title: Support surfaces for treating pressure ulcers.
abstract: 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.
  
  
  OBJECTIVE
  To assess the effects of pressure-relieving support surfaces in the treatment of pressure ulcers.
  
  
  METHODS
  We searched: The Cochrane Wounds Group Specialised Register (searched 15 July 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (2007 to July Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 14, 2011); Ovid EMBASE (2007 to 2011 Week 27); EBSCO CINAHL (2007 to 14 July 2011). The reference sections of included studies were also searched.
  
  
  METHODS
  We included published or unpublished randomised controlled trials (RCTs), that assessed the effects of support surfaces for treating pressure ulcers, in any patient group or setting, that reported an objective measure of wound healing.
  
  
  METHODS
  Data extraction and assessment of risk of bias were performed independently by two review authors. Trials with similar patients, comparisons and outcomes were considered for pooled analysis. Where pooling was inappropriate the results of the trials were reported narratively. Where possible, the risk ratio or mean difference was calculated for the results of individual studies.
  
  
  RESULTS
  We identified 18 trials of support surfaces for pressure ulcer treatment, involving 1309 participants with samples sizes that ranged from 14 to 160. Of three trials comparing air-fluidized devices with conventional therapy, two reported significant reductions in pressure ulcer size associated with air-fluidized devices. Due to lack of reported variance data we could not replicate the analyses. In relation to three of the trials that reported significant reductions in pressure ulcer size favouring low air loss devices compared with foam alternatives, we found no significant differences. A small trial found that sheepskin placed under the legs significantly reduced redness and similarly a small subgroup analysis favoured a profiling bed compared with a standard bed in terms of the healing of existing grade 1 pressure ulcers. Poor reporting, clinical heterogeneity, lack of variance data and methodological limitations in the eligible trials meant that no pooled comparisons were undertaken.
  
  
  CONCLUSIONS
  There is no conclusive evidence about the superiority of any support surface for the treatment of existing pressure ulcers. Methodological issues included variations in outcomes measured, sample sizes and comparison groups. Many studies had small sample sizes and often there was inadequate description of the intervention, standard care and co-interventions. Individual study results were often inadequately reported, with failure to report variance data common, thus hindering the calculation of mean differences. Some studies did not report P values when reporting on differences in outcomes. In addition, the age of some trials (some being 20 years old), means that other technologies may have superseded those investigated.Further and rigorous studies are required to address these concerns and to improve the evidence base before firm conclusions can be drawn about the most effective support surfaces to treat pressure ulcers.
authors.affiliation: Nursing Research Institute, St Vincent's and Mater Health Sydney ACU, National Centre for Clinical Outcomes Research (NaCCOR), Nursing and Midwifery, Australia, Research Room, Level 5 DeLacy Building, St Vincent's Hospital, Victoria Street, Darlinghurst, New South Wales, Australia, 2010.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McInnes
authors.forename: Jo C
authors.initials: JC
authors.lastname: Dumville
authors.forename: Asmara
authors.initials: A
authors.lastname: Jammali-Blasi
authors.forename: Sally Em
authors.initials: SE
authors.lastname: Bell-Syer
mesh_terms: D001512:Bedding and Linens / Q000592:standards*; D001513:Beds / Q000592:standards*; D004867:Equipment Design; D006801:Humans; D003668:Pressure Ulcer / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013499:Surface Properties; D014945:Wound Healing