Reactive air surfaces for preventing pressure ulcers (review)
Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Leung, V. and McInnes, E.. (2021). Reactive air surfaces for preventing pressure ulcers (review). Cochrane Database of Systematic Reviews. 2021(5), p. Article CD013622. https://doi.org/10.1002/14651858.CD013622.pub2
|Authors||Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Leung, V. and McInnes, E.|
Data collection and analysis
Primary outcome: Pressure ulcer incidence
Reactive air surfaces may reduce the proportion of participants developing a new pressure ulcer compared with foam surfaces (risk ratio (RR) 0.42; 95% confidence interval (CI) 0.18 to 0.96; I2 = 25%; 4 studies, 229 participants; low‐certainty evidence). It is uncertain if there is a difference in the proportions of participants developing a new pressure ulcer on reactive air surfaces compared with: alternating pressure (active) air surfaces (6 studies, 1648 participants); reactive water surfaces (1 study, 37 participants); reactive gel surfaces (1 study, 66 participants), or another type of reactive air surface (2 studies, 223 participants). Evidence for all these comparisons is of very low certainty.
Included studies have data on time to pressure ulcer incidence for two comparisons. When time to pressure ulcer incidence is considered using a hazard ratio (HR), low‐certainty evidence suggests that in the nursing home setting, people on reactive air surfaces may be less likely to develop a new pressure ulcer over 14 days' of follow‐up than people on alternating pressure (active) air surfaces (HR 0.44; 95% CI 0.21 to 0.96; 1 study, 308 participants). It is uncertain if there is a difference in the hazard of developing new pressure ulcers between two types of reactive air surfaces (1 study, 123 participants; very low‐certainty evidence).
Support‐surface‐associated patient comfort: the included studies have data on this outcome for three comparisons. We could not pool any data as comfort outcome measures differed between included studies; therefore a narrative summary is provided. It is uncertain if there is a difference in patient comfort responses between reactive air surfaces and foam surfaces over the top of an alternating pressure (active) air surfaces (1 study, 72 participants), and between those using reactive air surfaces and those using alternating pressure (active) air surfaces (4 studies, 1364 participants). Evidence for these two comparisons is of very low certainty. It is also uncertain if there is a difference in patient comfort responses between two types of reactive air surfaces (1 study, 84 participants; low‐certainty evidence).
All reported adverse events: there were data on this outcome for one comparison: it is uncertain if there is a difference in adverse events between reactive air surfaces and foam surfaces (1 study, 72 participants; very low‐certainty evidence).
The included studies have no data for health‐related quality of life and cost‐effectiveness for all five comparisons.
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 adjudicators of the photographs being blinded to group allocation. Further review using network meta‐analysis adds to the findings reported here.
|Journal||Cochrane Database of Systematic Reviews|
|Journal citation||2021 (5), p. Article CD013622|
|Publisher||John Wiley & Sons, Ltd|
|Digital Object Identifier (DOI)||https://doi.org/10.1002/14651858.CD013622.pub2|
|Open access||Published as ‘gold’ (paid) open access|
|Research or scholarly||Research|
File Access Level
|Online||07 May 2021|
|Publication process dates|
|Deposited||22 Nov 2021|
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