Review title (reference)	Search date	Eligibility criteria	Number of included trials and participants	Study sample size (median, range)	Settings included	Mean age	Proportions of participants by gender	Baseline skin status	Risk of bias of the included trials	Comparisons	Outcomes presented (including time points)
Pressure ulcer prevention
Alternating pressure (active) air surfaces for preventing pressure ulcers (Shi 2021a)	14 Nov. 2019	Randomised controlled trials that allocated participants to alternating pressure (active) air beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for preventing pressure ulcers.	32 studies (9058 participants)	83	A mixture of secondary and community in‐patient facilities (one study), acute care settings (19 studies), intensive care units (3 studies), and community and long‐term care settings (9 studies).	37.2 to 87.0 years (median: 69.1 years)	3654 (44.4%) male and 4571 (55.6%) female (26 studies)	27 studies (8620 participants) had people at risk of having a new ulcer; 18 studies had 3812 (44.2%) participants free of pressure ulcers at baseline; nine studies had 4808 (55.8%) participants with superficial ulcers); one study (10 participants) had participants without risk of developing a pressure ulcer; and two studies (116 participants) recruited people with severe full‐thickness pressure ulcers alone	26 (81.3%) of 32 studies rated at high overall risk of bias	(1) alternating pressure (active) air surfaces versus foam surfaces (six studies with 2427 participants)	Proportion of participants developing a new pressure ulcer follow‐up: median 60 days Time to pressure ulcer incidence follow‐up: median 60 days Support surface‐associated patient comfort follow‐up: median 30 days All reported adverse events follow‐up: range 30 days to 6 months Health‐related quality of life follow‐up: mean 90 days Cost‐effectiveness follow‐up: mean 90 days
										(2) alternating pressure (active) air surfaces versus reactive air surfaces (seven studies with 1728 participants)	Proportion of participants developing a new pressure ulcer follow‐up: median 12 days Time to pressure ulcer incidence follow‐up: mean 14 days Support surface‐associated patient comfort follow‐up: median 11 days
										(3) alternating pressure (active) air surfaces versus reactive water surfaces (three studies with 414 participants)	Proportion of participants developing a new pressure ulcer follow‐up: median 10 days
										(4) alternating pressure (active) air surfaces versus reactive fibre surfaces (four studies with 384 participants)	Proportion of participants developing a new pressure ulcer follow‐up: range 17.7 days to 3 months Support surface‐associated patient comfort follow‐up: mean 3 months
										(5) alternating pressure (active) air surfaces versus reactive gel surfaces used in operating room followed by foam surfaces used on ward bed (two studies with 415 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 7 days All reported adverse events follow‐up: mean 7 days
Foam surfaces for preventing pressure ulcers (Shi 2021b)	14 Nov. 2019	Randomised controlled trials that allocated participants to foam beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for preventing pressure ulcers	29 studies (9566 participants)	101	A mixture of secondary and community in‐patient facilities (2 studies), acute care settings (16 studies), intensive care units (3 studies), operating rooms (2 studies), and community and long‐term care settings (6 studies)	47.0 to 85.3 years (median: 76.0 years)	2659 (43.4%) male and 3466 (56.6%) female (24 studies)	25 studies (8601 participants) had people at risk of having a new ulcer; 21 studies had 5512 (64.1%) participants free of pressure ulcers at baseline; four studies had 3089 (35.9%) participants with superficial ulcers); and two studies (148 participants) had people with severe full‐thickness pressure ulcers alone	17 (58.6%) of 29 included studies rated at high overall risk of bias	(1) foam surfaces versus alternating pressure air surfaces (six studies, 2427 participants)	Proportion of participants developing a new pressure ulcer follow‐up: median 60 days Time to pressure ulcer incidence follow‐up: median 60 days Support surface‐associated patient comfort follow‐up: median 30 days All reported adverse events follow‐up: range 30 days to 6 months Health‐related quality of life follow‐up: mean 90 days Cost‐effectiveness follow‐up: mean 90 days
										(2) foam surfaces versus reactive air surfaces (four studies, 236 participants)	Proportion of participants developing a new pressure ulcer follow‐up: range 13 days to 6 months Support surface‐associated patient comfort follow‐up: mean 13 days All reported adverse events follow‐up: mean 13 days
										(3) foam surfaces versus reactive fibre surfaces (two studies, 228 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 17.7 days
										(4) foam surfaces versus reactive gel surfaces (one study, 135 participants)	Proportion of participants developing a new pressure ulcer
										(5) foam surfaces versus reactive foam and gel surfaces (one study, 91 participants)	Proportion of participants developing a new pressure ulcer
Reactive air surfaces for preventing pressure ulcers (Shi 2021c)	14 Nov. 2019	Randomised controlled trials that allocated participants to reactive air beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for preventing pressure ulcers.	17 studies (2604 participants)	83	A mixture of acute care and long‐term care settings (two studies), acute care settings (seven studies), intensive care units (four studies), and community and long‐term care settings (four studies)	56 to 87 years (median: 72 years)	1125 (44.8%) male and 1386 (55.2%) female (17 studies)	13 studies (2335 participants) had people at risk of having a new ulcer; 10 studies had 2033 (87.1%) participants free of pressure ulcers at baseline; three studies had 302 (12.9%) participants with superficial ulcers; one study (57 participants; Sideranko 1992) had all participants free of ulcers; and two studies (112 participants) had people with severe full‐thickness pressure ulcers alone	eight (47.1%) of the 17 studies rated at high overall risk of bias	(1) reactive air surfaces versus alternating pressure (active) air surfaces (seven studies with 1728 participants)	Proportion of participants developing a new pressure ulcer follow‐up: range 5 days to 15 days Time to pressure ulcer incidence follow‐up: mean 14 days Support surface‐associated patient comfort (median follow‐up duration 11 days, minimum 5 days maximum 14 days)
