How Are Support Surfaces Used in Pressure Ulcer Care Within Nursing Home Settings Assessed? A Scoping Review

Jérémy Enez; Marielle André; Romain Pichon; Dominique Somme; Karim Jamal

doi:10.1111/iwj.71044

. 2026 Sep 26;23(10):e71044. doi: 10.1111/iwj.71044

How Are Support Surfaces Used in Pressure Ulcer Care Within Nursing Home Settings Assessed? A Scoping Review

Jérémy Enez ^1,^2,^3,^✉, Marielle André ^3,⁴, Romain Pichon ^1,⁵, Dominique Somme ^1,³, Karim Jamal ^5,⁶

PMCID: PMC13615408 PMID: 42798267

ABSTRACT

The aim of this research was to synthesise evaluative research on support surfaces in pressure ulcer care in nursing homes, by examining how studies address effectiveness, efficiency, user satisfaction and context of use. Following the Joanna Briggs Institute methodology and PRISMA‐ScR guidelines, six databases were used. Studies assessing support surfaces in nursing homes were included. Data extraction covered studies' characteristics, support surfaces evaluated and methodologies employed. Among the 68 included studies, 40 focused primarily on support surface evaluation, mainly assessing effectiveness or efficiency (n = 31, 78%) rather than context of use (n = 5, 12%) or user satisfaction (n = 4, 10%). Residents' perspectives were captured in 42.5% (n = 17) of studies and quality of life in 25% (n = 10), with one qualitative study identified. Mattresses predominated among the 188 support surfaces evaluated (47%, n = 88). Studies were concentrated among seven research teams (49%, n = 33), and industry funding was the most common source overall (37%, n = 25). Current research prioritises effectiveness and efficiency assessment over holistic usability assessment. The limited incorporation of residents' and professionals' experiences and quality of life outcomes reveals a gap between biomedical approaches and person‐centred perspectives. Future research should place residents' and professionals' experiences at the centre of support surface evaluation to generate clinically relevant and ethically grounded evidence.

Keywords: assessment, medical device, nursing home, pressure ulcer, support surface, usability

Key Points

This scoping review synthesizes the evaluative literature on support surfaces used in nursing homes for pressure ulcer prevention and management.
Effectiveness and efficiency dominate current evaluations (78% of studies), while context of use (12%) and user satisfaction (10%) remain markedly underrepresented; only a single qualitative study was identified.
Resident and professional perspectives are insufficiently captured: only 42.5% of studies incorporated residents' viewpoints and 25% addressed quality‐of‐life outcomes.
These findings highlight a persistent gap between biomedical and person‐centered approaches to support surface evaluation, underscoring the need for future research to prioritize resident and professional experience to generate clinically relevant, ethically grounded evidence.

1. Introduction

Pressure ulcers are defined as localised damage to the skin and/or underlying tissue which typically occurs over bony prominences or following prolonged contact with an external surface [1]. They occur during daily activities and have significant consequences for patients' quality of life [2, 3]. Their prevalence remains high and has been estimated at 11.6% in nursing homes (NHs) [4]. The risk of pressure ulcers increases with exposure to immobilisation, pressure and shear forces. Previous studies have emphasised the importance of prevention by supporting older adults in mobilising independently and, where this is not possible, by supporting mobilisation by carers together with the appropriate use of medical devices to prevent pressure ulcers [5, 6, 7, 8, 9, 10, 11]. Support surfaces (healthcare beds, seat and positioning cushions, sheepskins, overlays or mattresses) are one of the most commonly used medical devices in the prevention of pressure ulcers [12, 13]. However, the possibilities and benefits for implementing support surfaces in pressure ulcer care vary depending on patients' individual characteristics and the environment in which it is used [12, 13, 14, 15, 16]. Thus, the context of use determines the effectiveness of the devices and, by extension, their usability. Indeed, usability is defined as the device's ability to achieve specified goals with effectiveness, efficiency and user satisfaction in a specific context of use [17].

To better understand the use of support surfaces for pressure ulcer prevention in NH, the contributions of studies on the context of use, effectiveness and usability appear to be complementary [18, 19, 20]. Accordingly, several studies have been conducted to clarify the conditions in which support surfaces are or should be used in the pressure ulcer care field [21, 22, 23, 24, 25, 26]. Systematic reviews have already been conducted to summarise research on the effectiveness of support surfaces [12, 13]. Moreover, other literature reviews have examined in detail the context of pressure ulcer care without focusing primarily on the usability of support surfaces in NH [27, 28, 29]. To the best of our knowledge, no review has focused on describing the evaluation approach used in research on the usability of support surfaces used for pressure ulcer care in NH.

