A Cochrane review [Abstract] 1 included 59 RCTs. 31 trials involved participants without pre-existing pressure ulcers. Ten trials included patients with ulcers greater than or equal to grade 1 at baseline; four trials did not specify the grading of the pre-existing ulcers, and one trial only included people with grade 4 pressure ulcers. In 13 trials the baseline skin status of the participants was unclear.
Foam alternatives to standard hospital foam mattresses reduced the incidence of pressure ulcers in people at risk (RR 0.40 95% CI 0.21 to 0.74). One high-quality trial suggested that alternating-pressure mattresses may be more cost effective than alternating-pressure overlays.Pressure-relieving overlays on the operating table reduced postoperative pressure ulcer incidence, although two studies indicated that foam overlays caused adverse skin changes. Meta-analysis of three trials indicated that Australian standard medical sheepskins prevent pressure ulcers (RR 0.56 95% CI 0.32 to 0.97).
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