Mattresses for Health Conditions – Directory of Scientific Studies

By Maurice

On this page we've gathered studies on the health impact of mattresses on senior citizens and the elderly. 

Please browse the studies below, and if you know of a study that we've missed, please drop us a line!

Sleep Quality (Elderly Overall)

Study Name

Effects of different mattresses on sleep quality in healthy subjects: an actigraphic study

Publication Biological Rhythm Research
Purpose The purpose of this study was to verify whether different technological solutions for mattresses had different effects on sleep quality.
Methods To this end, 16 healthy volunteers tested a latex mattress and 16 healthy participants tested an independent spring mattress. Sleep quality was assessed before and after introducing new mattresses both objectively and subjectively by means of actigraphy and Mini Sleep Questionnaire (MSQ), respectively.
Results Both kinds of mattress led to a significant improvement in several actigraphic sleep parameters: sleep efficiency, sleep onset latency and motor activity. On the contrary, no significant improvement in subjective sleep quality was detected.
Conclusion The use of both kinds of mattress is associated with an improvement in objective sleep quality. Future studies should investigate if sleep quality improvement is merely due to the introduction of a new mattress or prevalently to the technological features of the mattress.
Study Name

Grouped comparisons of sleep quality for new and personal bedding systems.

Publication Applied Ergonomics
Purpose The purpose of this study was to compare sleep comfort and quality between personal and new bedding systems.
Methods  A convenience sample (women, n=33; men, n=29) with no clinical history of disturbed sleep participated in the study. Subjects recorded back and shoulder pain, sleep quality, comfort, and efficiency for 28 days each in their personal beds (pre) and in new medium-firm bedding systems (post).
Results Repeated measures ANOVAs (Analysis of variance) revealed significant improvement between pre- and post-test means for all dependent variables. Furthermore, reduction of pain and stiffness and improvement of sleep comfort and quality became more prominent over time. No significant differences were found for the groupings of age, weight, height, or body mass index. It was found that for the cheapest category of beds, lower back pain was significantly (p<0.01) more prominent than for the medium and higher priced beds. Average bed age was 9.5yrs. It was concluded that new bedding systems can significantly improve selected sleep variables and that continuous sleep quality may be dependent on timely replacement of bedding systems.
Conclusion The results of the present study suggest that new bedding systems of medium-firmness and of quality construction provide improved comfort for those with minor pain and stiffness and such bedding systems also provide greater sleep quality, comfort, and efficiency. However, it is still uncertain at what point in time these conditions begin to level off and reverse. The statement by Hadler and Evans (2004) that the ideal mattress is still unknown should be impetus for future research. Such research may warrant finding a more accurate estimation of mattress life so that the consumer can more wisely determine the need for a change. Another area of interest is the customization of sleeping surfaces for people with different anthropometric features. For instance, Jacobson and associates (2002) found that heavier participants did not benefit equally from the bedding system used in their study. The concept that one-size-fits-all is likely in need of further investigation.

Poor sleep quality may have many causes. For instance, the mean age of the participant’s beds (9.5 years) illustrates that, in this case beds could be considered old. Possibly, a slow, unnoticed progression of poor sleep may have paralleled the degradation of the support provided by their personal beds over the years. While no study has attempted to determine the longevity and durability of bedding systems, it is plausible that, like other ‘‘appliances’’, beds need to be routinely replaced in order to sustain sleep quality.

Study Name

Quantitative effects of mattress types (comfortable vs. uncomfortable) on sleep quality through polysomnography and skin temperature

Publication International Journal of Industrial Ergonomics
Purpose Information concerning the stages of sleep is one of the most important clues for determining the quality of a particular mattress. The purpose of this study was to determine the effects of mattress type on sleep quality.
Methods Researchers assesed sleep quality by measuring skin temperature, by using a subjective mattress rating system, and through the use of Polysomnogram. Polysomnography involved the recording of brain waves through electroencephalography (EEG) and the generation of a video graphic record of eye movement (EOG), chin movements (EMG) and heart rhythm (ECG).
Sixteen subjects were used in this study, which was a test of mattress comfort. Subjects spent 6 days and nights in the laboratory. Data was recorded for a period of 7 h for each of 3 nights.
Results It was found that mean skin temperature, deep sleep (stage III and stage IV), sleep efficiency, wake after sleep onset (WASO), stage 1 and subjective ratings of mattress comfort were significantly affected according to mattress type. When subjects slept on “comfortable” mattresses, mean skin temperature was higher than for “uncomfortable” mattresses. Lower body skin temperature, sleep efficiency and percentage of deep sleep were higher as well. The percentages of WASO and stage 1 were lower when subjects slept on “comfortable” mattresses. Subjective ratings of sleep quality paralleled recorded sleep data.
Conclusion These results showed the difference of sleep quality and skin temperature between comfortable mattresses and uncomfortable mattresses. Uncomfortable mattresses do not provide enough support for the body, causing people have trouble in getting to deep sleep and made more body movements. Comfortable mattress are necessary to support the spine curvature naturally and to delete unnecessary body movements, therefore a comfortable mattress should facilitate higher sleep quality.
Further investigations are required with body movements, temperature and humidity inside blankets and outside. There are lots external factors to influence sleep, such as temperature, humidity, mattress firmness, pillow, blanket, nightgown and body movements. The majority of studies, including this study investigated about comfortable mattress that has two or three factors although sleep quality is influenced by complex environments. The impact on sleep quality through complex measurements should be studied. To find out comfort in mattress, we have to consider that comfort in mattress is a complex phenomenon based upon subjective feeling and physical properties of the interface between the mattress and human body.
Study Name

Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials

Publication Sleep Health
Purpose The purpose of this article was to gather the best available evidence in the literature related to the type and characteristics of a mattress that best serve the purpose of decreasing spinal pain, and improving spinal alignment and quality of sleep.
Methods This study conducted a systematic review of controlled trials that were published since the year of 2000. In those trials, mattresses were subjectively identified as soft, medium firm, firm, or custom inflated. Articles examining the effect of temperature alterations of mattresses on promoting sleep quality and reducing pain were included as well. Twenty-four articles qualified for inclusion into this systematic review. The methodological quality of the reviewed clinical trials was deemed moderate to high according to the PEDro scale.
Results n/a
Conclusion Results of this systematic review show that a mattress that is subjectively identified as a medium-firm mattress and is custom inflated (self-adjusted) is optimal for promoting sleep comfort, quality, and spinal alignment. Evidence is not sufficient yet regarding the appropriate temperature of the optimum mattress; however, warm temperature has been recommended by authors.
Study Name

Evaluation of the Effects of an Intervention Intended to Optimize the Sleep Environment Among the Elderly: An Exploratory Study

Publication Clinical Interventions in Aging
Purpose The objective of this exploratory study was to evaluate the effects of a brief intervention intended to optimize the sleep environment in older people living in the community and to examine the way these effects change over time.
Methods The sample was made up of 44 participants (19 men and 25 women) aged 65–85 years, with a mean age of 71.4. The intervention consisted in a group training session that covered the reasons for and ways to (“why” and “how”) optimize a sleep environment. It comprises six themes: air quality and odors, luminosity, noises and sounds, comfort of the mattress, comfort of the pillow, and temperature. Participants completed a set of questionnaires before the intervention, and one month and four months later.
Results Four months after the intervention, the replies to the questionnaires showed that the participants experienced reduced severity of insomnia, sleep latency and anxiety. The subjective quality of the participants’ sleep along with their sleep efficacy also increased significantly during the same period.
Conclusion A brief intervention intended to optimize the sleep environment appears promising as an addition or alternative to the two other sleep improvement options generally offered to older people: medication and cognitive behavioral therapy.
Study Name

Effect Of Mattresses And Pillow Designs On Promoting Sleep Quality, Spinal Alignment And Pain Reduction In Adults: Systematic Reviews Of Controlled Trials

Publication A Capstone Project Submitted to the faculty of Utica College, in Partial Fulfillment of the Requirements for the Degree of Doctor of Physical Therapy
Purpose The aim of this study was to conduct a systematic review that assessed all available clinical trials pertaining to the effect of different types of mattresses and pillows on reducing back pain and promoting sleep quality and spinal alignment.
Methods After setting the inclusion criteria the article search was conducted using a series of key words in several databases and was also expanded to include grey literature. Independent reviewers were used to review the articles and assign a PEDro score. It was determined that there were 6 pillow articles and 24 mattress articles that met the criteria to be included in the study.
Results n/a
Conclusion In regards to pillows, our results show that rubber (latex) pillows as well as cooling of the occipital region can enhance sleep. Pillows should also have multiple dimensions in order to reduce pain. However, there is currently a lack of sufficient evidence relating pillows and cervical spine stability. In regards to mattresses, it was concluded that medium-firm mattresses provide the best outcome for increased sleep quality and for reducing pain. Proximal warming of mattresses can also reduce early morning pain and individualized (custom-inflation) mattress systems can enhance spinal alignment.
Study Name

Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders

Publication Sleep Science
Purpose We aimed to evaluate the impact in sleep quality and musculoskeletal pain of a Medium-Firm Mattress (MFM), and their relationship with objective sleep parameters in a group of institutionalized elders.
Methods The sample size included forty older adults with musculoskeletal pain. We did a clinical assessment at baseline and weekly trough the study period of four weeks. We employed the Pittsburgh Sleep Quality Index (PSQI) and Pain Visual Analog Scale (P-VAS). Additionally a sub-group of good sleepers, selected from PSQI baseline evaluation, were studied with actigraphy and randomized to MFM or High Firm Mattress (HFM), in two consecutive nights.
Results We found a significant reduction of cervical, dorsal and lumbar pain. PSQI results did not change. The actigraphy evaluation found a significant shorter sleep onset latency with MFM, and a slightly better, but not statistically significant, sleep efficiency.
Conclusion The medium firmness mattress improved musculoskeletal pain and modified the sleep latency.
Study Name

Elevated airflow can maintain sleep quality and thermal comfort of the elderly in a hot environment

Publication Indoor Air Journal
Purpose The effect of elevated airflow on sleep quality was investigated with 18 elderly.
Methods Three airflow conditions were set: ceiling fan/30°C/max.0.8 m/s and mean 0.7 m/s, task fan/30°C/max.0.8 m/s and mean 0.6 m/s, and thermally neutral /27°C/0.2 m/s. Sleep quality was evaluated objectively by analysis of electroencephalogram signals that were continuously monitored during the sleeping period. Urinary cortisol concentrations were analyzed to measure the activity of sympathetic nervous system.
Results No significant difference in sleep quality, thermal comfort, or cortisol concentration was found between the ceiling fan and the neutral condition. The duration of total sleep time decreased by 35 minutes, the duration of REM sleep decreased by 15 minutes, and the cortisol concentration in the morning increased by 50 ng/mL in the task fan than the other two conditions. Compared with ceiling fan, less heat load was removed in the task fan condition, possibly due to the lower air speed.
Conclusion This study shows that even small heat load led to reduced sleep quality and overactive sympathetic nervous system of the elderly. By supplying an airflow of 0.8 m/s evenly over the human body, the elderly could maintain sleep quality and thermal comfort at an air temperature that was 3 K higher than the neutral temperature.
Study Name

A systematic review of nonpharmacological interventions to improve nighttime sleep among residents of long-term care settings

Publication BMC Geriatrics
Purpose Disturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents.
Methods The Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered.
Results Of the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure.
Conclusion Non-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices.
Study Name

Changes in sleep and wake in response to different sleeping surfaces: A pilot study

Publication Applied Ergonomics
Purpose The purpose of this study was to identify changes in sleep and wake in response to different sleeping surfaces, a conventional mattress and a specially-designed pressure-relief mattress.
Methods Six married couples (12 adults, mean age 34.8 years) were randomized as couples in a cross-over design to sleep on a queen-size conventional mattress for 2 weeks and a specially-designed pressure-relief mattress for 2 weeks. The pressure-relief mattress was designed to reduce the number of contact points exceeding 30 mm Hg. Actigraphic measurements of sleep and self-reports of sleep and daytime symptoms were collected at baseline for 2 weeks on each couple’s home mattress and box springs at home, followed by 2 weeks of data collection on each randomized mattress for a total of 6 weeks of data collection. Pressure maps were created for each participant on each sleeping surface.
Results There were no significant differences between the randomized sleeping surfaces for any measure of actigraphic sleep or self-reported sleep and daytime symptoms. However, poor pressure relief performance of the home mattress was associated with better actigraphic sleep on the randomized pressure-relief mattress.
Conclusion We conclude that while pressure-relief mattresses may not be universally preferred, baseline characteristics of the sleeper and/or their mattress may explain performance and sleeper preferences on future mattress selection.
Study Name

Effect of an Inflatable Air Mattress with Variable Rigidity on Sleep Quality

Publication MDPI
Purpose The present study developed a mattress whose rigidity can be varied by controlling the amount of air in its air cells.
Methods To investigate the effect of the variable rigidity of the air mattress on sleep quality, participants (Male, Age: 23.9 ± 2.74, BMI: 23.3 ± 1.60) were instructed to sleep on the air mattress under different conditions, and their sleep quality was subjectively and objectively investigated. Subjectively, sleep quality is assessed based on the participants’ evaluations of the depth and length of their sleep. Objectively, sleep is estimated using the sleep stage information obtained by analysing the movements and brain waves of the participants during their sleep.
Results A subjective assessment of the sleep quality demonstrates that the participants’ sleep was worse with the adjustment of the air mattress than that without; however, the objective sleep quality results demonstrates an improvement in the sleep quality when the rigidity of the air mattress is varied based on the participant’s preference.
Conclusion This paper proposes a design for mattresses that can result in more efficient sleep than that provided by traditional mattresses.
Study Name

Choosing a Mattress: Using Actigraphy and Diary Reports to Identify a Mattress That Provides Best Sleep

Publication RTI International
Purpose The aim of this study was to identify a mattress that provides best sleep by actigraphy and diary reports.
Methods We hypothesized that motion and self-reported measures of sleep quality and outcomes would demonstrate that the optimal mattress would differ from person to person. We hypothesized that individuals would be able to select one mattress from among several under showroom circumstances that would lead to optimal rest.
Results We find that optimal mattress firmness varies among individuals and is reflected, at least to a degree, by overnight motion. When allowed to test mattresses in a typical showroom experience, individuals choose a mattress that does not minimize overnight motion and maximize perceived sleep quality. This suggests that they may not be receiving the health benefits that come from optimal rest.
Conclusion Therefore, both manufacturers and sleep scientists could improve sleep outcomes by testing ways to help consumers select a mattress.
Study Name

Ergonomic Study of Mattress Firmness by Measuring Spinal Curve and Sleep Quality

Publication Ergonomics Society of Korea
Purpose We examined the influence of mattress firmness on the spinal curve, sleep quality, and subjective evaluations in healthy subjects.
Methods The firmness of the three equal parts of air /mattress was controlled by the air pressure in each part.
In Experiment 1, we created nine air mattress conditions by setting the air pressure of each of the upper and middle parts at 4, 6, or 8 kPa, and that of the lower part at 6 kPa. We measured the spinal curves of 10 healthy young male subjects from the coccyx to the 7th cervical vertebra by a fiber optic-based 3D bend and twist sensor, while they laid down on their right side with the angle of the trunk and thigh at 135° (abbreviated as lying135°) and when they laid supine, in each of the nine mattress conditions.
As Experiment 2, we compared sleep quality achieved with the 6:4:6 and 6:4:8 conditions over each of seven consecutive nights (three adaptation nights and four for analysis) in subjects’ homes. The sleep quality achieved by 20 healthy adult males and females was assessed by means of actigraphy, the standardized Oguri-Shirakawa-Azumi (OSA) Sleep Inventory (middle-aged version), and VAS subjective evaluations.
Results Experiment 1: We found that the spinal curve during supine position with the conditions of lower part: 6 kPa, middle: 4 kPa, and upper: 6 kPa (“6:4:6”) was the most similar to that during lying135°, which makes the spinal curve natural. However, the subjective evaluation of “comfort of the mattress” by a visual analog scale (VAS) scored highest in the 6:4:8 condition.
Experiment 2: The estimated sleep quality measured on the 6:4:6 mattresses was significantly higher than that on the 6:4:8 mattress. The VAS evaluations of “comfort of the lower back” and “comfort of the upper back” were also higher for the 6:4:6 mattress. There were no significant differences in the OSA scores between mattress conditions.
Conclusion Our results indicate that the 6:4:6 mattress condition, which appeared to provide a natural spinal curve, provided higher sleep quality and higher subjective evaluations during actual use compared to the 6:4:8 condition.

Health Issues (General)

Study Name

An overview of bed and mattress use in care homes

Publication Nursing & Residential Care
Purpose The article aims to help people selecting the beds and mattresses by the evaluating the types available.
Methods The author evaluates different types of mattresses and beds.
Types of mattresses: Pressure-reducing mattresses, and Pressure-relieving mattresses.
Types of beds: Divan beds, Height-adjustable beds, Non-electrical profiling beds, Electrical profiling beds
Results Key points:
Inappropriate beds can lead to loss of patients’ independence.
It is important that bed and mattress are compatible.
Pressure-reducing mattress are the first line of defence.
Conclusion When selecting beds and mattresses, it is important to consider them together. Support surfaces must be compatible with the bed frame. Incompatible mattresses can hinder the patient’s ability to transfer independently and may also increase the risk of patient injury; for example – if the length and/or width of the mattress is incorrect, any gaps at the foot of the bed and either side of the mattress could create a hazard and potentially trap a patient’s limbs.When purchasing beds and mattresses for the care home environment it is extremely important that selection criteria are developed by managers, end users and clinicians, so that the models decided upon provide best value for money and are entirely suitable for their intended use.
Study Name

Support Surfaces: Definitions and Utilization for Patient Care

Publication Support Surfaces. Advances in Skin & Wound Care
Purpose Members of the Terms and Definitions group of the NPUAP Support Surface Standards Initiative set out to develop standardized terms and definitions to ensure global consistency with support surface device nomenclature. The purpose of the project was to develop a common language regarding support surface design and technology that could be clearly understood by clinicians, engineers, and the support surface industry.
Methods Participants began by developing a list of terms related to support surface devices. First, a list of terms and definitions reported in journal articles, government publications, PrU guidelines, and industry marketing materials were complied and categorized. These terms were grouped according to type (eg, product categories, features, scientific terms, etc). The definitions were reviewed and discussed, and then the group developed and agreed on revised, new, changed, combined, or deleted definitions.
Results In January 2002, the group members determined which terms and definitions, including all existing physical, engineering, and industry terms that appeared in the literature, should be reviewed. Support surface terminology such as low air loss, alternating pressure, air-fluidized therapy, pressure reduction, and pressure relief, was the most challenging terminology for group consensus. Well-written, descriptive, measurable support surface terms and definitions were developed and validated both internally and externally by the inclusion of meeting participation and an online survey of interested parties. The terms will serve as a lexicon for performance test methods of support surfaces by the Tissue Integrity Group.
Conclusion The study provides definitions of support surfaces, categories and their characteristics.