The aim of this scoping review was therefore to map and describe how support surfaces used for pressure ulcer care in NHs have been evaluated in the scientific literature, with particular attention to the usability components addressed, the methodologies employed and the outcomes assessed.

2. Materials and Methods

This scoping review followed the recommendations of the Joanna Briggs Institute (JBI) [30, 31] and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) [32]. All this information is provided in Supporting Information I. The protocol was registered before the screening process on the Open Science Framework (OSF), https://doi.org/10.17605/OSF.IO/FHWDC.

2.1. Inclusion Criteria

The eligibility criteria were developed according to the Participants–Concept–Context (PCC) framework [30].

2.1.1. Participants

People with a risk of pressure ulcer and who live in NH were included. People under the age of 60 may sometimes be admitted to NH [33]. The inclusion criterion of being at least 60 years of age was retained in order to improve comparability across studies.

2.1.2. Concept

This review explored how support surfaces are assessed in scientific research conducted in NHs. Rather than evaluating the effectiveness of support surfaces themselves, the review examined the objectives, methodologies and outcomes used by researchers to assess these devices. This overarching concept was selected to provide a comprehensive and deductive framework for analysing how different components of usability, namely the context of use, effectiveness and efficiency and user satisfaction and acceptance, have been addressed in the literature.

2.1.3. Context

The context of this scoping review referred to the care setting in which support surfaces were used. The review therefore focused on studies conducted in NHs involving the use of support surfaces (including mattresses, cushions and beds) for pressure ulcer prevention and management.

2.2. Types of Evidence Sources

Qualitative and quantitative studies were included, including: prospective and retrospective studies, cohort studies, observational studies or interventional studies (like randomised controlled trials, non‐randomised trials, before‐and‐after studies). Studies published in English and French were eligible for inclusion, as the research team did not have the linguistic competence required to assess publications in other languages. No date restrictions were applied.

2.3. Data Collection Procedures

2.3.1. Search Strategy

The search strategy followed the JBI three‐step methodology:

Step 1: An initial search of PubMed and Web of Science was conducted. This search was conducted using keywords such as ‘pressure ulcer’, ‘Nursing Homes’, ‘support surface’ and ‘assessment’. Keywords, main words in titles and abstracts were used for the search strategy.
Step 2: The full‐search strategy was conducted on 11 January 2025 on six databases: Medline, Google Scholar, Web of Science, CINAHL, Cochrane Library and Science Direct [34] (see Supporting Information II). The search strategy was adapted as necessary for each database. For Google Scholar database, the first 200 results were included [35].
Step 3: The reference lists of all articles included were checked for additional sources.

2.3.2. Source of Evidence Selection

Selection stages were carried out using the Rayyan‐Intelligent Systematic Review web‐tool (https://www.rayyan.ai/). Two members of the review team (J.E., M.A.), an occupational therapist specialising in medical device for pressure‐ulcer care (J.E.) and an occupational therapist expert in older adult care (M.A.), independently reviewed the title, abstracts and keywords of the articles identified. Articles whose titles and abstracts did not allow the research team to make a clear decision were included in the full‐text stage. The two team members (J.E., M.A.) then independently reviewed the full texts. In case of disagreement, a reasoned discussion took place between the two reviewers to reach a consensus and a third team member (K.J.) was consulted if the discussion did not lead to a decision. Reasons for study exclusion were recorded and presented in the final review.

2.4. Data Extraction

All data were extracted from the selected documents using a standardised form (see Supporting Information III) independently by two authors (J.E., K.J.). This tool was independently tested by 2 reviewers (J.E., K.J.) on 25 randomly selected sources. The data extraction form was refined to improve efficiency and avoid interpretation and comprehension bias between reviewers. Finally, four groups of data were extracted from the studies: (1) Characteristics of studies included, (2) Characteristics of NH and participants, (3) Characteristics of support surfaces assessed, (4) Characteristics of methodologies used to assess support surfaces.

The data concerning the characteristics of the studies addressed: Data concerning the year of publication and the country where the study took place were extracted. The authors, their number of publications included and the connections between them were also identified. The funding and conflict of interest (COI) were described.

