The effectiveness of lying surfaces in nursing care beds, a comparison of spring element systems versus conventional systems: A post marketing clinical follow-up pilot study

Background : Reduced mobility is a strong risk factor for pressure ulcer development in a nursing home setting Despite this, there is a surprising lack of data regarding suitable nursing care beds in general and the prevention of pressure ulcers provided by lying surface systems in particular. In this context we aimed to assess the mobility of patients using lying surface systems either with spring elements (SES) and to compare these to conventional systems (CS); wooden slats or steel bars). Methods: This was a prospective, randomized, controlled study in 29 patients with an age range of 54-95 years. Patients were randomly assigned to SES (n = 15) or CS (n = 14). The primary objective was to show a statis tically significant difference in the proportion of patients with normal (up to 4 movements per hour) movements as evaluated by the Mobility Monitor*. Pressure distribution of the lying body weight was measured by a full body pressure mapping system XSensor*. Comfort, possibility of movement and recovery of sleep as well as pain at rest were self rated. Results: We screened a total of 39 patients of which 29 were eligible to be randomized into the two groups and 27 were finally analysed (SES = 14; CS = 13). The mean age was 81.7 +/- 9.5 years, 81.5% were female and the mean Braden Scale Score 22.4 +/- 1.3. We observed no statistically significant difference in the primary evaluation criterion (proportion of patients with a normal number of movements across 14 nights) between the SES group (81.4 +/- 10.8%) and the CS group (72.9 +/- 16.3%, p = 0.0757). There was a consistent trend for more movements in the normal range in the SES group however, which was observed when the number of hours with normal movement was plotted per night (p = 0. 0004). Measured pressure values showed overall higher values for the lateral compared to the dorsal position with the SES but not the CS forming a "shoulder" between 35-55 mmHg in the dorsal position and between 35-45 mmHg in the lateral position. Self-rated comfort was sig nficantly higher with the SES after night 14 (p = 0.0192) than with CS. Conclusions: The study is not aimed at the hard endpoint pressure ulcer, but at the physiological movement profile of patients in bed, which justifies a much smaller number of cases. For elderly nursing home patients it appears that beds with spring elements may be associated with higher normality of body movements and higher self rated comfort. The presented study could be a contribution to reduce the care dependency of patients regarding mobility.