The presentation of the operational process used to develop and agree on the revised, new, changed, or combined terms and definitions will be reported, including information that will enable attendees to obtain the new terms and definitions.

Study Name

The Influence of Mattress Material on Sleeping Comfort of Different Age

Publication Part of the Lecture Notes in Electrical Engineering book series (LNEE, volume 645)
Purpose This paper studied the relationship between the characteristic of mattress materials and sleeping comfort with supine and lateral sleeping of different age groups.
Methods The test adopted the pressure distribution system, subjective evaluation and the subjective and objective analysis of correlation on ergonomics methods.
Results The results showed that, as the subjects’ age increasing, the subjects’ sensitivity of mattress materials increased and had partiality for harder material.
Conclusion The elder subjects had the highest sensitivity on different mattress materials. The young and middle-aged subjects had high evaluation on memory foam, and latex mattress in supine and lateral position. The young-elder subjects had higher evaluation on memory foam, and coir mattress in supine and lateral position. And the elder subjects preferred coir and cotton mattress in supine position and preferred memory foam and coir mattress in lateral position. The subjects lay on back preferred softer material than subjects lay on side.

Pain (General)

Study Name

The use of a new overlay mattress in patients with chronic pain: impact on sleep and self-reported pain

Publication Clinical Rehabilitation
Purpose Objective: To evaluate the use of an air flotation mattress overlay in patients with chronic pain.
Methods Design: Four-week prospective AB design.
Setting: The mattress overlay was used in a community setting.
Subjects: Adult patients attending an outpatients clinic in a department of rheumatology, with chronic pain plus sleep problems, or pain sufficient to disturb sleep.
Interventions: An inexpensive low-pressure inflatable mattress overlay (Repose), which is readily portable and has no electrical supply, was introduced to the patients. They were encouraged to use the support surface every night.
Main outcome measures: The primary outcome was measured by self-reported changes in sleep quantity and frequency of sleep disturbance. Secondary outcomes were self-reported changes in pain and use of analgesia, verified by medical notes.
Results Nineteen female patients (mean age 61 years) completed the study. At baseline, mean length of sleep time was 3.8 h, with mean of 4.9 interruptions of mean 25.3 min: week 4, mean sleep time = 6.4 h, with a mean of 2.3 interruptions for mean 14.2 min (all measures p < 0.001). At baseline, median pain during the day was 6 and at night-time was 7; by week 4 a reduction in pain was reported both for the day (median = 5) and the night (median = 5) (both p < 0.001). Thirteen patients reported a reduction in the use of analgesia during the study.
Conclusion In this pilot study of a new mattress overlay, statistically significant improvements in sleep and pain were noted over a four-week period.
Study Name

Magnetic mattress pad use in patients with fibromyalgia: a randomized double-blind pilot study

Publication Journal of Back and Musculoskeletal Rehabilitation
Purpose To determine if the chronic pain and sleep disturbances experienced by patients with fibromyalgia can be improved by sleeping on a magnetic mattress pad.
Methods Design: A double-blind randomized controlled trial.
Setting: Patients’ homes and the private practice office of the principal investigator.
Patients: Thirty-five female subjects diagnosed with fibromyalgia syndrome were recruited. Thirty met inclusion/exclusion criteria and entered the study. Twenty-five completed it. One was lost to follow-up. Three were withdrawn for protocol violations and one because of an intercurrent hospitalization.
Intervention: Sleeping on an experimental (magnetized at a magnet surface field strength of 1100 ± 50 Gauss and delivering 200–600 Gauss to the skin surface or a sham (non-magnetized) mattress pad over a 16 week period.
Main Outcome Measures: Visual Analog Scales (VAS) for global wellbeing, pain, sleep, fatigue and tiredness on awakening; Total Myalgic Score; Pain Distribution Drawings; and a modified Fibromyalgia Impact Questionnaire.
Results Subjects sleeping on the experimental mattress pad experienced a significant decrease in pain (p<.05), fatigue (p<.006), total myalgic score (p<.03), and pain distribution drawing (p<.02). Additionally, these subjects showed significant improvement in reported sleep (p<.01) and physical functioning as evidenced from the modified Fibromyalgia Impact Questionnaire (p<.04). Subjects sleeping on the sham mattress pad experienced no significant change in these same outcome measures. Subjects in both the control and experimental groups showed improvement in tiredness on wakening, demonstrating a placebo effect in this parameter. Neither group showed any effect on global wellbeing.
Conclusion Sleeping on a magnetic mattress pad, with a magnet surface field strength of 1100 ± 50 Gauss, delivering 200–600 Gauss at the skin surface, provides statistically significant and clinically relevant pain relief and sleep improvement in subjects with fibromyalgia. No adverse reactions were noted during the 16-week trial period.
Study Name

Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders

Publication Sleep Science
Purpose We aimed to evaluate the impact in sleep quality and musculoskeletal pain of a Medium-Firm Mattress (MFM), and their relationship with objective sleep parameters in a group of institutionalized elders.
Methods The sample size included forty older adults with musculoskeletal pain. We did a clinical assessment at baseline and weekly trough the study period of four weeks. We employed the Pittsburgh Sleep Quality Index (PSQI) and Pain Visual Analog Scale (P-VAS). Additionally a sub-group of good sleepers, selected from PSQI baseline evaluation, were studied with actigraphy and randomized to MFM or High Firm Mattress (HFM), in two consecutive nights.
Results We found a significant reduction of cervical, dorsal and lumbar pain. PSQI results did not change. The actigraphy evaluation found a significant shorter sleep onset latency with MFM, and a slightly better, but not statistically significant, sleep efficiency.
Conclusion The medium firmness mattress improved musculoskeletal pain and modified the sleep latency.

Allergies & Asthma

Study Name

Mattress encasings and mite allergen levels in the Prevention and Incidence of Asthma and Mite Allergy study

Publication Clinical Experimental Allergy
Purpose Objective: To measure the influence of mite allergen-impermeable mattress encasings and cotton placebo encasings on the amount of dust and mite allergen in beds.
Methods A total of 810 children with allergic mothers took part in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study. Allergen-impermeable and placebo mattress encasings were applied to the childrens’ and the parents’ beds before birth. Dust samples were taken from the beds of children and their parents before birth and 3 and 12 months after birth. Extracts of dust samples were analysed for mite allergens (Der p 1 and Der f 1).
Results Active mattress encasings were significantly more effective in reducing dust and mite allergen levels than placebo encasings. Mite allergen levels were low in general and the treatment effect was modest. Twelve months after birth, mattresses with active mattress encasings had about half the amount of Der 1 (Der p 1 + Der f 1)/m2, compared to mattresses with placebo encasings, for the child’s and the parental mattress.
Conclusion This study shows that mite-impermeable mattress encasings have a significant but modest effect on dust and mite allergen levels of mattresses with low initial mite allergen levels, compared to placebo.
Study Name

Clinical effectiveness of a mite allergen–impermeable bed-covering system in asthmatic mite-sensitive patients

Publication Journal of Allergy and Clinical Immunology
Purpose The effect of HDM (House dust mite)-impermeable covers on HDM allergen levels, peak flow values, and asthma symptoms were measured. Therefore a randomized clinical trial was carried out.
Methods Fifty-two allergic asthmatic patients were randomly allocated to use the HDM-impermeable or placebo covers. During the study period, daily peak flow and asthma symptom scores were recorded. Dust samples were taken from the mattresses.
Results We observed a significant reduction in HDM allergen levels on the mattresses after encasing them with HDM-impermeable covers (reduction of 87% of Der p 1 in micrograms per gram of dust; P < .001). Baseline symptoms were so low that no improvement could be established. Morning peak expiratory flow is significantly higher in the intervention group compared with that seen in the placebo group during the study period (β = 20.2; P < .01).
Conclusion HDM-impermeable covers significantly decreased the level of HDM allergens. Furthermore, morning peak flow was significantly increased during the intervention period. This study indicates that HDM allergen-avoidance measures might have beneficial effects on allergen reduction and asthma outcome.
Study Name

Results of a field study on the influence of HygienicWood mattress toppers on the number of mites in bed dust and the state of health of people with house dust mite allergies

