title: Pressure relief with visco-elastic foam or with combined static air overlay? A prospective, crossover randomized clinical trial in a dutch nursing home.
abstract: OBJECTIVE
  Evidence of the best mattress for preventing pressure ulcers is not conclusive. In a single center, prospective, crossover trial on pressure ulcer incidence in nursing home residents, a static air overlay mattress, without a pump, on top of a visco-elastic foam mattress was compared with a visco-elastic foam mattress alone.
  
  
  METHODS
  The study was performed using a randomized crossover design. Forty-one patients with a score of 19 or lower on the Braden scale, but with no pressure ulcer at the start, were divided into 2 groups; 21 patients received a visco-elastic foam mattress (control group) and 20 patients a static air overlay on top of a visco-elastic foam mattress (intervention group) for a period of 6 months. In the second (crossover) period of 6 months, 19 patients participated in each group. Patients were checked weekly and, only when signs of development of a pressure ulcer were present was treatment altered to reposition patients according to the nursing home pressure ulcer protocol. No statistically significant differences were noted between the 2 groups with regard to age, gender, or Braden scale score.
  
  
  RESULTS
  Of 41 patients, 3 died and were unable to participate in the crossover period, 8 patients (22.2%) developed a category 2 or higher pressure ulcer on a visco-elastic foam mattress (control group) and 2 (5.2%) on a static air mattress (intervention group)(P = 0.087). There was a difference regarding pressure ulcer incidence between patients with a very low Braden score between 6 and 12, and patients with a mean score between 13-19. Out of 8 patients, in the 2(25%) who developed a pressure ulcer on a foam mattress, the ulcers showed no signs of healing. In the static air group all pressure ulcers healed by normal treatment according to a standardized pressure ulcer treatment protocol.
  
  
  CONCLUSIONS
  In this small study, static air overlay mattresses provided a better prevention than visco-elastic foam mattresses alone (5.2% vs 22.2%). The Braden scores of the patients in both groups did not change during the 6-month test. The decision to use repositioning only when there were signs of a pressure ulcer is acceptable when a static air overlay is in position. The 22.2% incidence of pressure ulcers in the foam group, however, may stress the need to continue repositioning when using this type of mattress. ﻿.
authors: Avoord Zorg en Wonen, Etten-Leur, The Netherlands; email:martin_van_leen@zonnet.nl.
authors: Martin
authors: M
authors: van Leen
authors: Department of Plastic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Steven
authors: S
authors: Hovius
authors: Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors: Ruud
authors: R
authors: Halfens
authors: Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; and De Riethorst Stromenland, Geertruidenberg, Netherlands.
authors: Jacques
authors: J
authors: Neyens
authors: Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors: Jos
authors: J
authors: Schols