Classification of Support Surfaces (SSs) - A Need for Reassessment in Pressure Ulcer (PU) Prevention

There are many ways to classify SSs depending on structural or functional basis (1). Comparative clinical trials on efficacy and systematic reviews based on trials are the best ways to assess the ability of SSs to prevent PUs. They, however, assume that there is a class effect (2-4) for example that all static (foam vs air-filled) or powered (irrespective of functionality) SSs have the same clinical efficacy. Consensus exists that higher specification foam mattresses (HSFM) are better that standard foam mattresses (SFMs) (1,2) but definitions of HSFMs have previously been vague (1,5). Powered mattresses seem to be more effective that SFMs but they may provide less comfort than SFMs (4). As to the mattress classification, however, real functionality i.e. adjustability is the key, not merely use of electricity (6,7). Since clinical trials with each type of mattresses are impossible, each mattress manufacturer has also to summarize data (Clinical Evaluation Report) of a single mattress type on pathophysiology behind PU development (5-8) as required by Medical Device Regulation 2020.

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