Randomised control trial shows very little difference between alternating pressure mattresses and high specification foam

Clinical evidence has been published in the journal EClinical Medicine comparing the cost and effectiveness of alternating pressure mattresses and high specification foam in pressure ulcer prevention.

The randomised control trial – ‘Pressure Relieving Support Surfaces for Pressure Ulcer Prevention (PRESSURE 2): Clinical and Health Economic Results of a Randomised Controlled Trial’ – aimed to provide much-needed evidence about specialist mattresses used in pressure ulcer prevention.

According to the study, there is a lack of evidence about comparative effectiveness between different mattress types in pressure ulcer prevention. This could lead to widespread adoption of more expensive mattress types (such as alternating pressure mattress) without demonstrated patient benefit.

It says that despite a lack of evidence, alternating pressure mattresses are commonly used for prevention of pressure ulcers.

In light of this, the randomised control trial compared the clinical and cost effectiveness of two different mattress types: alternating pressure mattresses and high specification foam.

2,029 patients were chosen, at random, to take part in the randomised control trial across 42 UK secondary/community in-patient facilities. The patients were chosen if they were: acutely ill, bedfast/chairfast and/or had a Category 1 pressure ulcer or pain at the place of pressure ulcer.

Then, the patients were randomly allocated either an alternating pressure mattress (1,016 patients) or high specification foam (1,013 patient) for a treatment phase over 60 days. The study looked at how long it took patients to develop a Category 2 pressure ulcer from randomisation to 30-day post-treatment follow-up in intention-to treat population.

The findings of the randomised control trial showed that there was insufficient evidence of a difference between the two groups for time to develop a new Category 2 pressure ulcer. However, the trial did reveal that alternating pressure mattresses are more cost-effective than high specification foam.

As a result, the trial recommends that decision-making on what type of mattress should be used for any given patient with a pressure ulcer should consider patient preference, comfort, rehabilitation needs and the presence of potentially modifiable risk factors – such as being completely immobile, nutritional deficits and Category 1 pressure ulcers.