Concerning the characteristics of NH and participants: A description of the number of NH included, the participants and their characteristics (age, gender, medical condition and occupations) was also provided.

For data concerning the characteristics of support surfaces: All of the support surfaces evaluated were described and classified according to McInnes' classification [13]: This author identified three main categories of support surfaces, ‘low‐tech’ support surfaces (such as foam mattresses, static air overlay, sheepskin, etc.), ‘high‐tech’ support surfaces (such as alternating‐pressure mattresses, low‐air‐loss beds, etc.) and ‘other support surfaces’ (wheelchair cushions, limb protectors, turning beds/frames, etc.).

Data concerning methodologies used (the design, the objectives and the outcomes of the studies) were described. The description of the studies' objectives and methodologies enabled a two‐stage classification process. First, studies were classified according to the role of support surface assessment within the study, distinguishing those in which support surface assessment constituted the primary objective from those in which it was addressed as a secondary explanatory variable. Second, all included studies were deductively categorised according to the principal usability component addressed in relation to support surfaces: (1) assessment of the context of use, (2) assessment of effectiveness or efficiency or (3) assessment of user satisfaction and acceptance. For studies in which support surface assessment was a secondary objective, the categorisation was based on the usability component addressed through the support surface‐related outcomes or analyses. Studies that took into account the opinions of residents and/or healthcare professionals regarding their quality of life and comfort were also highlighted.

2.5. Analysis of the Data

Descriptive analysis of included studies using median or median of mean reported and IQR were identified for the year of publication, the NH included and characteristics of participants. Percentages were calculated for the year of publication, country origin, funding, COI, NH included and characteristics of participants, type of medical device, objectives, methodology and outcomes. A narrative synthesis of the methodologies from the included studies was provided. The analysis was carried out independently by two authors (J.E. and K.J.). Claude AI Sonnet 4.6 was used solely to assist with language refinement during manuscript preparation (https://claude.ai/new). The figures were created using the Flourish application (https://flourish.studio/) and Canva Pro+ (https://www.canva.com/).

3. Results

3.1. Study Inclusion

Out of the 975 initial records identified, 68 studies were included in this scoping review. A total of 188 duplicate records were removed; 621 articles were excluded at the title/abstract screening and then 95 articles at the full‐text assessment. All information about the identification and study selection is represented in the flow diagram (Figure 1 and Supporting Informations IV and V). The eligibility of 38 articles (5%) was discussed by J.E. and M.A. at the title and abstract screening stage, while 8 articles (5%) were discussed by the same reviewers at the full article stage. No articles required the opinion of the third member of the team.

3.2. Characteristics of Studies

3.2.1. Publication Characteristics

The median year of publication was 2016, while 2019 saw the highest number of publications (n = 8) [36, 37, 38, 39, 40, 41, 42, 43]. Half of the studies were conducted in Europe (notably in Belgium n = 10 [36, 37, 44, 45, 46, 47, 48, 49, 50, 51], United Kingdom n = 9 [39, 52, 53, 54, 55, 56, 57, 58, 59], Netherlands n = 6 [60, 61, 62, 63, 64, 65] and France n = 4 [66, 67, 68, 69]), while 29% of the studies took place in the United States (n = 20) [40, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88]. Of the 68 articles included, 217 individual authors were identified (Supporting Information IV) and 49% (n = 33) of the studies originated from seven research teams. A representation of the main authors and their collaborative links is presented in Figure 2.

Main authors and their collaboration in studies included.

3.2.2. Funding and Conflict of Interest

Details regarding funding and conflicts of interest (COI) are presented in Table 1 and Supporting Information VI. Twenty‐five studies (37%) were funded exclusively by industry, 3 (4%) by industry and grants [72, 78, 86], 19 (28%) by grants and 7 (10%) did not report external funding. Information regarding the funding of research was unclear for the remaining 14 studies (21%). The company that funded the most research was Frontier Medical Group (South Wales, UK) (n = 4, 6%) [36, 37, 49, 89]. The other COIs identified were related to training provided by industrial companies during research on how to use support surface [54], the presence of authors on scientific committees of industrial companies [67, 75] or being a co‐owner of a website [74]. One study did not specify the funding arrangements or potential COI, but provided the contact details of a company supplying the evaluated support [56].

TABLE 1.

Funding and conflict of interest of studies included.

