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Pressure-relieving devices for treating heel pressure ulcers

  1. Elizabeth McGinnis1,*,
  2. Nikki Stubbs2

Editorial Group: Cochrane Wounds Group

Published Online: 12 FEB 2014

Assessed as up-to-date: 10 MAY 2013

DOI: 10.1002/14651858.CD005485.pub3


How to Cite

McGinnis E, Stubbs N. Pressure-relieving devices for treating heel pressure ulcers. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD005485. DOI: 10.1002/14651858.CD005485.pub3.

Author Information

  1. 1

    Leeds Teaching Hospitals NHS Trust, Leeds, UK

  2. 2

    Leeds Community Health Care NHS Trust, St Mary's Hospital, Tissue Viability, Leeds, UK

*Elizabeth McGinnis, Leeds Teaching Hospitals NHS Trust, c/o 2nd Floor Stable Block, Old Trust HQ, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK. Elizabeth.mcginnis@leedsth.nhs.uk. e.mcginnis@btinternet.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 12 FEB 2014

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Russell 2000 {published and unpublished data}
  • Russell L, Reynolds TM. Randomised controlled trial of two pressure-relieving systems. Journal of Wound Care 2000;9(2):52-5.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Allman 1987a {published data only}
  • Allman RM, Keruly JC, Smith CR. Cost effectiveness of air-fluidized beds versus conventional therapy for pressure sores. Clinical Research 1987;35(3):A728.
Allman 1987b {published data only}
  • Allman RM, Walker JM, Hart MK, Laprade CA, Noel LB, Smith CR. Air-fluidized beds or conventional therapy for pressure sores. A randomized trial. Annals of Internal Medicine 1987;107(5):641-8.
Andrews 1989 {published data only}
  • Andrews J, Balai R. The prevention and treatment of pressure sores by use of pressure distributing mattresses. Care Science and Practice 1989;7(3):72-6.
Bates Jenson 1998 {published data only}
  • Bates Jenson BM. A quantitative analysis of wound characteristics as early predictors of healing in pressure sores. Dissertation. University of California, LosAngeles 1998.
Bell 1993 {published data only}
  • Bell JC, Matthew SD. Results of a clinical investigation of four pressure reduction replacement mattresses. Journal of ET Nursing 1993;20(5):204-10.
Benbow 1995 {published data only}
  • Benbow M. Easing the pressure. Nursing Times 1995;91(47):64,68,70.
Bennett 1998 {published data only}
  • Bennett RG, Baran PJ, DeVone LV, Bacetti H, Kristo B, Tayback M, et al. Low air loss hydrotherapy versus standard care for incontinent hospitalized participants. Journal of American Geriatric Society 1998;46(5):569-76.
Blanco Blanco 2002 {published data only (unpublished sought but not used)}
  • Blanco Blanco J, Ballester Torralba J, Rueda Lopez J, Torra i Bou JE. Comparative study of the use of a heel protecting bandage and a special hydrocellular dressing in the prevention of pressure ulcers in elderly participants. 12th Conference of the EWMA, Granada, Spain, May 23-25. 2002:114.
Bliss 1966 {published data only}
  • Bliss MR, McLaren R, Exton Smith AN. Mattresses for preventing pressure sores in geriatric participants. Monthly Bulletin of the Ministry of Health and Public Health Laboratory Service 1966;25:238-68.
Bliss 1967 {published data only}
  • Bliss MR, McLaren R, Exton Smith AN. Preventing pressure sores in hospital: controlled trial of a large-celled ripple mattress. British Medical Journal 1967;67(1):394-7.
Bliss 1995 {published data only}
Braniff-Matthews 1997 {published data only (unpublished sought but not used)}
  • Braniff-Matthews C, Rhodes J. Prevention versus treatment: long-term management of care. European Wound Management Association Conference; 1997, 27-29 April; Milan, Italy. 1997:6.
Branom 1999 {published data only (unpublished sought but not used)}
  • Branom R, Knox L. Low air loss vs non powered/dynamic surfaces in wound management. 31st Annual Wound, Ostomy and Continence Conference: Minneapolis, MN, USA. 1999:483.
