Bed Positioning21. Use bed positioning devices and techniques that are compatible with the bed type and the individual's health status.Avoid positioning individuals directly on pressure ulcers regardless of the pressure ulcer anatomical location (trochanter, ischium, sacrum, and heel) unless such position is necessanry for performance of ADLs, such as eating or hygiene.Use pillows, cushions, and positioning aids to reduce pressure on existing pressure ulcers or vulnerable skin areas by elevating them away from the support surface.Avoid closed cutouts or donut-type cushions.Prevent contact between bony prominences.Elevate the head of the bed no higher than 30 degrees unless medically necessary.Reposition individuals in bed at least every 2 hours. Sources: Sackett, D.L. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95 (2 Suppl) (1989): 25-45; and the U.S. Preventive Health Services Task Force. Guide to clinical preventive services: An assessment of the effectiveness of 169 interventions. Baltimore, MD: Williams and Wilkins, 1996.

Clinical practice guidelines (CPGs) provide an efficient route from research to practice because they follow a prescribed, vetted process for evidence collection. CPGs offer underserved fields, such as burn rehabilitation, an accessible approach to reliable treatment. A literature search was performed using the terms “Burns AND CPGs AND Rehabilitation.” Three reviewers determined whether guideline development followed an established vetting process. “Rehabilitation” required evidence of treatment to improve, maintain, or restore human function and provide treatment to facilitate recovery. Only 160 articles were obtained and, after adding the term “functional outcome,” 62 remained for full-text review, of which 21 were eligible. When articles were scored for inclusion of both rehabilitation AND function or functional outcome AND guideline vetting, seven articles remained. One was community based. Nine articles had no recorded vetting process but addressed rehabilitation as an outcome. There is a paucity of CPGs relevant to clinical rehabilitation for burn survivors, likely a result of very few published intervention trials, rare randomized controlled trials addressing rehabilitation, absence of data to establish an evidence base for practice recommendations, an inadequate number of community-based intervention trials, and little patient input. It is likely that rehabilitation of burn survivors will improve if more people gain skills in meeting the needs of people with burn injury. An increase in trained professionals may lead to an increase in intervention trials and research to establish evidence for CPGs. People engaged in burn research have an opportunity to devise a systematic, generally agreed-upon approach toward evaluating burn patients and treatment outcomes that will permit data sharing across the world and assess patients throughout the acute and chronic phases of burn injury.