	Funding by industry	Funding by industry and grant	Funding by grants	No funding	Unclear or no details about funding	Total
Without other COI than funding	17 [36, 48, 49, 50, 51, 52, 53, 55, 59, 64, 66, 68, 69, 73, 84, 89, 90]	1 [78]	11 [61, 62, 76, 79, 88, 91, 92, 93, 94, 95, 96]	7 [43, 44, 63, 65, 82, 97, 98]	3 [46, 99, 100]	39
With other details about COI or potential COI than funding	2 [54, 67]	0	2 [74, 75]	0	1 [56]	5
Without other details about COI	6 [37, 38, 40, 58, 80, 101]	2 [72, 86]	6 [39, 42, 70, 71, 77, 87]	0	10 [41, 45, 47, 57, 60, 81, 83, 85, 102, 103]	24
Total	25	3	19	7	14	68

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3.2.3. Characteristics of NH and Participants

The median number of NH included in these studies was 3 (IQR: 1–12). The participants were residents in 63 studies (93%) and/or healthcare professionals in 8 studies (12%) [39, 44, 46, 47, 77, 89, 93, 94]. The median number of healthcare professionals (mostly nurses) included was 25.5 (IQR: 22.8–42.5). The median number of residents included in all studies was 80 (IQR: 13–308). The median reported mean age was 84 years and more than 75% of residents were women. Sixty‐two percent of the participants had dementia, a minimum of 49% had functional limitations, 85% experienced urinary and/or faecal incontinence, 70% had poor dietary intake. Eight articles conducted prevalence surveys of pressure ulcers in NH and showed varying results from under 5%–48% (Figure 3). The characteristics of this population are described in Supporting Information VII.

Prevalence of PU in nursing homes according to studies included.

3.2.4. Support Surfaces Identified Across the Included Studies

A total of 188 medical devices were mentioned in all studies, and three major types of support surfaces were identified: mattresses (47%, n = 88), seat cushions (21%, n = 39) and positioning equipment (18%, n = 33). Models and categorisations regarding the types of medical devices studied are available in Figures 4 and 5 (for details see Supporting Information VIII). The model of the support surfaces evaluated was specified in 38 studies (56%) [36, 37, 38, 45, 47, 48, 49, 50, 51, 52, 53, 55, 56, 57, 58, 59, 61, 62, 63, 64, 65, 66, 67, 68, 69, 72, 75, 76, 78, 80, 82, 83, 84, 89, 90, 94, 97, 102] and 68 different models of support surfaces were identified. In this case, devices from Frontier Medical Group (South Wales, UK) were the most commonly evaluated (n = 14) in 6 studies [36, 37, 45, 49, 50, 89] and only one support surface evaluated used artificial intelligence [97]. In our review, ‘low‐tech’ support surfaces represented 30% (n = 57), ‘high‐tech’ support surfaces 21% (n = 40) and ‘other support surfaces’ 48% (n = 91).

Distribution of support surfaces assessed by type according to studies include.

Classification of the 188 support surfaces identified across the included studies according to McInnes' taxonomy.

3.3. Characteristics of Evaluative Research Used for Support Surfaces

Full details of objectives, study design and outcomes of all included studies are provided in Supporting Information IX. Among the 68 included studies, 40 (59%) had the primary objective of evaluating support surfaces, whereas the remaining 28 studies (41%) considered support surfaces as secondary explanatory variables. Regardless of the role of support surface evaluation within each study, all 68 studies were deductively categorised according to the principal usability component addressed in relation to support surfaces. Consequently, studies in which support surfaces were considered as secondary explanatory variables (n = 28) also contributed evidence relating to the context of use, effectiveness or efficiency and user satisfaction or acceptance. These 28 studies primarily aimed, notably, to identify the prevalence of pressure ulcers (n = 6, 21%), clinical practices and knowledge (n = 7, 25%), as well as effectiveness or cost‐effectiveness assessments of other pressure ulcer interventions (n = 11, 39%). This information is summarised in Table 2.

TABLE 2.

Categories of main objectives.

