Foam surfaces for preventing pressure ulcers (Review)
Shi, C., Dumville, J. C., Cullum, N., Rhodes, S. and McInnes, E.. (2021). Foam surfaces for preventing pressure ulcers (Review). Cochrane Database of Systematic Reviews. (5), p. Article CD013621. https://doi.org/10.1002/14651858.CD013621.pub2
|Authors||Shi, C., Dumville, J. C., Cullum, N., Rhodes, S. and McInnes, E.|
Data collection and analysis
Primary outcome: pressure ulcer incidence
Low‐certainty evidence suggests that foam surfaces may increase the risk of developing new pressure ulcers compared with (1) alternating pressure (active) air surfaces (risk ratio (RR) 1.59, 95% confidence interval (CI) 0.86 to 2.95; I2 = 63%; 4 studies, 2247 participants), and (2) reactive air surfaces (RR 2.40, 95% CI 1.04 to 5.54; I2 = 25%; 4 studies, 229 participants).
We are uncertain regarding the difference in pressure ulcer incidence in people treated with foam surfaces and the following surfaces: (1) reactive fibre surfaces (1 study, 68 participants); (2) reactive gel surfaces (1 study, 135 participants); (3) reactive gel and foam surfaces (1 study, 91 participants); and (4) another type of foam surface (6 studies, 733 participants). These had very low‐certainty evidence.
Included studies have data on time to pressure ulcer development for two comparisons. When time to ulcer development is considered using hazard ratios, the difference in the risk of having new pressure ulcers, over 90 days' follow‐up, between foam surfaces and alternating pressure air surfaces is uncertain (2 studies, 2105 participants; very low‐certainty evidence). Two further studies comparing different types of foam surfaces also reported time‐to‐event data, suggesting that viscoelastic foam surfaces with a density of 40 to 60 kg/m3 may decrease the risk of having new pressure ulcers over 11.5 days' follow‐up compared with foam surfaces with a density of 33 kg/m3 (1 study, 62 participants); and solid foam surfaces may decrease the risk of having new pressure ulcers over one month's follow‐up compared with convoluted foam surfaces (1 study, 84 participants). Both had low‐certainty evidence.
There was no analysable data for the comparison of foam surfaces with reactive water surfaces (one study with 117 participants).
Support‐surface‐associated patient comfort: the review contains data for three comparisons for this outcome. It is uncertain if there is a difference in patient comfort measure between foam surfaces and alternating pressure air surfaces (1 study, 76 participants; very low‐certainty evidence); foam surfaces and reactive air surfaces (1 study, 72 participants; very low‐certainty evidence); and different types of foam surfaces (4 studies, 669 participants; very low‐certainty evidence).
All reported adverse events: the review contains data for two comparisons for this outcome. We are uncertain about differences in adverse effects between foam surfaces and alternating pressure (active) air surfaces (3 studies, 2181 participants; very low‐certainty evidence), and between foam surfaces and reactive air surfaces (1 study, 72 participants; very low‐certainty evidence).
Health‐related quality of life: only one study reported data on this outcome. It is uncertain if there is a difference (low‐certainty evidence) between foam surfaces and alternating pressure (active) air surfaces in health‐related quality of life measured with two different questionnaires, the EQ‐5D‐5L (267 participants) and the PU‐QoL‐UI (233 participants).
Cost‐effectiveness: one study reported trial‐based cost‐effectiveness evaluations. Alternating pressure (active) air surfaces are probably more cost‐effective than foam surfaces in preventing pressure ulcer incidence (2029 participants; moderate‐certainty evidence).
Future research in this area should consider evaluation of the most important support surfaces from the perspective of decision‐makers. Time‐to‐event outcomes, careful assessment of adverse events and trial‐level cost‐effectiveness evaluation should be considered in future studies. Trials should be designed to minimise the risk of detection bias; for example, by using digital photography and by blinding adjudicators of the photographs to group allocation. Further review using network meta‐analysis adds to the findings reported here.
|Journal||Cochrane Database of Systematic Reviews|
|Journal citation||(5), p. Article CD013621|
|Publisher||John Wiley & Sons|
|Digital Object Identifier (DOI)||https://doi.org/10.1002/14651858.CD013621.pub2|
|Open access||Published as ‘gold’ (paid) open access|
|Research or scholarly||Research|
File Access Level
|Online||06 May 2021|
|Publication process dates|
|Deposited||01 Sep 2021|
|License: CC BY-NC 4.0|
|File access level: Open|
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