										(2) reactive air surfaces versus foam surfaces (four studies with 236 participants)	Proportion of participants developing a new pressure ulcer follow‐up: range 13 days to 6 months Support surface‐associated patient comfort follow‐up: 13 days All reported adverse events follow‐up: 13 days
										(3) reactive air surfaces versus reactive water surfaces (one study with 37 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 9.5 days
										(4) reactive air surfaces versus reactive gel surfaces (one study with 74 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 6 months
Alternative reactive support surfaces (non‐foam and non‐air‐filled) for preventing pressure ulcers (Shi 2021d)	14 Nov. 2019	Randomised controlled trials that allocated participants to non‐foam and non‐air filled reactive beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for preventing pressure ulcers	21 studies (4693 participants)	192.5	Acute care settings (11 studies), intensive care units (one study), operating rooms (two studies), and long‐term care settings (seven studies)	37.2 to 85.4 years (median: 72.5 years)	1729 (43.2%) male and 2274 (56.8%) female (18 studies)	16 studies (4152 participants) recruited people at risk of having a new ulcer; 13 studies had 3087 (76.4%) participants free of pressure ulcers at baseline; three had 953 (23.6%) participants with superficial ulcers; two studies (112 participants) had people with severe full‐thickness pressure ulcers alone	17 (80.9%) of the 21 studies at high overall risk of bias	(1) reactive water surfaces versus alternating pressure (active) air surfaces (three studies with 414 participants)	Proportion of participants developing a new pressure ulcer follow‐up: median 10 days
										(2) reactive water surfaces versus foam surfaces (one study with 117 participants)
										(3) reactive water surfaces versus reactive air surfaces (one study with 37 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 9.5 days
										(4) reactive water surfaces versus reactive fibre surfaces (one study with 87 participants)
										(5) reactive fibre surfaces versus alternating pressure (active) air surfaces (four studies with 384 participants)	Proportion of participants developing a new pressure ulcer follow‐up: range 17.7 days to 3 months Support surface‐associated patient comfort follow‐up: mean 3 months
										(6) reactive fibre surfaces versus foam surfaces (two studies with 228 participants)	Proportion of participants developing a new pressure ulcer follow‐up: 17.7 days
										(7) reactive gel surfaces on operating tables followed by foam surfaces on ward beds versus alternating pressure (active) air surfaces on operating tables and subsequently on ward beds (two studies with 415 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 7 days All reported adverse events follow‐up: mean 7 days
										(8) reactive gel surfaces versus reactive air surfaces (one study with 74 participants)	Proportion of participants developing a new pressure ulcer follow‐up: mean 6 months
										(9) reactive gel surfaces versus foam surfaces (one study with 135 participants)	Proportion of participants developing a new pressure ulcer
										(10) reactive gel surfaces versus reactive gel surfaces (one study with 113 participants)
										(11) reactive foam and gel surfaces versus foam surfaces (one study with 91 participants)	Proportion of participants developing a new pressure ulcer
										(12) reactive foam and gel surfaces versus reactive gel surfaces (one study with 166 participants)	Proportion of participants developing a new pressure ulcer
Pressure ulcer treatment
Beds, overlays and mattresses for treating pressure ulcers (Shi 2021e)	14 Nov. 2019	Randomised controlled trials that allocated participants to pressure redistributing beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for treating pressure ulcers.	13 studies (972 participants)	72	Acute care settings (including hospitals in general; six studies), and community and long‐term care settings (including community, nursing homes, long‐term facilities, geriatric unit; seven studies)	64.0 to 86.5 years (median: 82.7 years)	284 (46.3%) male and 329 (53.7%) female (10 studies)	All people with existing pressure ulcers; average size of pressure ulcers in seven studies (353 participants) median 6.6 cm2 (range 4.2 to 18.6 cm2)	6 (46.2%) of the 13 included studies at high overall risk of bias	(1) alternating pressure (active) air surfaces versus foam surfaces (two studies with 132 participants)	Proportion of participants with pressure ulcers completely healed follow‐up: range 7 days to 12 weeks Support surface‐associated patient comfort follow‐up: mean 7 days All reported adverse events follow‐up: median 12 weeks
										(2) reactive air surfaces versus foam surfaces (three studies with 156 participants)	Proportion of participants with pressure ulcers completely healed follow‐up: 13.0 days and 37.5 days Time to complete pressure ulcer healing follow‐up: median 37.5 days Support surface‐associated patient comfort follow‐up: median 13 days All reported adverse events follow‐up: range 13.0 days to 37.5 days Cost‐effectiveness follow‐up: mean 37.5 days
										(3) foam surfaces versus reactive water surfaces (one study with 120 participants)	Proportion of participants with pressure ulcers completely healed follow‐up: mean 4 weeks All reported adverse events follow‐up: mean 4 weeks
Pressure‐relieving devices for treating heel pressure ulcers (McGinnis 2014)	May 2013	Randomised controlled trials that compared the effects of pressure‐relieving devices on the healing of pressure ulcers of the heel. Participants were treated in any care setting. Interventions were any pressure‐relieving devices including mattresses and specific heel devices.	One study (141 participants)	141	Long‐term care setting (elderly care setting)	Average 84.7 years	No data available	All people with heel pressure ulcers; the average severity score of ulcers 2.46 (SD 0.49) in Nimbus 3; 2.57 (0.48) in Cairwave	One study at high overall risk of bias	(1) alternating pressure (active) air surfaces (Nimbus 3) versus alternating pressure (active) air surfaces (Cairwave) (one study with 141 participants)	Proportion of participants with pressure ulcers healed Support surface‐associated patient comfort All reported adverse events