Categories for main objectives

Context of use assessment of support surfaces

Effectiveness and efficiency assessments of support surfaces

Satisfaction and acceptance assessments of support sur faces

Total

Studies with principal focus on pressure ulcer support surfaces

[47, 53, 71, 72, 97]

[37, 38, 45, 48, 50, 51, 52, 54, 55, 57, 58, 59, 61, 62, 63, 64, 65, 66, 67, 68, 69, 75, 76, 78, 80, 81, 82, 83, 84, 90, 102]

[49, 56, 89, 94]

[37, 38, 45, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 61, 62, 63, 64, 65, 66, 67, 68, 69, 71, 72, 75, 76, 78, 80, 81, 82, 83, 84, 89, 90, 94, 97, 102]

Studies with secondarily focus on pressure ulcer support surfaces

[36, 39, 41, 43, 44, 46, 60, 70, 73, 74, 77, 79, 85, 86, 88, 91, 92, 93, 95, 96, 98, 99, 100, 101, 103]

[40, 42, 87]

[36, 39, 40, 41, 42, 43, 44, 46, 60, 70, 73, 74, 77, 79, 85, 86, 87, 88, 91, 92, 93, 95, 96, 98, 99, 100, 101, 103]

Total

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However, because the aim of the following analyses was to examine the methodologies specifically used to evaluate support surfaces, the next sections focus exclusively on the 40 studies in which support surface evaluation constituted the primary objective.

3.3.1. Support Surfaces Assessments

The 40 studies whose primary objective was the evaluation of medical devices for pressure ulcer care were deductively categorised according to the principal usability component addressed (Table 2):

Studies addressing the context of use of support surfaces (n = 5, 12%),
Studies addressing the effectiveness and/or efficiency of support surfaces (n = 31, 78%),
Studies addressing user satisfaction or support surfaces acceptance (n = 4, 10%).

3.3.1.1. Context of Use Assessments of Support Surfaces

The five studies included in the ‘Context of use’ group were predominantly observational (including three case studies and cohort studies) [47, 71, 97]. The five studies aimed to improve the use of support surfaces during daily care by describing the use of devices or specifying whether their use was appropriate for an identified population. These studies mainly used observations (n = 4) [53, 71, 72, 97] and medical or sociodemographic data (n = 3) [47, 71, 97] to achieve their objectives.

3.3.1.2. Effectiveness and Efficiency Assessments of Support Surfaces

RCTs (n = 9, 29%) [37, 62, 63, 64, 65, 75, 76, 82, 90] and other interventional studies, including non‐randomised or uncontrolled studies (n = 7, 23%) [52, 55, 57, 59, 80, 83, 102], were the most frequently employed to evaluate device effectiveness. The main variable observed was the incidence of pressure ulcers (n = 19, 61%) [37, 45, 48, 50, 51, 52, 57, 59, 62, 63, 64, 66, 67, 68, 69, 75, 76, 80, 84] or their evolution (n = 6, 19%) [54, 55, 58, 81, 82, 102]. Researchers assessed this evolution through skin assessment performed by healthcare professionals or skin care experts during daily care (n = 26, 84%) [37, 38, 45, 48, 50, 51, 52, 54, 55, 57, 58, 59, 62, 63, 64, 65, 66, 67, 68, 69, 75, 76, 82, 83, 84, 102] sometimes supplemented by a questionnaire (n = 10, 32%) [48, 51, 55, 59, 62, 66, 67, 68, 69, 80] or sensing mattresses (n = 5, 16%) [55, 76, 82, 83, 90] and photos (n = 3, 10%) [54, 57, 58]. The two cost‐effectiveness studies focused on the use of support surface addressed the use of sheepskins or low‐air‐loss beds compared to conventional foam mattresses [61, 78].

3.3.1.3. Satisfaction and Acceptance Assessments of Support Surfaces

Interviews and questionnaires are the most commonly used methods for assessing satisfaction and acceptance. Only one qualitative study was identified in this scoping review which aimed to explore the meaning of NH residents' perspectives about the implementation of a new non‐powered static air mattress overlay [49]. The concept of usability was rarely defined and mentioned in the included articles. Nils Lahmann's research is the one that most closely examines usability through the lens of ‘user acceptance’ [89].

3.3.2. Patients' Perspectives

Across the 40 studies whose primary objective was the evaluation of medical devices for pressure ulcer care, 75% of studies collected data on changes in skin condition and patients' perspectives were gathered in 17 studies (42.5%) [48, 49, 51, 52, 53, 56, 57, 58, 59, 62, 66, 67, 68, 69, 83, 90, 102]. One research group participated in four included studies that systematically collected user feedback using a Likert scale [66, 67, 68, 69]. Two other studies also used surveys [48, 51], while interviews with residents were used in two studies [49, 83]. Details can be found in Supporting Information X.