Publication GMS Krankenhaushygiene interdisziplinär
Purpose So far, there has been no practical or toxicologically non-hazardous way to decimate mites – without interrupting use of beds – in their main reservoir on bed mattresses to such an extent that the allergic condtion of people suffering from house dust mite allergies is reduced or even remedied. As so-called HygienicWood was effective against mites under simulated conditions, the influence of a mattress topper filled with HygienicWood chips on the content of mite antigen Der p1 was to be investigated and the influence on the state of health of the persons concerned analysed at the same time.
Methods 32 test persons suffering from dust mite allergy were randomly selected.
During the course of 5 months, the influence of a HygienicWood mattress topper on the content of the mite antigen Der p1 as well as the number of bacteria, dermatophytes and yeasts in the bed dust were determined and compared with the values obtained during the 5 weeks prior to the application of HygienicWood mattress toppers. The samples were taken from between the HygienicWood mattress topper and the sheet below.
At the same time, changes in well-being, state of health, typical allergy symptoms and frequency of taking antihistamines and glucocorticoids were recorded as self-assessments in the form of questionnaires.
Results The most striking finding was the significant decrease (p=0.000) of the house dust mite antigen Der p1 during usage of the HygienicWood mattress toppers. The effect started immediately after applying the toppers and continued with little fluctuation until the end of the observation period without lessening. At the end of the study, 43% of the test persons stated a slight improvement in their well-being. 13% of the test persons felt no change, and 6% of the test persons stated a slight deterioration. The situation was similar with regard to allergy symptoms: 43% reported a significant reduction, 38% a slight reduction, and 19% did not notice any change. The improvement in symptomatology could not be ascribed to an increased intake of antihistamines or glucocorticoids.
The dermatophytes, too, showed a slight, albeit statistically not significant decrease after application of HygienicWood mattress toppers. In contrast, the pollution of bed dust with yeasts rose significantly (p=0.002), whereas there was only a tendency towards an increase in the number of bacteria, which, if one considers the slight increase, is without hygienic relevance.
Conclusion HygienicWood mattress toppers are able to reduce the house dust mite allergen load. This leads to a distinct reduction in the allergy symptomatology, and the well-being of the persons concerned increased significantly.
Study Name

Influence of mattress characteristics on house dust mite allergen concentration

Publication Clinical & Experimental Allergy
Purpose The aim of this study was to evaluate the association between mattress characteristics and HDMA concentrations on mattresses.
Methods Dust samples of mattress surfaces were taken to evaluate the level of Der p 1 allergen. All participants filled in a questionnaire about the type of mattress, the type of covering (upper layer) of the mattress, dwelling characteristics and cleaning habits. Humidity and temperature of the bedroom were measured at the time of dust sampling.
Results One hundred and sixty‐eight questionnaires were filled in. Synthetic upper layer of the mattress was associated with a higher level of Der p 1 compared with cotton upper layer (2.6 vs. 0.8 μg/g Der p 1). Moreover, higher relative humidity (RH) was associated with significant higher concentrations and density of Der p 1.
Conclusion Two factors were associated with lower levels of Der p 1 found on mattresses, namely: a cotton upper layer of the mattress compared with a layer of synthetic material and lower RH at the time of sampling. As far as we know, the association between type of upper layer and concentration of Der p 1 has not been described before and could lead to the formulation of practical advices in order to reduce HDMA concentrations on mattresses.
Study Name

Nonwoven in contrast to woven mattress encasings accumulate mite and cat allergen

Publication Journal of Allergy and Clinical Immunology
Purpose To investigate if nonwoven or woven mattress encasings accumulate more mite and cat allergen, we carried out 2 studies: (1) examination of live mites and mite feces placed on the surface of these fabrics and (2) assay of allergen levels on mattress encasings that had been in daily use for more than 1 year.
Methods To investigate whether allergen accumulated on the surface of these encasings during normal use, we obtained 20 nonwoven mattress encasings and 12 woven mattress encasings (of the same types as shown in Figs E1 and E2 in this article’s Online Repository at www.jacionline.org) from patients who had used them continuously for at least 1 year (mean period of use, 17.2 months and 17.5 months, respectively). The nonwoven and woven fabrics used in these encasings had been demonstrated to be impermeable to Der p 1 and Fel d 1 by using the technique described previously.5 Mattress covers were returned by express mail and kept at 75% relative humidity for several days before they were examined for live mites. They were then refrigerated for up to 2 weeks before collection of dust samples and assays of allergen levels (see Table E1 in this article’s Online Repository at www.jacionline.org for details of dust collection and assays).8
A 15 × 15–cm area at the head end of the top outer surface of each mattress encasing was first examined microscopically for mite colonization and then checked for live mites by using the heat escape method.9 With this technique, gradually increasing heat causes any live mites to move upward to a clear adhesive paper placed on the fabric, where they can be counted. Subsequently, dust samples were obtained from a square meter of the outer and inner surfaces of each used encasing by vacuuming. These samples were weighed and analyzed for Der p 1, Der f 1, and Fel d 1 by means of ELISA (see Fig 1 and Fig E3 and Table E1 in this article’s Online Repository at www.jacionline.org).8
Results Four of the used nonwoven encasings had macroscopically visible dirt and dust embedded in their fabric. Although no mites were seen either by means of microscopy or heat escape, the used nonwoven encasings had higher quantities of dust and higher levels of mite allergen on their outer surfaces (see Fig 1 and Table E2 in this article’s Online Repository at www.jacionline.org), with mean Der p 1 and Der f 1 concentrations of 1.35 μg/g and 17.74 μg/g, respectively, compared with mean concentrations of 0.014 μg/g and 0.227 μg/g, respectively, on the used woven encasings (P < .001, Mann-Whitney U test).
Nine of 20 nonwoven mattress encasings had levels of Der p 1, Der f 1, or both of greater than 2 μg/g on their outside surface, and 5 had levels of greater than 10 μg/g. High levels of Fel d 1 were also present on the outer surface of 5 of 20 used nonwoven mattress encasings, but none of the 12 used woven encasings, despite the fact that at least 2 of the owners of the woven encasings allowed a cat in the bedroom. Mean Fel d 1 was 5.1 μg/g on the nonwoven encasings and 0.2 μg/g on the woven encasings (P = .01). Comparable differences in mite and cat allergen were found in dust samples from the inside of the fabrics (see Table E2 and Fig E3 in this article’s Online Repository at www.jacionline.org).
Conclusion Taken together, these findings indicate that the ability of a fabric to block the passage of allergen over a 20-minute period is by itself an insufficient criterion for its use in allergen avoidance. The encasing should also be smooth enough to prevent mite colonization and to prevent allergen accumulation. Because we were unable to find mites in the encasing material itself, it is not clear that the mite allergen measured on its surface was produced by mites that had colonized the fabric. More likely, the nonwoven fabric, with its irregularly shaped interstices, was acting as a sink that trapped and retained allergen produced elsewhere. This is supported by the high cat allergen levels and the video imaging showing mite fecal entrapment in the nonwoven fabric. We cannot exclude, however, the possibility that some of the mite allergen was produced by mites that had colonized the fabric but left that substrate before it was studied.
The finding of high allergen levels and the fact that mites can penetrate into these fabrics raise serious questions about the use of nonwoven fabrics for allergen avoidance.

Back Pain – Sciatica

Study Name

Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain

Publication Applied Ergonomics
Purpose The purpose of this study was to assess sleep quality and comfort of participants diagnosed with low back pain and stiffness following sleep on individually prescribed mattresses based on dominant sleeping positions.
Methods Subjects consisted of 27 patients (females, n = 14; males, n = 13; age 44.8 yrs ± SD 14.6, weight 174 lb. ±SD 39.6, height 68.3 in. ± SD 3.7) referred by chiropractic physicians for the study.
For the baseline (pretest) data subjects recorded back and shoulder discomfort, sleep quality and comfort by visual analog scales (VAS) for 21 days while sleeping in their own beds.
Subsequently, participants’ beds were replaced by medium-firm mattresses specifically layered with foam and latex based on the participants’ reported prominent sleeping position and they again rated their sleep comfort and quality daily for the following 12 weeks.
Results Analysis yielded significant differences between pre- and post means for all variables and for back pain, we found significant (p < 0.01) differences between the first posttest mean and weeks 4 and weeks 8–12, thus indicating progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experiencing poor sleep and physical discomfort decreased significantly.
Conclusion An inherent and unresolved issue centers around terms such as “firm” and “soft” which are not globally defined either in the market place or in research. Yet, these data support both the benefit of a “medium-firm” sleep surface constructed of layers of viscoelastic polyurethane foam and latex and the suitability of prescribing the sleep surface based on the prominent sleeping position.
It was concluded that sleep surfaces are related to sleep discomfort and that is indeed possible to reduce pain and discomfort and to increase sleep quality in those with chronic back pain by replacing mattresses based on sleeping position.
Study Name

Effect of firmness of mattress on chronic nonspecific low-back pain: randomized, double-blind, controlled, multicentre trial.

