The overview presents a lot of data from randomised controlled trials and contains an advanced analysis called 'network meta-analysis'. The analysis allows comparisons of all types of support surfaces for preventing or treating pressure ulcers. This interactive tool may help with navigation of the data https://stopthepressure.shinyapps.io/Cochrane_support_surface_reviews/.
Key messages
Static air mattresses or overlays, alternating pressure air mattresses or overlays, and gel pads used on operating tables may be better than foam mattresses for preventing pressure ulcers.
Compared with foam mattresses, alternating pressure air mattresses or overlays probably result in health benefits that outweigh their costs in preventing pressure ulcers.
Static air mattresses or overlays may be better than foam mattresses for ulcer healing, but may cost more.
It is unclear what the best treatment is for either preventing or treating pressure ulcers; what the effects of these treatment options are on people’s comfort and quality of life; and whether or not there are any unwanted effects.
What are pressure ulcers?
Pressure ulcers (also known as pressure sores or bed sores) are wounds to the skin and underlying tissue caused by prolonged pressure or rubbing. People who have mobility problems or who lie in bed for long periods are at risk of developing pressure ulcers.
What did we want to find out?
There are many types of beds, mattresses and overlays specifically designed for people with pressure ulcers. These can be made from a range of materials (such as foam, air cells and gel pads) and are divided into two groups:
- reactive (static) surfaces that apply a constant pressure to the skin; and
- active (alternating pressure) surfaces that regularly redistribute the pressure under the body.
We wanted to find out if different types of reactive and active surfaces:
- prevent pressure ulcers;
- help ulcers to heal;
- are comfortable and improve people’s quality of life;
- have health benefits that outweigh their costs; and
- have any unwanted effects.
We also wanted to find out what the best treatment options are for either preventing or healing pressure ulcers.
What did we do?
We searched for Cochrane Reviews that summarised the results of all available carefully designed studies (controlled trials) evaluating different beds, mattresses and overlays in preventing and treating pressure ulcers. A Cochrane Review provides a high level of evidence on the effectiveness of healthcare interventions. We summarised the results of these reviews in a single document (called an overview of reviews).
We also collected studies included in these reviews and compared all available treatments at the same time in a single analysis (called network meta-analysis). We then summarised these results, and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
Effects in preventing pressure ulcers
We found four reviews on the use of beds, mattresses and overlays for preventing pressure ulcers. From these, we included 40 studies (12,517 people) in a network meta-analysis evaluating reduction of pressure ulcer risk. The network meta-analysis evidence suggests that static (reactive) air overlays, alternating pressure air mattresses, and (reactive) gel pads used on operating tables may reduce pressure ulcer risk compared with foam mattresses.
We also included 10 studies (7211 people) in a network meta-analysis evaluating the time taken for new ulcers to develop. The network meta-analysis evidence suggests that reactive air surfaces may reduce the chances of developing new ulcers compared with foam surfaces.
Effects in treating pressure ulcers
We found two reviews on pressure ulcer healing. From these, we included four studies (397 people) in a network meta-analysis. The network meta-analysis evidence suggests that more people with ulcers may heal completely using reactive air surfaces than foam surfaces.
The overview evidence suggests that, if the time needed to completely heal an ulcer is looked at, reactive air surfaces may improve the chances of pressure ulcers healing when compared with foam mattresses.
However, it is unclear which treatment is best for either preventing or treating pressure ulcers.
Other effects in preventing and treating pressure ulcers
The overview evidence suggests that:
- compared with foam mattresses, alternating pressure air surfaces probably result in health benefits that outweigh their costs in preventing pressure ulcers;
- reactive air-filled surfaces may cost more than foam mattresses in healing ulcers; and
- the other benefits and risks of these beds, mattresses and mattress overlays are unclear.
What are the limitations of the evidence?
Although the reviews we found used reliable methods, most of the studies in them were small and used methods likely to introduce errors in their results.
How up-to-date is this evidence?
The evidence in this overview is current to July 2020.
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