3.3.3. Focus on Comfort and Quality of Life

Ten studies collected data concerning the influence of medical devices on the quality of life or comfort of the residents (25%) [48, 49, 51, 62, 66, 67, 68, 69, 83, 102]. Researchers collected data through direct questioning of residents (n = 10) [48, 49, 51, 62, 66, 67, 68, 69, 83, 102], most commonly using Likert scales for data collection purposes (n = 4) [66, 67, 68, 69].

4. Discussion

4.1. Characteristics of Approaches to Support Surface Assessment

This scoping review aimed to map the research methodologies used to assess support surfaces in pressure ulcer care within NH settings. A total of 68 studies were included and most of them originated from Europe and the United States (79%). The marked concentration of publications among only seven research teams (representative 49% of studies, n = 33) introduces a tangible risk of bias [104]. The small number of teams involved could reflect a broader underinvestment in NH research, disproportionate to the public health burden of caring for older adults [105, 106]. At the same time, the large diversity of support surfaces identified (n = 188) illustrates the heterogeneity of the devices evaluated across studies. Studies whose primary objective was to evaluate support surfaces (n = 40, 59%) mainly assessed two components of usability, known as effectiveness and efficiency (n = 31, 78%), whereas comparatively few examined the context of use (n = 5, 12%) or user satisfaction and acceptance (n = 4, 10%). These trends were not only found in our research; another review highlighted that the frequency of pressure ulcers (71%) was assessed more often than the acceptance of preventive measures (18%) in pressure ulcer care studies [21].

4.2. Effectiveness and Efficiency: A Predominant but Insufficient Focus

Our findings indicate that the effectiveness or efficiency of the support surfaces studied was mainly assessed in terms of pressure prevention and healing (n = 25, 81%). The evaluation of the effectiveness and efficiency of support surfaces on skin conditions is necessary in order to promote quality of care and prevent the misuse of medical devices [107]. However, assessing changes in skin condition is not sufficient to identify areas of interest for these support surfaces [10]. Indeed, the superior medical effectiveness of a treatment does not guarantee that it is the most appropriate option [41]. Moreover, our findings also identified two major risks of bias for the effectiveness and efficiency assessment. First, funding sources and COI constitute a pervasive risk of bias. The most common source of funding came from industry (n = 28, 41%); whereas the most evaluated device brand was also among the principal research funders in this field. Industry‐funded research has been consistently associated with an increased risk of bias [108] and COI may also arise in other forms, such as an article providing the contact details for a device supplier without declaring a COI [56]. These findings underscore the critical importance of full and transparent disclosure of all potential COIs to preserve the integrity of evidence and its safe translation into clinical practice [109, 110, 111, 112]. Second, the populations studied were generally modest in size: studies evaluating support surfaces reported a median of three NHs (IQR: 1–12) and 80 residents (IQR: 13–308) per study. The multifactorial nature of pressure ulcer development and substantial interindividual variability compound these limitations, underscoring the need for larger, more representative samples in future research.

4.3. Context of Use: An Underexplored Dimension

Although only five studies explicitly focused on evaluating the context of use, this element was indirectly addressed in all studies investigating support surface devices. Nonetheless, limited or imprecise reporting of contextual or methodological aspects may restrict the applicability of research findings in practice. In the present review, the type of mattress was not specified in 33 instances across the included studies, despite the fact that precise device descriptions are essential to ensure research reproducibility and clearly describe the practices or the factors that influence the usability of devices [113]. Comparable attention should also be given to describing the characteristics of the population and care environment. For example, the wide variability in pressure ulcer prevalence across included studies (from under 5%–48%) reflects potential differences in NH populations, organisational structures and healthcare systems internationally, which may introduce comparative bias when assessing the context of use and usability of support surfaces [12, 114].

The five studies focusing on the context of use primarily described clinical practice or wished to clarify the context of use of support surfaces. Many other areas of the context of use remain unexplored. For example, the daily use of automated support surfaces or the more frequent use of AI‐enable support surfaces, identified in two articles included only, raises questions about the ethical and environmental issues related to the context of use of these devices [89, 97, 115, 116]. Therefore, further research is needed to clarify the context of use, recommendations and other algorithms for selecting support surfaces in light of environmental and ethical considerations [10, 115, 116, 117, 118].