Branom 2001 {published data only}
  • Branom R, Rappl LM. 'Constant force technology' versus low air loss therapy in the treatment of pressure ulcers. Ostomy/Wound Management 2001;47(9):38-46.
Bridel-Nixon 1997 {published data only}
  • Bridel-Nixon J, McElvenny D, Brown J, Mason S. A randomized controlled trial using a double-triangular sequential design: methodology and management issues. European Wound Management Association Conference; 1997, 27-29 April; Milan, Italy. 1997:65-66.
Brown 2001 {published data only}
  • Brown SJ. Bed surfaces and pressure sore prevention: an abridged report. Orthopaedic Nursing 2001;20(4):38-40.
Caley 1994 {unpublished data only}
  • Caley L, Jones S, Freer J, Muller JS. Two types of low air loss therapy. Personal Communication 1994:378-380.
Chaloner 2000 {published data only}
  • Chaloner D. A prospective controlled comparison between two dynamic alternating mattress replacement systems within a community setting. 9th European Conference on Advances in Wound Management: Harrogate, UK, November 9-11 1999. 2000:9-11.
Cheneworth 1994 {published data only (unpublished sought but not used)}
  • Cheneworth CC, Hagglund KH, Valmassoi B, Brannon C. Portrait of practice: healing of heel ulcers. Advances in Wound Care 1994;7(2):44-8.
Clark 2002 {published data only}
  • Clark M, Benbow M, Butcher M, Gebhardt K, Teasley G, Zoller J. Collecting pressure ulcer prevention and management outcomes: 1. British Journal of Nursing 2002;11(4):230, 232, 234.
Collins 2002 {published data only}
  • Collins AS, Todd R, McCoy A, Deitz G, Pruitt D, Garner M, et al. Stride right. Nursing Management 2002;33(9):33-6.
Conine 1990a {published data only}
  • Conine TA, Daechsel D, Lau MS. The role of alternating air and Silicore overlays in preventing decubitus ulcers. International Journal of Rehabilitation Research 1990;13(1):57-65.
Conine 1990b {published data only}
  • Conine TA, Daechse lD, Choi AK, Lau MS. Costs and acceptability of two special overlays for the prevention of pressure sores. Rehabilitation Nursing 1990;15(3):133-7.
Crook 1998 {published data only (unpublished sought but not used)}
  • Crook H. Using a low-pressure inflatable support system in the prevention of pressure sores in orthopaedic participants. European Wound Management Association Conference; 1998 November; Harrogate, UK. 1998:24.
Cullum 2001 {published data only}
  • Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technology Assessment 2001; Vol. 5, issue 9:1-221.
Day 1990 {published data only}
  • Day AL, Leonard FE, Racz TM. Developing a research approach for the treatment of pressure ulcers. Ostomy/Wound Management 1990 Nov-Dec;31:30-6.
Day 1993 {published data only (unpublished sought but not used)}
  • Day A, Leonard F. Seeking quality care for participants with pressure ulcers. Decubitus 1993;6(1):32-43.
De Keyser 1994 {published data only}
  • De Keyser G, Dejaeger E, DeMeyst H, Eders GC. Pressure-reducing effects of heel protectors. Advanced Wound Care 1994;7(4):30-2, 34.
Devine 1995a {published data only (unpublished sought but not used)}
  • Devine B. Alternating pressure air mattresses in the management of established pressure sores. Journal of Tissue Viability 1995;5(3):94-8.
Devine 1995b {published data only}
  • Devine BL. Alternating pressure air mattresses in the management of established pressure sores. Proceedings of the 5th European Conference on Advances in Wound Management: Harrogate, UK, November 21-24. 1995:19-20.
Ernst 2009 {published data only}
  • Ernst AA. Review: little evidence exists for type of dressing or support surface or for nutritional supplements for pressure ulcers. ACP Journal Club 2009; Vol. 151, issue 1.
Evans 2000 {published data only (unpublished sought but not used)}
  • Evans D, Land L, Geary A. A clinical evaluation of the Nimbus 3 alternating pressure mattress replacement system. Journal of Wound Care 2000;9(4):181-6.
Ewing 1964 {published data only}