Publication The Lancet, Vol. 362
Purpose A firm mattress is commonly believed to be beneficial for low-back pain, although evidence supporting this recommendation is lacking. We assessed the effect of different firmnesses of mattresses on the clinical course of patients with chronic non-specific low-back pain.
Methods In a randomised, double-blind, controlled, multicentre trial, we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising.
Mattress firmness is rated on a scale developed by the European Committee for Standardisation. The Hs scale starts at 1·0 (firmest) and stops at 10·0 (softest). We randomly assigned participants firm mattresses (Hs=2·3) or medium-firm mattresses (Hs=5·6). We did clinical assessments at baseline and at 90 days.
Primary endpoints were improvements in pain while lying in bed, pain on rising, and disability.
Results At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed (odds ratio 2·36 [95% CI 1·13–4·93]), pain on rising (1·93 [0·97–3·86]), and disability (2·10 [1·24–3·56]) than did patients with firm mattresses.
Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain (p=0·059), pain while lying in bed (p=0·064), and pain on rising (p=0·008) than did patients with firm mattresses.
Conclusion A mattress of medium firmness improves pain and disability among patients with chronic non-specific lowback ain.
Study Name

Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials

Publication Sleep Health
Purpose The aim of this article is to provide a systematic review of controlled trails available in literature on the effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment.
Methods This study gathered the best available evidence in the literature related to this matter through conducting a systematic review of controlled trials that were published since the year of 2000. In those trials, mattresses were subjectively identified as soft, medium firm, firm, or custom inflated. Articles examining the effect of temperature alterations of mattresses on promoting sleep quality and reducing pain were included as well. Twenty-four articles qualified for inclusion into this systematic review. The methodological quality of the reviewed clinical trials was deemed moderate to high according to the PEDro scale.
Results Results of this systematic review show that a mattress that is subjectively identified as a medium-firm mattress and is custom inflated (self-adjusted) is optimal for promoting sleep comfort, quality, and spinal alignment. Evidence is not sufficient yet regarding the appropriate temperature of the optimum mattress; however, warm temperature has been recommended by authors.
Conclusion According to this systematic review, the following conclusions could be reached:

  • Medium-firm mattresses are beneficial for individuals with chronic nonspecific lowback pain andwere rated as more comfortable than soft bedding systems. Studies have shown that medium-firm mattresses improve sleep quality by 55% and decrease back pain by 48% in patients with chronic low back pain.
  • When an individual has active control of bed properties (custom inflation), there is an improvement in spinal alignment as well as sleep quality. In addition, in both young and older adults, proximal warming enhanced sleep.
  • Mild skin temperature manipulation can be chosen to reduce early morning awakening and enhance deeper sleep; however, the reader should be cautious that this temperature conclusion is solely based on the findings of a single article that met the inclusion criteria of this systematic review.
  • Soft mattresses decrease excessive compressive forces on joints. On the other hand, firm mattresses help maintain appropriate sleeping posture especially in side-lying position, as it prevents the sagging of the pelvis. However, the clinical value of such findings has not been confirmed yet.
Study Name

Subjective rating of perceived back pain, stiffness and sleep quality following introduction of medium-firm bedding systems

Publication Journal of Chiropractic Medicine
Purpose The purpose of the study is to compare personal and new bedding systems between subjects with reported high and low base line sleep quality.
Methods A convenience sample of healthy subjects (women = 30; men = 29) with no clinical history of disturbed sleep participated in the study. Subjects recorded perceived back discomfort and stiffness, sleep quality and comfort, and sleep efficiency upon waking for 28 consecutive days in their own beds (baseline) and for 28 consecutive days (post) on a new bedding system. Repeated measures analysis of variance was used to treat sleep data.
Results Analysis revealed significant differences between pre- and post means in all areas for both high and low sleep quality groups. Analysis of sleep efficiency also yielded significant differences between, but not among pre- and post means. Improvement of sleep comfort and quality became more prominent with time (from wk 1 to 4 post observation).
Conclusion Similar significant benefits of new, medium- firm bedding systems can occur for those reporting both good and poor current sleep quality and variables such as age, weight, height, and body mass index are independent of such improvements.
Study Name

Short-term outcomes of chronic back pain patients on an airbed vs innerspring mattresses

Publication Medscape General Medicine
Purpose Objective: To compare SF-36, pain Visual Analog Scale (VAS), and sleep VAS outcomes of an adjustable airbed with innerspring mattresses in a population of chronic back pain sufferers.
Methods Study design: A-B-A trial, in 3 phases: the patients on their own bed for 1 night, on an adjustable airbed for 28 nights, and on their bed for 14 nights.
Setting: Outpatient pain rehabilitation, physical therapy, and alternative medicine clinics.
Patients: Three centers recruited 30 patients each with severe chronic back pain and without sleep apnea or other sleep disorders.
Main outcome measures: SF-36 health status survey and VAS pain and sleep quality scales.
Results On VAS scales, 95% showed pain improvement, and 88% reported better sleep. The average improvements were a 32% pain decrease and a 73% increase in sleep quality, significant at P less than.001 (two-tail t test). Eighty percent improved on the SF-36 physical functioning dimension and 88% improved on the bodily pain dimension. The average score on each dimension improved (P less than.001). Eighty-five percent preferred the adjustable airbed.
Conclusion SF-36 and VAS outcomes measures showed a highly significant benefit for the airbed design in this short-term comparison. The airbed appears to be a useful sleep aid and an adjunct to medical and physical therapies for chronic back pain sufferers.
Study Name

Better backs by better beds?

Publication Spine
Purpose The objective of the study is to evaluate 3 structurally different mattresses relative influence on patients with chronic low back pain (CLBP).
Methods Study design: A “randomized”/stratified, single-blinded, parallel-group study.
Summary of background data: In several advertisements, it is proclaimed that certain mattresses have a positive effect on LBP, and especially a hard mattress is commonly believed to have a positive effect.
One hundred sixty CLBP patients were randomized to 1 of 3 groups, having a mattress/bed mounted in their sleeping room for 1 month. The beds were: (1) waterbed (Akva), (2) body-conforming foam mattress (Tempur), and (3) a hard mattress (Innovation Futon).
At baseline and after 4 weeks, a blinded observer interviewed the patients on LBP levels (0-10), daily function (activities of daily living, 0-30), and on the amount of sleeping hours/night.
Results Because of dropout of 19 patients before baseline, the analyses were performed on 141 patients. During the 1-month trial period another 27 patients stopped ahead of time, which were accounted for by “worse case” as well as “no-change” analyses. Both the waterbed and the foam mattress seemed superior to the hard mattress, especially when using the probably most relevant “worst case” data. There were no relevant difference between the effects of the water bed and the foam bed.
Conclusion The Waterbed and foam mattress’ did influence back symptoms, function and sleep more positively as apposed to the hard mattress, but the differences were small.
Study Name

Objective firmness, average pressure and subjective perception in mattresses for the elderly

Publication Applied Ergonomics
Purpose This paper aims to cover the salient mechanical aspects of comfort and usability (rolling, getting up). The results should help manufacturers to know if the long-term benefits of their products are perceived in the short term by senior citizen customers.
Methods Four mattresses for the elderly chosen from a sample of 17 available on the Spanish market were compared in pairs for short-term effects (1 min pressure with both hands, 1 min sitting, 1 min lying on back, and 1 min lying on side), simulating a store purchasing trial by a group of young and elderly people in terms of differences between perceived firmness, usability (ease of movement) and comfort.
The results of these comparisons were correlated to differences in objective properties such as pressure distribution and objective firmness.
Results No differences in perception were found between young and old users. Only two of the four test methods for perceiving mattress firmness were necessary to explain the majority of variance: pressing the surface of the mattress with a part of the body (both hands or buttocks), and contact using the entire body (lying on back or side).
A number of significant relationships were found, with the following of note: increments in ‘objective firmness’ (estimated from test load/deflection) correlate positively to increments in ‘perceived firmness’; increments in ‘average pressure’ (measured using a mannequin) correlate positively to increments (within certain limits) in ‘perceived firmness’; increments in ‘objective firmness’ and in ‘average pressure’ are associated with increments in ‘overall comfort’ and with reductions in ‘difficulty in rolling”. Finally, it was found that people with a higher body mass index tend to be (weak correlation) more sensitive to changes in ‘objective firmness’.
Conclusion The contradiction between firmness and lower back pain seems to be offset if we consider that our study was conducted using healthy subjects and the test duration was rather short. Changes in body structures (joints, muscles, ligaments, vessels) associated with negative perceptions may require extended periods to occur.

As for users’ preferences for higher average pressure, this may be due to the relatively low importance of blood flow hindrance compared to other factors such as posture. In this context, capillary occlusion is a progressive effect of external pressure that is relevant only from a certain threshold. So numbness and other negative perceptions derived from high pressures may be negligible in comparison to other effects such as hyperextension of back muscles and ligaments due to uncomfortable postures. For both aspects, as stated by Zhang (Zhang et al., 1996), comfort is more than the absence of discomfort because it requires other positive attributes associated with a relative high level of hardness and average pressure (ease of rolling, for example). In conclusion, more effort should be directed to clarifying these aspects.

Finally, the relationship between the body build of the user and subjective firmness indicates that people who are overweight are more sensitive to changes in perceived firmness (and therefore in objective firmness) than slimmer people. We have checked that the correlation between BMI and difference in hardness is not significant (so the first correlation is not derived from an imbalanced experimental design). This result implies the need for some kind of customisation in mattresses: If comfort depends on perceived firmness and perceived firmness depends on hardness, subjects with different BMIs will need mattresses of different hardnesses to feel equally comfortable. In particular, we suggest that people with a high BMI will feel more comfortable over the short term using a firm mattress than a soft one.