4.4. Users' Satisfaction, Acceptance and Quality of Life Assessments: Residents' and Healthcare Workers' Perspectives

Only 17 studies (42.5%) whose primary objective was the evaluation of medical devices for pressure ulcer care incorporated patients' perspectives into their objectives or outcome measures. Moreover, only four of the studies included had user acceptance or satisfaction assessment for their primary objective. The fact that 62% of patients receiving pressure ulcers were living with dementia, according to our results, may explain why they are rarely questioned about their quality of life. Although scales for assessing the quality of life of residents receiving pressure ulcer care can be used in practice, none were identified in the included studies [119, 120, 121, 122]. The use of these assessment scales could also be supplemented by the opinions of professionals about residents' comfort gathered by 3 studies included in our research [43, 74, 76]. Indeed, qualitative approaches are highly relevant for assessing the user acceptance of the support surfaces during day‐to‐day use, but they remain underutilised in our findings and according to scientific literature [49, 123, 124].

Healthcare professionals constituted a second category of users and were included in 8 studies. These professionals were mainly nurses. While nurses play an essential role in the treatment of pressure ulcers, it would seem necessary to include a broader range of healthcare professionals. Indeed, although nurses are among the professionals most involved in the use of support surfaces, they are not necessarily the ones who prescribe or recommend them [10]. Thus, it will be possible to enrich the results and perspectives related to the daily use of support surfaces in NH during pressure ulcer care.

Conducting more research in the field of users' satisfaction, acceptance, and quality of life could significantly strengthen the process of evaluating support surfaces for the treatment of pressure ulcers in NH by encouraging feedback from those most concerned.

4.5. Clinical Implications for Rehabilitation Practice

The findings of this review carry direct implications for rehabilitation professionals working in NH settings. The predominance of biomedical outcome measures in the literature may contribute to a narrow conception of support surface assessment that insufficiently reflects the priorities of residents and rehabilitation teams [15, 125, 126, 127, 128, 129]. Occupational therapists, physiotherapists and other allied health professionals are well positioned to advocate for a broader, function‐oriented approach to device assessment that incorporates daily living activities, comfort and occupational participation [11, 130].

The application of conceptual models drawn from rehabilitation practice, such as frameworks prioritising occupational participation and person‐environment‐occupation, could offer valuable new perspectives for both research design and clinical decision‐making in order to focus on what really matters [131, 132]. Embedding such frameworks into future studies would help ensure that support surface evaluation aligns with the goals of residents and supports meaningful rehabilitation outcomes, rather than focusing exclusively on wound prevention metrics.

4.6. Strength and Limitations

This review was strengthened by the number of databases consulted, the participation of several independent reviewers in the selection and extraction process, and the use of PRISMA guidelines. The inclusion of research focusing only on assessments carried out in NH enabled the identification of assessments specific to a particular population and context of use but potentially limits the broader findings that could have been made on the assessment of support surfaces across all types of healthcare facilities. One limitation of this scoping review was related to the significant scope of the research area, leading to difficulties in comparing studies. The lack of a common definition of usability in the included studies made it difficult to categorise the studies according to their objectives. Moreover, the analysis was made difficult by the lack of precise information concerning the support surfaces used and assessed. The fact that the studies depended on a limited number of research teams also constituted a potential limitation in terms of methodological diversity. Finally, the frequent funding of research by industry also introduces potential bias in the non‐publication of studies with negative results, even though this type of research could be relevant in clarifying the usability of support surfaces [108, 133].

4.7. Perspectives

The information gathered suggests innovative avenues of research concerning the evaluation of medical devices intended for the treatment of pressure ulcers. Several key examples of research in these areas are developed in Table 3.

TABLE 3.

Key examples of research in the field of support surfaces assessment in pressure ulcer care in nursing homes.

	Objectives	Potential design
1	Determine the influences of the contexts of use on the usability and cost effectiveness of support surface used for pressure ulcer care in NH	Time motion studies with TDABC methodology in different NH [134]
2	Clarify the link between the use of surface supports and quality of life, as well as the occupational participation of NH residents	Single Case Experimental Design (SCED), which allows each participant to serve as their own control [135]
3	Describe users' acceptances and participation for the use of support surfaces in NH	Qualitative study with observation during daily life and interviews with NH residents and healthcare professionals
4	Clarify environmental consequences of the use of support surfaces in NH	Mixed method with prevalence survey about the use of MD and interviews with healthcare professional and industrial companies
5	Describe ethical considerations in the use of support surfaces in NH	Qualitative study with focus groups
6	Specify the potential benefits of a new reasoning heuristic for the use of support surfaces in NH and develop practice guidelines	Using focus groups (with healthcare professionals, experts of skin care and residents) in the first phase and a Delphi method on a second phase for developing practice guidelines

