title: Preventing pressure ulcers--Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis.
abstract: OBJECTIVE
  To undertake a systematic review of the effectiveness of pressure redistributing support surfaces in the prevention of pressure ulcers.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials.
  
  
  METHODS
  Randomised controlled trials and quasi-randomised trials, published or unpublished, which assessed the effects of support surfaces in preventing pressure ulcers (of any grade), in any patient group, in any setting compared to any other support surface, were sought. Two reviewers extracted and summarised details of eligible trials using a standardised form and assessed the methodological quality of each trial using the Cochrane risk of bias tool.
  
  
  RESULTS
  Fifty-three eligible trials were identified with a total of 16,285 study participants. Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i) foam alternatives to the standard hospital foam mattress reduce the incidence of pressure ulcers in people at risk (RR 0.40, 95% CI 0.21-0.74) and Australian standard medical sheepskins prevent pressure ulcers compared to standard care (RR 0.48, 95% CI 0.31-0.74). Pressure-redistributing overlays on the operating table compared to standard care reduce postoperative pressure ulcer incidence (RR 0.53, 95% CI 0.33-0.85).
  
  
  CONCLUSIONS
  While there is good evidence that higher specification foam mattresses, sheepskins, and that some overlays in the operative setting are effective in preventing pressure ulcers, there is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. More robust trials are required to address these research gaps.
authors: Nursing Research Institute-St Vincents and Mater Health Sydney & Australian Catholic University, National Centre for Clinical Outcomes Research Level 5, Delacy Building, 379 Victoria St Darlinghurst, NSW 2010, Australia. liz.mcinnes@acu.edu.au
authors: Elizabeth
authors: E
authors: McInnes
authors: Asmara
authors: A
authors: Jammali-Blasi
authors: Sally
authors: S
authors: Bell-Syer
authors: Jo
authors: J
authors: Dumville
authors: Nicky
authors: N
authors: Cullum
mesh_terms: D001513:Beds; D006801:Humans; D003668:Pressure Ulcer / Q000517:prevention & control*