All the results discussed above offer short-term validity. And although some of these may be valid over longer periods, certain background information indicates that after longer periods of use softer mattresses are associated with better subjective perceptions than firmer ones (Bader and Engdal, 2000). Supporting this statement are works by Kovacs and co-workers (Kovacs et al., 2004), in which a firm mattress caused a higher risk of lumbar pain in pathologic subjects than a soft mattress.

In addition, an unpublished study by the present authors carried out in nursing homes using the sample of 17 mattresses mentioned in this work (see Methods) revealed that the elderly found softer mattresses more comfortable than firmer ones after a 7-night trial. Short-term behaviour may be influenced by user education, as subjects are accustomed to hearing medical advice indicating firm mattresses for the prevention of spinal and back problems. These generalised recommendations tend to stay in users’ minds, so our results should be considered a useful guide for short-term interactions such as the purchase of a mattress. This may lead to designing mattresses to satisfy both short and longer-term perceptions, or encourage users to interact with the product for longer periods before making a purchasing decision.

In turn, if the idea of softer mattresses reaches the majority of the population, it is likely to produce a convergence between short and long-term perceptions. Future works should be addressed to clarifying these issues, in line with works initiated by Gyi (Gyi and Porter, 1999) in the field of car seats aimed at conducting long-term studies to complete previous results which were only valid for the short term.

Study Name

Effectiveness of an innovative mattress overlay for improving rehabilitation in low back pain: A pilot randomized controlled study

Publication Journal of Back and Musculoskeletal Rehabilitation
Purpose The aim of this study was to assess the effectiveness of an innovative mattress overlay as add-on treatment to LBP rehabilitation.
Methods Thirty eight LBP patients were randomized to standard rehabilitation plus mattress overlay use (cases) or standard rehabilitation only (controls). The intervention duration was 2 months and the following assessments were performed before and after: pain intensity; level of perceived back disability and sleep health; spine mobility; thickness and echo intensity of the lumbar multifidus.
Results Significant pre-post-intervention improvements were observed in cases for resting and movement pain, perceived back disability, sleep, fingertip-to-floor distance, multifidus thickness (∼ 6% increase) and echo intensity (∼ 13% decrease). On the contrary, all these variables remained constant between the two experimental phases in controls.
Conclusion A combination of rehabilitation and mattress overlay use seems an effective approach for improvement of pain, perceived back disability, sleep, spine mobility, and lumbar multifidus size and structure of LBP patients.
Study Name

A randomized controlled trial of the effectiveness of exercise and/or alternating air mattress in the control of back pain after percutaneous transluminal coronary angioplasty.

Publication Heart & Lung : the Journal of Critical Care
Purpose Objective: To determine whether an alternating air mattress, a specifically designed exercise program, or both were effective in alleviating back pain in patients after percutaneous transluminal coronary angioplasty (PTCA).
Methods Design: 2 by 2 factorial, randomized control trial.
Setting: Intermediate cardiac care unit in a Canadian regional cardiac referral center.
Subjects: The sample included 100 subjects, X age 57.4 years, undergoing PTCA.
Instruments: 10 cm visual analog and Borg scales, both of which measured subjects’ perception of pain.
Results The combination of exercise and alternating air mattress is most effective in pain reduction (p = 0.012).
Conclusion The combination of exercise and alternating air mattress is more effective in alleviating back pain in patients after PTCA than conventional methods or exercise and alternating air mattress alone.
Study Name

Associations between back pain, quality of sleep and quality of mattresses. Double-blind pilot study with hotel guests

Publication Der Schmerz
Purpose The aim of this study was to systematically investigate the associations between back pain, the quality of sleep and the quality of mattress.
Methods At check-out we asked 265 consecutive guests of a trade fair hotel about the subjective quality of sleep in the previous night. Nine rooms had been equipped with new mattresses of three different qualities and prices, but this was kept blind to the hotel staff and the guests. Sleep quality was assessed on an analog scale between 1 (very good) and 5 (very bad) and was analyzed in comparison to the remaining 8-year old mattresses of the hotel, but also with respect to social (e.g. private vs. professional reason for the stay) as well as personal (e.g. previous experience with low back and sleep complaints) characteristics of the guests.
Results The three qualities of the mattresses correlated significantly and positively with the perceived quality of sleep, but the difference to the “old” mattresses was most pronounced for those guests who were staying overnight for professional reasons, or who frequently were suffering from low back pain or sleep disturbances.
Conclusion At least for chronic sufferers from back pain and sleep problems, the association between sleep quality and quality of the mattress is significant.
Study Name

Biomechanical effects of a lumbar support in a mattress

Publication The Journal of the Canadian Chiropractic Association
Purpose The goal of this study is to measure the contact pressure forces acting on the spine with and without an inflatable support in various experimental conditions. Our hypothesis is that a lumbar support will distribute the force of gravity more uniformly over the pelvic, lumbar and thoracic areas, maintaining the lumbar lordosis, in a supine posture.
Methods In this study, 10 participants were tested when lying supine in six separate experimental conditions. These conditions varied according to the surface (no mattress, foam, mattress) and the fact that the support was inflated or not. The dependent variable measured was the contact pressure. It was measured using a pressure sensor mat (Tekscan™).
Results When the cushion was inflated the distribution of contact pressure in the different areas (pelvic, lumbar and thoracic) was modified. The comparison of the mean forces revealed that when the cushion was not inflated, the pressure distribution was mainly localized in the pelvic area. After the cushion was inflated, a significant decrease of contact pressure in the pelvic region and a significant increase in the lumbar area were observed.
Conclusion Our results confirm the hypothesis that a lumbar support inserted in a mattress allows a more homogenous distribution of contact pressure over the pelvic, lumbar and thoracic areas during supine posture. The use of an inflatable cushion favouring a transition of the contact pressure from the pelvic to the lumbar region could potentially limit unfavourable compressive and shearing forces acting on the lumbar spine.
Study Name

The foam mattress-back syndrome

Publication The Journal of the Association of Physicians of India
Purpose Objective: To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital.
Methods One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed.
Results Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattresses, only to recur after sleeping again on the foam mattress in the hospital/hostel.
Conclusion Sleeping on foam mattress is associated with the appearance of backache in medical residents which is reproducible and gets relieved after using regular cotton mattresses.
Study Name

Lower Back Pain and Sleep: Mattresses, Sleep Quality and Daytime Symptoms

Publication Sleep Diagnois and Therapy
Purpose Objective: To determine whether sleep architecture is disturbed in patients with severe lower back pain (LBP) and whether a proprietary mattress affects the quality of sleep.
Methods Patients: 8 patients with severe lower back pain.
Patients had polysomnography (PSG) on conventional spring and test mattresses within a one-week period. They also reported symptoms and quality of life in the month before PSG testing, while sleeping on their conventional spring mattresses, and after PSG testing, while sleeping on the test mattress.
Results PSG demonstrated reduced REM latency, duration and percent. Slow wave sleep was also markedly reduced (1/4 normal). There were no significant differences in PSG variables between sleep on conventional and test mattresses. One patient had an exacerbation of severe LBP in the month following PSG. In the 7 remaining, reported LBP was significantly less and SF-36-measured physical and mental health scores tended to be better (P = 0.05 and 0.07 respectively) during the month sleeping on the test mattresses.
Conclusion These preliminary data suggest that sleep architecture is disturbed in patients with LBP and that the specific test mattress may attenuate pain and enhance quality of life. Due to limitations of this small pilot, additional confirmatory studies are required.

Fibromyalgia

Study Name

Magnetic mattress pad use in patients with fibromyalgia: a randomized double-blind pilot study

Publication Journal of Back and Musculoskeletal Rehabilitation
Purpose Objective: To determine if the chronic pain and sleep disturbances experienced by patients with fibromyalgia can be improved by sleeping on a magnetic mattress pad.
Methods Design: A double-blind randomized controlled trial.
Setting: Patients’ homes and the private practice office of the principal investigator.
Patients: Thirty-five female subjects diagnosed with fibromyalgia syndrome were recruited. Thirty met inclusion/exclusion criteria and entered the study. Twenty-five completed it. One was lost to follow-up. Three were withdrawn for protocol violations and one because of an intercurrent hospitalization.
Intervention: Sleeping on an experimental (magnetized at a magnet surface field strength of 1100 ± 50 Gauss and delivering 200–600 Gauss to the skin surface or a sham (non-magnetized) mattress pad over a 16 week period.
Main Outcome Measures: Visual Analog Scales (VAS) for global wellbeing, pain, sleep, fatigue and tiredness on awakening; Total Myalgic Score; Pain Distribution Drawings; and a modified Fibromyalgia Impact Questionnaire.
Results Subjects sleeping on the experimental mattress pad experienced a significant decrease in pain (p<.05), fatigue (p<.006), total myalgic score (p<.03), and pain distribution drawing (p<.02). Additionally, these subjects showed significant improvement in reported sleep (p<.01) and physical functioning as evidenced from the modified Fibromyalgia Impact Questionnaire (p<.04). Subjects sleeping on the sham mattress pad experienced no significant change in these same outcome measures. Subjects in both the control and experimental groups showed improvement in tiredness on wakening, demonstrating a placebo effect in this parameter. Neither group showed any effect on global wellbeing.
Conclusion Sleeping on a magnetic mattress pad, with a magnet surface field strength of 1100 ± 50 Gauss, delivering 200–600 Gauss at the skin surface provides statistically significant and clinically relevant pain relief and sleep improvement in subjects with fibromyalgia. No adverse reactions were noted during the 16-week trial period.