  • Ewing MR, Garrow C, Pressley TA, Ashley C, Kinsella NM. Further experiences in the use of sheepskins as an aid to nursing. Medical Journal of Australia 1964;2:139-41.
Ferrell 1993 {published data only}
  • Ferrell B, Keeler E, Siu A, Ahn S, Osterweil D. Cost-effectivness of low-air-loss beds for treatment of pressure ulcers. Journal of Gerontology 1995;50A(3):M141-6.
  • Ferrell BA, Osterweil D, Christenson P. A randomised trial of low air loss beds for treatment of pressure ulcers. JAMA 1993;269(4):494-7.
Fleischer 1997 {published data only}
  • Fleischer I, Bryant D. Evaluating replacement mattresses. Nursing Management 1997;28(8):38-42.
Goldstone 1982 {published data only}
Gray 1998 {published data only (unpublished sought but not used)}
  • Gray D, Smith M. A randomized controlled trial of two pressure-reducing foam mattresses. European Wound Management Association Conference; 1998 November; Harrogate, UK. 1998:4.
Greer 1988 {published data only}
  • Greer DM, Morris J, Walsh NE, Glenn AM, Keppler J. Cost-effectiveness and efficacy of air-fluidized therapy in the treatment of pressure ulcers. Journal of Enterostomal Therapy 1988;15(6):247-51.
Groen 1999 {published data only}
  • Groen HW, Groenier KH, Schuling J. Comparative study of a foam mattress and a water mattress. Journal of Wound Care 1999;8(7):333-5.
Hardin 2000 {published data only}
  • Hardin JB, Cronin SN, Cahill K. Comparison of the effectiveness of two pressure-relieving surfaces: low-air-loss versus static fluid. Ostomy/Wound Management 2000;49(9):50-6.
Henn 2004 {published data only (unpublished sought but not used)}
  • Henn G, Russell L, Towns A, Taylor H. A Two-centre prospective study to determine the utility of a dynamic mattress and mattress overlay. 2nd World Union of Wound Healing Societies Meeting; 2004 July 8-13; Paris, France. 2004:54.
Johnson 1991 {published data only (unpublished sought but not used)}
  • Johnson G, Daily C, Francisus V. A clinical study of hospital replacement mattresses. Journal of ET Nursing 1991;18(5):153-7.
Knight 1999 {published data only (unpublished sought but not used)}
  • Knight M, Simpson J, Fear-Price M. An evaluation of pressure-reducing overlay mattresses in the community situation. 9th European Conference on Advances in Wound Management; November 9-11; Harrogate, UK. 1999:25.
Knowles 1999 {published data only}
  • Knowles C, Horsey I. Clinical evaluation of an electronic pressure-relieving mattress. British Journal of Nursing 1999;8(20):1392-5.
Land 2000 {published data only (unpublished sought but not used)}
  • Land L, Evans D, Geary A, Taylor C. A clinical evaluation of an alternating-pressure mattress replacement system in hospital and residential care settings. Journal of Tissue Viability 2000;10(1):6-11.
Laurent 1997 {published data only}
  • Laurent S. Effectiveness of pressure decreasing mattresses in cardiovascular surgery participants: a controlled clinical trial. 3rd European Conference for Nurse Managers; 1997 Oct; Brussels, Belgium. 1997.
Lazzara 1991 {published data only}
  • Lazzara DJ, Buschmann MT. Prevention of pressure ulcers in elderly nursing home residents: are special support surfaces the answer?. Decubitus 1991;4(4):42-6.
Marchand 1993 {published data only}
  • Marchand AC, Lidowski H. Reassessment of the use of genuine sheepskin for pressure ulcer prevention and treatment. Decubitus 1993;6(1):44-7.
Melland 1998 {published data only}
  • Melland HI, Langemo D, Hanson D, Olson B, Hunter S. Clinical trial of the Freedom bed. Prairie Rose 1998;67(2):11a-12a.
Moody 1993 {published data only (unpublished sought but not used)}
  • Moody M. The role of a pressure relief dressing in the prevention and treatment of pressure sores. 3rd European Conference on Advances in Wound Management; October 19-22, 1993; Harrogate, UK. 1994:174.
Mulder 1994 {published data only}
  • Mulder GD, Taro N, Seeley J, Andrews K. A study of pressure ulcer response to low air loss beds vs. conventional treatment. Journal of Geriatric Dermatology 1994;2(3):87-91.
