McInnes E, Jammali-Blasi A, Bell-Syer SE, Leung V, et al.
The Cochrane database of systematic reviews. Date of publication 2018 Oct 11;volume 10():CD009490.
1. Cochrane Database Syst Rev. 2018 Oct 11;10:CD009490. doi:
10.1002/14651858.CD009490.pub2.
Support surfaces for treating pressure ulcers.
McInnes E(1), Jammali-Blasi A, Bell-Syer SE, Leung V.
Author information:
(1)Nursing Research Institute, St Vincent's Health Australia (Sydney) and
Australian Catholic University (ACU), School of Nursing, Midwifery and
Paramedicine, Australian Catholic University, Executive Suite, Level 5 DeLacy
Building, St Vincent's Hospital, 390 Victoria Road, Darlinghurst, New South
Wales, Australia, 2010.
Update of
Cochrane Database Syst Rev. 2011 Dec 07;(12):CD009490.
BACKGROUND: Pressure ulcers are treated by reducing pressure on the areas of
damaged skin. Special support surfaces (including beds, mattresses and cushions)
designed to redistribute pressure, are widely used as treatments. The relative
effects of different support surfaces are unclear. This is an update of an
existing review.
OBJECTIVES: To assess the effects of pressure-relieving support surfaces in the
treatment of pressure ulcers.
SEARCH METHODS: In September 2017 we searched the Cochrane Wounds Specialised
Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid
MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and
EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and
unpublished studies, and scanned reference lists of relevant included studies as
well as reviews, meta-analyses and health technology reports to identify
additional studies. There were no restrictions with respect to language, date of
publication or study setting.
SELECTION CRITERIA: We included published or unpublished randomised controlled
trials (RCTs), that assessed the effects of support surfaces for treating
pressure ulcers, in any participant group or setting.
DATA COLLECTION AND ANALYSIS: Data extraction, assessment of 'Risk of bias' and
GRADE assessments were performed independently by two review authors. Trials with
similar participants, comparisons and outcomes were considered for meta-analysis.
Where meta-analysis was inappropriate, we reported the results of the trials
narratively. Where possible, we planned to report data as either risk ratio or
mean difference as appropriate.
MAIN RESULTS: For this update we identified one new trial of support surfaces for
pressure ulcer treatment, bringing the total to 19 trials involving 3241
participants. Most trials were small, with sample sizes ranging from 20 to 1971,
and were generally at high or unclear risk of bias.
PRIMARY OUTCOME: healing of existing pressure ulcersLow-tech constant pressure
support surfacesIt is uncertain whether profiling beds increase the proportion of
pressure ulcer which heal compared with standard hospital beds as the evidence is
of very low certainty: (RR 3.96, 95% CI 1.28 to 12.24), downgraded for serious
risk of bias, serious imprecision and indirectness (1 study; 70
participants).There is currently no clear difference in ulcer healing between
water-filled support surfaces and foam replacement mattresses: (RR 0.93, 95% CI
0.63 to 1.37); low-certainty evidence downgraded for serious risk of bias and
serious imprecision (1 study; 120 participants).Further analysis could not be
performed for polyester overlays versus gel overlays (1 study; 72 participants),
non-powered mattresses versus low-air-loss mattresses (1 study; 20 participants)
or standard hospital mattresses with sheepskin overlays versus standard hospital
mattresses (1 study; 36 participants).High-tech pressure support surfacesIt is
currently unclear whether high-tech pressure support surfaces (such as
low-air-loss beds, air suspension beds, and alternating pressure surfaces)
improve the healing of pressure ulcers (14 studies; 2923 participants) or which
intervention may be more effective. The certainty of the evidence is generally
low, downgraded mostly for risk of bias, indirectness and imprecision.Secondary
outcomesNo analyses were undertaken with respect to secondary outcomes including
participant comfort and surface reliability and acceptability as reporting of
these within the included trials was very limited.Overall, the evidence is of low
to very low certainty and was primarily downgraded due to risk of bias and
imprecision with some indirectness.
AUTHORS' CONCLUSIONS: Based on the current evidence, it is unclear whether any
particular type of low- or high-tech support surface is more effective at healing
pressure ulcers than standard support surfaces.
DOI: 10.1002/14651858.CD009490.pub2
PMID: 30307602
