to −0.859) | 0.002 | 1.6 |
Skin tears | 0.150 (1.336 to 11.095) | 0.013 | 1.1 |
R2
| 0.304 | ||
Durbin Watson | 1.8 | ||
Independent variables | Dependent variable: pH leg (mean) | ||
Standardized Beta coefficient (95% CI) | P value | VIF | |
Demography | |||
Barthel Index (total score) | −0.088 (−0.007 to 0.002) | 0.346 | 2.9 |
Braden score | −0.113 (−0.048 to 0.011) | 0.228 | 2.9 |
Skin physiology | |||
pH (arm) | 0.567 (0.465 to 0.683) | <0.001 | 1.0 |
R2
| 0.367 | ||
Durbin Watson | 1.8 | ||
Independent variables | Dependent variable: TEWL arm (mean) | ||
Standardized Beta coefficient (95% CI) | P value | VIF | |
Skin physiology | |||
TEWL (leg) | 0.786 (0.813 to 0.995) | <0.001 | 1.0 |
ODS (arm) | −0.122 (−1.700 to −0.361) | 0.003 | 1.0 |
R2
| 0.655 | ||
Durbin Watson | 1.9 | ||
Independent variables | Dependent variable: TEWL leg (mean) | ||
Standardized Beta coefficient (95% CI) | P value | VIF | |
Skin physiology | |||
TEWL (arm) | 0.779 (0.605 to 0.749) | <0.001 | 1.1 |
Skin tears | 0.039 (−1.131 to 3.165) | 0.352 | 1.1 |
PU | 0.076 (−0.109 to 3.462) | 0.066 | 1.0 |
R2
| 0.648 | ||
Durbin Watson | 1.8 |
Independent variables | Dependent variable: ODS arm | ||
---|---|---|---|
Standardized Beta coefficient (95% CI) |
P value | VIF | |
Skin physiology | |||
TEWL (arm) | −0.203 (−0.039 to −0.009) | 0.002 | 1.0 |
SCH (leg) | −0.230 (−0.029 to −0.009) | <0.001 | 1.0 |
R2
| 0.100 | ||
Durbin Watson | 1.2 | ||
Independent variables | Dependent variable ODS leg | ||
Standardized Beta coefficient (95% CI) | P value | VIF | |
Skin physiology | |||
SCH (leg) | −0.143 (−0.024 to −0.003) | 0.010 | 1.1 |
ODS (arm) | 0.576 (0.529 to 0.776) | <0.001 | 1.1 |
R2
| 0.392 | ||
Durbin Watson | 1.3 |