The market for speciality support surfaces is broadening into homes due to a shift from expensive hospital stays to alternate and ‘at home’ care. As such, consumers are seeking better information about the available products, and help in understanding which product is right for them.
This document looks at how therapeutic support surfaces work and reviews the different types of support surfaces on the market, with a focus on features, uses, benefits and disadvantages.
Support surfaces are the special mattresses, mattress overlays, seat cushions and specialty beds that support your body in bed or in a chair. Specifically, these support surfaces are used to reduce or relieve pressure that the weight of your body, and especially your bones, exert on your skin as it presses against the surface of a bed or seat of a chair.
The word ‘pressure’ describes a force over an area – in this case, the pressure of a mattress or seat cushion against a patient’s skin. A pressure reducing support surface lowers pressure below that exerted by a standard mattress – relieving pressure below the capillary closing pressure of 26-32 millimetres of mercury (mmHg). Note that pressure of 70 mmHg applied to healthy tissue for just two hours can result in tissue damage.
By relieving or reducing this pressure, therapeutic support surfaces are designed to prevent or promote the healing of pressure ulcers by reducing or eliminating tissue interface pressure, minimising surface friction to reduce shear, and providing temperature and moisture control.
A number of different types of support surfaces are available and no single support surface has been shown to consistently perform better than all others under all circumstances. The type of support surface best for you will depend on a number of factors such as your general health, your ability to change positions, and your body build, as well as the condition, number and location of your pressure ulcers.
Your healthcare provider will make the appropriate choice during any hospital stay and can recommend support surfaces for use at home. Additional support surface selection considerations for the home
include the ease of use of the support surface, maintenance requirements, personal preferences, insurance coverage and availability.
The look of the product is also important in the home environment. When someone walks into your room, one of the first things they see is the bed and mattress, equipment that doesn’t look clinical is a real benefit to maintaining your sense of home.
Of course cost is another important factor. When selecting therapeutic support surfaces, it is critical to evaluate their clinical efficacy and application in proportion to their acquisition cost. Costs for therapeutic support surfaces vary widely, ranging from hundreds of dollars to tens of thousands – and with no compelling evidence to show that one support surface works better under all circumstances, it is important to evaluate the product that is right for you.
Anyone using a pressure reducing support surface should have a care plan, established in consultation with your physician and home care nurse, which should generally include the following:
- education of the patient and caregiver on the prevention and/or management of pressure ulcers
- regular assessment by a nurse, physician, or other licensed healthcare practitioner
- appropriate turning and positioning
- appropriate woundcare (for stage 2, 3, or 4 ulcer)
- appropriate management of moisture/incontinence
- nutritional assessment and intervention consistent with the overall plan
guidelines for use
The AHRQ is the Agency for Healthcare Research and Quality – the USA’s lead Federal agency for research on health care quality, costs, outcomes, and patient safety. Guidelines developed by the AHRQ for managing existing pressure ulcers include the following:
- Use positioning devices to raise a pressure ulcer off the support surface. If the patient is no longer at risk for developing pressure ulcers, these devices may reduce the need for pressure-reducing overlays, mattresses, and beds. Avoid using donut-type devices.
- Assess all patients with existing pressure ulcers to determine their risk for developing additional pressure ulcers. If the patient remains at risk, use a pressure-reducing surface.
- If patients can assume a variety of positions without bearing weight on the lesion and without “bottoming out,” a static support surface should be used.
- If the patient cannot assume a variety of positions without bearing weight on the ulcer, if the patient fully compresses the static support surface, or if the pressure ulcer does not show evidence of healing, a dynamic surface should be used.
- If the patient has large stage III or stage IV pressure ulcers on multiple turning surfaces, a pressure relieving product is warranted.
The performance characteristics suggested by the AHCPR for decisions on support surfaces include providing an increased support area, low moisture retention, reduced heat accumulation, shear reduction and pressure reduction properties. Other properties for consideration are the dynamic versus static properties and cost per day.
categories of support surfaces
Support surfaces can be categorised according to whether the support is “dynamic” or “static”. Support surface technologies can be classified in many different ways but usually according to their mechanical characteristics or unique therapeutic function. In practice, most products consist of a combination of materials and incorporate multiple therapeutic strategies.