Munro 1989 {published data only (unpublished sought but not used)}
  • Munro BH, Brown L, Heitman BB. Pressure ulcers: one bed or another?. Geriatric Nursing 1989;10(4):190-2.
Osterbrink 2005 {published data only (unpublished sought but not used)}
  • Osterbrink J, Mayer H, Schroder G. Clinical evaluation of the effectiveness of a multimodal static pressure relieving device. European Wound Management Association Conference; 2005, 15-17 September; Stuttgart, Germany. 2005; Vol. Thur 14:00-15:30; V26-6:73.
Phillips 2000 {published data only (unpublished sought but not used)}
  • Phillips L. Cost-effective strategy for managing pressure ulcers in critical care: a prospective, non-randomised, cohort study. Journal of Tissue Viability 2000;10(Suppl 3):2-6.
Price 1999 {published data only}
  • Price P, Bale S, Newcombe R, Harding K. Challenging the pressure sore paradigm. Journal of Wound Care 1999;8(4):187-90.
Regan 2009 {published data only}
  • Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JL. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Archives of Physical Medicine and Rehabilitation  2009;90(2):213-31.
Russell 1998 {published data only (unpublished sought but not used)}
  • Russell L. Randomized comparative clinical trial of the Pegasus Cairwave mattress and Proactive seating cushion and the Huntleigh Nimbus III mattress and Alpha Transcell seating cushion. European Wound Management Association and Journal of Wound Care Autumn Conference; November 9-11; Harrogate, UK. 1998:4.
Russell 2000a {published data only}
  • Russell L, Reynolds T, Carr J, Evans A, Holmes M. A comparison of healing rates on two pressure-relieving systems. British Journal of Nursing 2000;9(22):2270-80.
  • Russell L, Reynolds T, Carr J, Evans A, Holmes M. Randomised controlled trial of two pressure-relieving systems. Journal of Wound Care 2000;9(2):52-5.
Russell 2003 {published data only (unpublished sought but not used)}
  • Russell L, Reynolds TM, Towns A, Worth W, Greenman A, Turner R. Product evaluation. Randomized comparison trial of the RIK and the Nimbus 3 mattresses. British Journal of Nursing 2003;12(4):256-9.
Scott 1995 {published data only}
  • Scott F. Easing the pressure for hip fracture participants. Nursing Times 1995;91(29):20-31.
Sharp 2007 {published data only (unpublished sought but not used)}
  • Sharp A. Pilot study to compare the incidence of pressure ulceration on two therapeutic support surfaces in elderly care. 17th Conference of the European Wound Managment Association; May 2-4, 2007; Glasgow, Scotland. 2007:Oral presentation 114, 73.
Smith 1995 {published data only}
  • Smith DM. Pressure ulcers in the nursing home. Annals of Internal Medicine 1995;123(6):433-42.
Soppi 2004 {published data only (unpublished sought but not used)}
  • Soppi E, Takala J. Novel carital speciality mattress in the management of pressure sores. 2nd World Union of Wound Healing Societies Meeting:Paris, France, July 8-13. 2004:X023.
Strauss 1991 {published data only}
  • Strauss MJ, Gong J, Gary BD, Kalsbeek WD, Spear S. The cost of home air-fluidized therapy for pressure sores: a randomized controlled trial. Journal of Family Practice 1991;33(1):52-9.
Taylor 1999 {published data only}
  • Taylor L. Evaluating the Pegasus Trinova: a data hierarchy approach. British Journal of Nursing 1999;8(12):771-4, 776-8.
Tewes 1993 {published data only}
  • Tewes M. Prevention and treatment of pressure sores - a neglected research subject. An overview of clinically controlled studies in the period 1987-91. Vård i Norden 1993;13(2):4-7.
Thomas 2001a {published data only}
  • Thomas D. Prevention and management of pressure ulcers. Reviews in Clinical Gerontology 2001;11:115-30.
Thomas 2001b {published data only}
  • Thomas DR. Prevention and treatment of pressure ulcers: what works? what doesn't?. Cleveland Clinic Journal of Medicine 2001;68:704-7, 710-4, 717-2.