Pressure Sores – Ulcers

Study Name

Support surfaces for pressure ulcer prevention

Publication The Cochrane Collaboration
Purpose This systematic review seeks to answer the following questions:
(1) to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the incidence of pressure ulcers compared with standard support surfaces?
(2) how effective are different pressure-relieving surfaces in preventing pressure ulcers, compared to one another?
Methods Search strategy: For this second update the Cochrane Wounds Group Specialised Register was searched (28/2/08), The Cochrane Central Register of Controlled Trials (CENTRAL)(2008 Issue 1), Ovid MEDLINE (1950 to February Week 3 2008), Ovid EMBASE (1980 to 2008 Week 08) and Ovid CINAHL (1982 to February Week 3 2008). The reference sections of included studies were searched for further trials.

Selection criteria: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure ulcers, in any patient group, in any setting. Study selection was undertaken by at least two authors independently with a third author resolving uncertainty. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as incidence and severity of new of pressure ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded.

Data collection and analysis: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis.

Results For this second update 11 trials met the inclusion criteria bringing the total number of RCTs included in the review to 52. Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure ulcers in people at risk. The relative merits of alternating and constant low pressure devices are unclear. There is one high quality trial comparing the different alternating pressure devices for pressure ulcer prevention which suggests that alternating pressure mattresses may be more cost effective than alternating pressure overlays. Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure ulcer incidence, although two studies indicated that foam overlays resulted in adverse skin changes. Two trials indicated that Australian standard medical sheepskins prevented pressure ulcers.

There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure ulcer incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and two types of operating theatre overlays are harmful.

Conclusion In people at high risk of pressure ulcer development, higher specification foam mattresses, rather than standard hospital foam mattresses, should be used. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear but alternating pressure mattresses may be more cost effective than alternating pressure overlays. Medical grade sheepskins are associated with a decrease in pressure ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.
Study Name

A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores

Publication International Journal of Nursing Studies
Purpose The main aim of the study was to compare the post operative pressure sore incidence in patients positioned on the standard operating table mattress with those positioned on the dry visco!elastic polymer pad.
Methods Four hundred and forty-six general, vascular and gynaecological surgical patients were recruited to a two centre, double triangular sequential randomised controlled trial to compare the post-operative pressure sore incidence in patients positioned on the standard operating table mattress with those positioned on the dry visco-elastic polymer pad (Action Products Inc.). Two hundred and twenty two patients were randomised to the experimental group and 224 to the standard mattress.
Results The main endpoint failure rate (a pressure sore) was found to be 11% (22\205) for patients allocated to the dry visco-elastic polymer pad and 20% (43\211) for patients allocated to the standard operating table mattress. There was a significant reduction in the odds of developing a pressure sore on the dry visco-elastic polymer pad as compared to the standard,⊝ = 0.46 with 95% confidence interval of (0.26, 0.82), P = 0.010. The adjusted point estimates of the probability of developing a pressure sore on the dry visco-elastic polymer pad and the standard operating table mattress were 0.11 and 0.21 respectively.
Conclusion The use of a dry visco-elastic polymer pad intra-operatively reduced the probability of pressure sore development by half. The minimal cost of the dry visco-elastic polymer pads in comparison to the cost of pressure sore treatment and the personal cost to patients, in relation to pain and discomfort supports their general use within theatre practice.
Study Name

Effects of Mattress Material on Body Pressure Profiles in Different Sleeping Postures

Publication Journal of Chiropractic Medicine
Purpose This study compared the body contact pressure profiles of 2 types of mattresses: latex and polyurethane.
Methods Twenty participants were required to lie down on the different mattresses in 3 different postures for 6 minutes, and their body contact pressure profiles were recorded with a pressure mat sensor.
Results The data indicated that the latex mattress was able to reduce the peak body pressure on the torso and buttocks and achieve a higher proportion of low-pressure regions compared with the polyurethane mattress.
Conclusion Latex mattress reduced peak body pressure and achieved a more even distribution of pressure compared with polyurethane mattress across different sleeping postures.
Study Name

Does a Foamy-Block Mattress System Prevent Pressure Sores? A Prospective Randomised Clinical Trial in 1729 Patients

Publication Acta Chirurgica Belgica
Purpose Pressure ulcers are a frequent complication of bed rest. The development of an efficient and low cost pressure relieving system for the prevention of bed-sores would be of considerable hospital health and economic interest. Our study was designed to determine the effectiveness in pressure-sore prevention of an interface pressure-decreasing mattress, the Kliniplot® mattress, used in our institution since 1978.
Methods In a prospective randomised controlled 7-month clinical trial we compared the Kliniplot® mattress with our standard hospital mattress in 1729 patients admitted to medical and surgical departments (neurology, cardiology, oncology-haematology, neurosurgery, thoracic surgery and orthopaedic surgery). Two groups (Klinipot® mattress and standard hospital mattress) were monitored for the prevention of pressure sores. The patients were evaluated on a daily basis from their admission until the eventual occurrence of a bed-sore. Patients’ characteristics and pressure-sore risk factors were similar at the baseline in both groups. Patients presenting with a pressure sore at the time of admission were excluded.
Results Forty-two of the 1729 patients (2.4%) who entered the study developed at least one pressure sore. Twenty-one of the 657 patients (3.2%) nursed on the Kliniplot® mattress, and 21 of the 1072 patients (1.9%) on the standard mattress developed bed-sores (p = 0.154). The median time for the occurrence of pressure sores was 31 days (range 687) with the Kliniplot® mattress and 18 days (range 2 to 38) with the standard mattress (p < 0.001). The risk categories for developing bed-sores using the modified Ek’s scale were no different at the baseline between both groups (p = 0.764). The severity of the pressure sores was no different between both groups (p = 0.918).
Conclusion Our results show that the occurrence of pressure sores is not reduced but is delayed when patients are nursed on a Kliniplot® pressure-decreasing mattress.
Study Name

Preventing Pressure Sores in Elderly Patients: A Comparison of Seven Mattress Overlays

Publication Age and Ageing
Purpose The purpose of this study was to assess which mattress is more effective for people at risk of pressure sores.
Methods Long-term elderly patients at risk of pressure sores as shown by superficial skin breaks in the pressure areas were randomly allocated to seven low-priced mattress overlays, alternating pressure (AP): Large Cell Ripplebed; constant low pressure (CLP): Preventix, a ‘Groove’ prototype, Modular Propad (contoured foam); Ardo Watersoft; Spenco, Surgicgoods Hollowcore Mattress Pad (fibrefills). Assessments of the patients’ medical condition, nursing management and pressure areas were carried out twice weekly for a mean of 17.7 days. If the pressure areas deteriorated significantly the trials were stopped and the patients were transferred to other supports
Results Thirteen per cent of trials on Ripplebeds had to be stopped compared with 32%, 35% and 37% respectively on contoured foam mattresses (p = 0.0005), 47% on the water mattress (p < 0.001) and 51% and 54% on fibrefills (p < 0.0001). Respective healing rates were: 45%, 37%, 24% and 20% (p = 0.001).
Conclusion Although the contoured foam mattresses provided better protection than the fibrefills (p < 0.01), only the AP mattress effectively prevented and healed sores in these patients who could not be regularly repositioned.
Study Name

Mattresses and beds

Publication Journal of Wound Care
Purpose The aim of this paper is to provide a guide to systems available for relieving and reducing pressure.
Methods The study reviews the types of support systems, providing a short description of each, details of how to use them and examples of mattresses and beds. It also lists the questions to be considered when selecting a support system.
Type of support systems reviewed: air support systems (5 types), fibre and foam support systems, and gel support systmes.
Results n/a
Conclusion The study reviews the types of support systems, providing a short description of each, details of how to use them and examples of mattresses and beds. It also lists the questions to be considered when selecting a support system.
Type of support systems reviewed: air support systems (5 types), fibre and foam support systems, and gel support systmes.There is a wide range of pressure-reliev- ing/reducing mattresses and beds to choose from. The lack of evidence to support the effectiveness of one system over another creates problems. While a flow chart may assist in the decisionmaking process, further investigation is required to evaluate such tools.
Study Name