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5. Conclusion

This scoping review of 68 studies evaluating support surfaces in NH reveals a variety of methods used in research to assess the usability of support surfaces used in pressure ulcer care in NH. Mattresses were the most assessed type of medical device (47%) among the 188 support surfaces identified in the included research. The majority of the studies included focused on effectiveness assessment of support surfaces and do not provide holistic assessments of usability in real‐world settings. Indeed, 42.5% of studies questioned residents' perspectives and 25% addressed comfort or quality of life. These findings suggest that residents' perspectives remain underrepresented in research evaluating support surfaces. Evidence regarding the determinants of real‐world use and their person‐centred outcomes remain limited. To advance evidence‐based, person‐centred care, research must consider residents' experiences as a valuable source of evidence regarding device effectiveness and usability.

Funding

This research was funded by the IFPEK association, a School of Rehabilitation sciences for podiatry, physiotherapy and occupational therapy.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information I PRISMA ScR.

Supporting Information II: Different searches for each database.

Supporting Information III: Extraction table.

Supporting Information IV: Studies included.

Supporting Information V: Studies excluded at full text stage.

Supporting Information VI: Details about funding and COI.

Supporting Information VII: Participants characteristics according to studies included.

Supporting Information VIII: Supports surfaces according to studies included.

Supporting Information IX: Methods of studied included.

Supporting Information X: Details about patients' perspectives and focus on quality of life or comfort.

IWJ-23-e71044-s001.docx^{(146.4KB, docx)}

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting Information I PRISMA ScR.

Supporting Information II: Different searches for each database.

Supporting Information III: Extraction table.

Supporting Information IV: Studies included.

Supporting Information V: Studies excluded at full text stage.

Supporting Information VI: Details about funding and COI.

Supporting Information VII: Participants characteristics according to studies included.

Supporting Information VIII: Supports surfaces according to studies included.

Supporting Information IX: Methods of studied included.

Supporting Information X: Details about patients' perspectives and focus on quality of life or comfort.

IWJ-23-e71044-s001.docx^{(146.4KB, docx)}

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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PERMALINK

How Are Support Surfaces Used in Pressure Ulcer Care Within Nursing Home Settings Assessed? A Scoping Review

Jérémy Enez

Marielle André

Romain Pichon

Dominique Somme

Karim Jamal

ABSTRACT

Key Points

1. Introduction

2. Materials and Methods

2.1. Inclusion Criteria

2.1.1. Participants

2.1.2. Concept

2.1.3. Context

2.2. Types of Evidence Sources

2.3. Data Collection Procedures

2.3.1. Search Strategy

2.3.2. Source of Evidence Selection

2.4. Data Extraction

2.5. Analysis of the Data

3. Results

3.1. Study Inclusion

FIGURE 1.

3.2. Characteristics of Studies

3.2.1. Publication Characteristics

FIGURE 2.

3.2.2. Funding and Conflict of Interest

TABLE 1.

3.2.3. Characteristics of NH and Participants

FIGURE 3.

3.2.4. Support Surfaces Identified Across the Included Studies

FIGURE 4.

FIGURE 5.

3.3. Characteristics of Evaluative Research Used for Support Surfaces

TABLE 2.

3.3.1. Support Surfaces Assessments

3.3.1.1. Context of Use Assessments of Support Surfaces

3.3.1.2. Effectiveness and Efficiency Assessments of Support Surfaces

3.3.1.3. Satisfaction and Acceptance Assessments of Support Surfaces

3.3.2. Patients' Perspectives

3.3.3. Focus on Comfort and Quality of Life

4. Discussion

4.1. Characteristics of Approaches to Support Surface Assessment

4.2. Effectiveness and Efficiency: A Predominant but Insufficient Focus

4.3. Context of Use: An Underexplored Dimension

4.4. Users' Satisfaction, Acceptance and Quality of Life Assessments: Residents' and Healthcare Workers' Perspectives

4.5. Clinical Implications for Rehabilitation Practice

4.6. Strength and Limitations

4.7. Perspectives

TABLE 3.

5. Conclusion

Funding

Conflicts of Interest

Supporting information

Data Availability Statement

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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