Thomas 2006 {published data only}
Thomas 2007 {published data only}
  • Thomas DR. The prevention and management of pressure ulcers. Reviews in Clinical Gerontology  2007;17(4):241-57.
Whittingham 1999 {published data only}
  • Whittingham K. Randomized control trial of six pressure-redistributing foam mattresses. Journal of Tissue Viability 1999;9:104.
Yang 2007 {published data only}
  • Yang R, Feng L, Chen D-Z. Clinical evidence on nursing care for participants with pressure sore. Chinese Journal of Evidence-Based Medicine 2007;7(9):694-6.
Young 1992 {published data only}
  • Young JB, Dobrzanski S. Pressure sores: epidemiology and current management concepts. Drugs and Aging 1992;2(1):42-57.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Allman 1997
Briggs 2003
  • Briggs M. The prevalence, characteristics and treatment of pain in chronic venous leg ulcers. PhD Thesis, University of Leeds 2003.
Ciocon 1993
Clark 1994
Dealey 1991
  • Dealey C. Are your participants sitting comfortably?. Journal of Tissue Viability 1991;1(2):36-9.
Dealey 1991a
Essex 2009
Gray 1994
  • Gray DG, Campbell MK. Randomised clinical trial of two foam mattresses. Journal of Tissue Viability 1994;4(4):128-32.
Higgins 2003
Higgins 2011
  • Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (Editors). Chapter 8. Assessing risk of bias in included studies. In: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org..
Kaltenthaler 2001
  • Kaltenthaler E, Whitfield MD, Walter SJ, Akehurst RL, Paisley S. UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare?. Journal of Wound Care 2001;10(1):530-5.
Kannell 1973
Kosiak 1959
  • Kosiak M. Etiology and pathology of ischemic ulcers. Archives of Physical Medicine and Rehabilitation 1959;40(2):62-9.
Langer 2003
  • Langer G, Schloemer G, Knerr A, Kuss O, Behrens J. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003216]
Lefebvre 2011
  • Lefebvre C, Manheimer E, Glanville J, on behalf of the Cochrane Information Retrieval Methods Group. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
McInnes 2011
  • McInnes E, Cullum NA, Bell-Syer SEM, Dumville JC, Jammali-Blasi A. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews 2011, Issue 4. [DOI: 10.1002/14651858.CD001735.pub4]
McNeeley 1995
  • McNeeley MJ, Boyko EJ, Ahroni JH, Stensel VL, Reiber GE, Smith DG, et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks?. Diabetes Care 1995;18(2):216-9.
Neale 1981
  • Lorimer DL, French G, O'Donnell M, Burman JG (editors). Neale's disorders of the foot: diagnosis and management. Churchill Livingston, 1981.
Nixon 2005
Raney 1989
  • Raney JP. A comparison of the prevalence of pressure sores in hospitalised ALS and MS participants. Decubitus 1989;2(2):4-51.
RCN 2005
  • RCN. The Management of Pressure Ulcers in Primary & Secondary Care: A Clinical Practice Guideline. http://www.rcn.org.uk/__data/assets/pdf_file/0017/65015/management_pressure_ulcers.pdf 2005.
Reswick 1976
  • Reswick JB, Rogers J. Experiences at Ranchos Los Amigos hospital with devices and techniques to prevent pressure ulcers. In: Kenedi RM, Cowden JM, Scales JT editor(s). Bedsore biomechanics. London: Macmillan Press, 1976:301-13.
Ryan 1969
  • Ryan TJ. The epidermis and its blood supply in venous disorders of the leg. Transcriptions of the St John's Hospital Dermatological Society 1969; Vol. 55:51-7.
SIGN 2010
  • Scottish Intercollegiate Guidelines Network (SIGN). Search filters. http://www.sign.ac.uk/methodology/filters.html#random (accessed 27 September 2010).
Spencer 2000
  • Spencer S. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. [DOI: 10.1002/14651858.CD002302]
Thoolen 2000
  • Thoolen M, Ryan TJ, Bristow I. A study of the skin of the sole of the foot using high-frequency ultrasonography and histology. The Foot 2000;10:14-7.
Tortora 1996
  • Tortora GJ, Grabowski SR. Principles of Anatomy and Physiology. 8th Edition. USA: Harper Collins, 1996.
Valk 2010
Vogt 1992