Summary of findings 2. Alternating pressure (active) air surfaces compared with reactive air surfaces for pressure ulcer prevention.
| Alternating pressure (active) air surfaces compared with reactive air surfaces for pressure ulcer prevention | ||||||
| Patient or population: pressure ulcer prevention Setting: any care setting Intervention: alternating pressure (active) air surfaces Comparison: reactive air surfaces | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with reactive air surfaces | Risk with alternating pressure (active) air surfaces | |||||
| Proportion of participants developing a new pressure ulcer Follow‐up: median 14 days | Study population | RR 1.61 (0.90 to 2.88) | 1648 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b | It is uncertain if the proportion of people developing a new pressure ulcer is decreased or increased when alternating pressure (active) air surfaces are compared with reactive air surfaces. | |
| 22 per 1,000 | 36 per 1,000 (20 to 64) | |||||
| Time to pressure ulcer development Follow‐up: 14 days | Study population | HR 2.25 (1.05 to 4.83) | 308 (1 RCT) | ⊕⊕⊝⊝ Lowc | People treated with alternating pressure (active) air surfaces may have a higher risk of developing an incident pressure ulcer than those treated with reactive air surfaces at any time within 14 days. | |
| 52 per 1,000 | 113 per 1,000 (54 to 227) | |||||
| Support surface‐associated patient comfort Follow‐up: median 11 days | Three studies appeared to report equivalent comfort between their study arms (Cavicchioli 2007; Jiang 2014; Price 1999) whilst Finnegan 2008 seemed to suggest that the use of alternating pressure (active) air surfaces was associated with better comfort than reactive air surfaces. | ‐ | 1364 (4 RCTs) | ⊕⊝⊝⊝ Very lowd,e | It is uncertain if there is any difference in support surface‐associated patient comfort between alternating pressure (active) air surfaces and reactive air surfaces. | |
| All reported adverse events | Included studies did not report this outcome. | |||||
| Health‐related quality of life | Included studies did not report this outcome. | |||||
| Cost effectiveness | Included studies did not report this outcome. | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; HR: hazard ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded twice for high risk of bias in domains other than performance bias in 3 studies with more than 54% analysis weight. bDowngraded once for moderate imprecision as, despite the fact that the OIS was met, the wide confidence interval crossed RR = 1.25. cDowngraded twice for high risk of detection bias. dDowngraded once for high overall risk of bias in 3 small studies but unclear risk of bias in 1 large study. eDowngraded twice for substantial inconsistency due to the large variation of outcome measurement methods and findings.