A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents

Publication International Journal of Nursing Studies
Purpose Objectives: To compare the effectiveness and cost of static air support surfaces versus alternating air pressure support surfaces in a nursing home population at high risk for pressure ulcers.
Methods Design: Prospective, multicentre, randomised controlled clinical, non-inferiority trial.
Setting: Twenty-six nursing homes in Flanders, Belgium.
Participants: A consecutive sample of 308 participants was selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair bound, aged > 65 years, and use of an alternating air pressure mattress.
Methods: The participants were allocated to the intervention group (n = 154) using static air support surfaces and the control group (n = 154) using alternating air pressure support surfaces. The main outcome measures were cumulative incidence and incidence density of the participants developing a new category II–IV pressure ulcer within a 14-day observation period, time to develop a new pressure ulcer, and purchase costs of the support surfaces.
Results The intention-to-treat analysis revealed a significantly lower incidence of category II–IV pressure ulcer in the intervention group (n = 8/154, 5.2%) than in the control group (n = 18/154, 11.7%) (p = 0.04). The median time to develop a pressure ulcer was significantly longer in the intervention group (10.5 days, interquartile range [IQR]: 1–14) than in the control group (5.4 days, [IQR]: 1–12; p = 0.05). The probability to remain pressure ulcer free differed significantly between the two study groups (log-rank X² = 4.051, df = 1, p = 0.04). The overall cost of the mattress was lower in the intervention group than in the control group.
Conclusion A static air mattress was significantly more effective than an alternating air pressure mattress in preventing pressure ulcer in a high-risk nursing home population. Considering multiple lifespans and purchase costs, static air mattresses were more cost-effective than alternating air pressure mattresses.
Study Name

A randomized trial of low-air-loss beds for treatment of pressure ulcers

Publication Journal of the American Medical Association
Purpose Objective: To assess the effectiveness of low-air-loss beds for the treatment of pressure ulcers in nursing homes.
Methods Design: Prospective, randomized, clinical trial.
Setting: Three teaching nursing homes in Los Angeles, Calif.
Subjects: Eighty-four nursing home residents with trunk or trochanter pressure ulcers (Shea stage > or = 2).
Interventions: Subjects were randomly assigned to use either a low-air-loss bed (n = 43) or a 10-cm corrugated foam mattress (n = 41) throughout the healing of their ulcers.
Outcome measures: Ulcers were assessed twice weekly using surface area and two observational scales (median follow-up, 37.5 days; range, 4 to 571 days).
Results Groups were similar with respect to demographics, medical variables, wound care, and early dropouts. Results indicate more than a threefold improvement in median rate of healing for low-air-loss beds compared with foam mattresses (9.0 vs 2.5 mm2/d; P = .0002). This finding was true for deep as well as superficial ulcers (deep ulcers, 9.9 vs 0.7 mm2/d; P = .02; superficial ulcers, 9.0 vs 3.2 mm2/d; P = .004). Cox regression models revealed that the bed, ulcer depth, and fecal continence had independent effects on healing. After controlling for fecal continence, the deep and superficial subgroups using low-air-loss beds remained 2.5 times more likely to heal in a given length of time compared with those using foam mattresses (combined cure probability ratio, 2.66; 95% confidence interval, 1.34 to 5.17; P < .004).
Conclusion Low-air-loss beds provide substantial improvement compared with foam mattresses despite other factors in pressure ulcer healing.
Study Name

Use of Pressurease and Airform mattresses in pressure ulcer care

Publication British Journal of Nursing
Purpose This article reviews two mattresses from Sareo Healthcare Ltd: a static system, Pressurease; and a unique dynamic system, Airform. These two systems offer a cost-effective and clinically effective method of pressure ulcer prevention and therapy.
Methods Tests completed on Pressurease: Initial laboratory tests have indicated that the Pressurease mattress provides good interface pressures. Further laboratory testing is currently in progress. A nursing home that was identified as having a substantial incidence of pressure ulcers has been supplied with Pressurease mattresses for each bed. An audit of pressure ulcer incidence is to be carried out monthly and this will continue over a period of 3 years in order to identify pressure ulcer incidence reduction and longevity of the Pressurease mattress.
Case study for the Airform mattress: Mrs A is a 72-year old lady with diabetes. Unable to control her condition through selfmedication (blood glucose of 35 mmol), she was admitted to a nursing home for care. Polyurea caused her to use the commode every hour, where she would sit for up to 45 minutes at a time. Mrs A refused catheterization and a sacral pressure ulcer began to develop due to the time spent sitting on a hard surface (Figure 3). She finally agreed to a temporary catheter until the diabetes could be controlled. The sacral pressure sore continued to develop over the following 2 weeks. After 2 weeks, Mrs A was supplied with an Airform mattress and the nurses were instructed by the tissue viability nurse consultant as follows:
1. Mrs A could sit or lay on the pressure ulcer site as much as she wished or could tolerate
2. She should either be kept in bed or allowed to walk around and mobilization should gradually increase. Figures 4 and 5 demonstrate the rapid healing of the pressure ulcer following the provision of an Airform mattress.
Mrs A is now mobilizing very well and claims to be very comfortable on the Airform. Her blood sugars remain fairly high and unstable but her physical condition and strength is improving. Mrs A will remain on Airform until the pressure
ulcer is healed when she will be provided with a Pressurease mattress.
Results In terms of pressure ulcer prevention, the Pressurease mattress is used for prevention, and the Airform mattress for therapy.
The Intellifoam used in the Pressurease mattress quickly responds to body movements and redistributes pressure over bony prominences.
Intellifoam is inherently fire retardant.
The Airform mattress utilizes alternating air therapy with viscoelastic foam resulting in a comfortable alternating pressure-relieving system.
Conclusion Pressure ulcer prevention need not be complicated or expensive. The provision of Airform and Pressurease, education on physical assessment and a pressure ulcer management policy is a cost-effective method of preventing pressure ulcers.
Study Name

Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study

Publication Journal of Wound Care
Purpose Our aim was to compare Axtair One, an alternating pressure air mattress (APAM), with a viscoelastic foam mattress (VFM) in elderly patients at moderate to high risk of developing pressure ulcers (PUs).
Methods A randomised, controlled, superiority, parallel-group, open-label, multicentre study, was conducted, between February 2012 and March 2015, in nine French, medium- and long-term stay facilities. Eligible patients were aged 70 and over, had no PUs on enrolment, were bedridden for at least 15 hours per day, had reduced mobility, an absent or minimal positioning capability, a Braden score <14, a nutritional status score >12 and a Karnofsky score <40%. The primary endpoint was the appearance of PUs over a 30-day monitoring period. The primary objective was to demonstrate a 50% reduction in instantaneous risk of PUs in the APAM versus the VFM group. Secondary objectives were to determine if preventive care was less frequent in the APAM group, the instantaneous relative risk of PUs (hazard ratio) was constant over time and the comfort experienced was higher in the APAM group and to verify the uniformity of the preventive benefit of an APAM, regardless of the level of exposure to major risk factors for PUs.
Results We randomised 76 patients (39 in the APAM group and 37 in the VFM group). The groups were comparable on enrolment and throughout the study. The cumulative risk of PUs was estimated at 6.46% [95% confidence interval (CI): 1.64; 23.66] in the APAM group and at 38.91% [95% CI: 24.66; 57.59] in the VFM group, p=0.001 (log-rank test). The adjusted hazard ratio according to the Cox model with four prognostic factors for the appearance of PUs was 7.57 [95% CI: 1.67; 34.38, p=0.009]. Preventive care proved to be equivalent in both groups. The only risk factor significantly associated with an increased risk of PUs was the type of mattress (VFM). The comfort and tolerance perceived by the patients were both high and similar in the two groups. The constancy over time of the preventive benefit of an APAM could not be verified because of the lack of a sufficient number of events (appearance of PUs) in the APAM group.
Conclusion The APAM was superior to a VFM for preventing PUs in elderly patients, bedridden for more than 15 hours per day, severely dependent, at moderate-to high-risk of PUs, with an instantaneous risk for the appearance of PUs 7.57 times greater in the VFM group than in the APAM group. This study provides descriptive information and evidence for practice.
Study Name

Effects of Mattress Material on Body Pressure Profiles in Different Sleeping Postures

Publication Journal of Chiropractic Medicine
Purpose This study compared the body contact pressure profiles of 2 types of mattresses: latex and polyurethane.
Methods Twenty participants were required to lie down on the different mattresses in 3 different postures for 6 minutes, and their body contact pressure profiles were recorded with a pressure mat sensor.
Results The data indicated that the latex mattress was able to reduce the peak body pressure on the torso and buttocks and achieve a higher proportion of low-pressure regions compared with the polyurethane mattress.
Conclusion Latex mattress reduced peak body pressure and achieved a more even distribution of pressure compared with polyurethane mattress across different sleeping postures.
Study Name

Alternating pressure air mattresses as prevention for pressure ulcers: A literature review

Publication International Journal of Nursing Studies
Purpose The purpose of this paper is to examine and synthesise the literature on alternating pressure air mattresses (APAMs) as a preventive measure for pressure ulcers.
Methods Design: Literature review.
Data sources: PubMed, Cinahl, Central, Embase, and Medline databases were searched to identify original and relevant articles. Additional publications were retrieved from the references cited in the publications identified during the electronic database search.
Results Thirty-five studies were included. Effectiveness and comfort of APAMs were the main focuses of the studies evaluating APAMs. Pressure ulcer incidence, contact interface pressure, and blood perfusion were the most frequently used outcome measures to evaluate the effectiveness of APAMs. Fifteen randomised controlled trials (RCTs) analysed the pressure ulcer incidence. One RCT compared a standard hospital mattress with an APAM and found that the APAM was a more effective preventive measure. RCTs comparing APAMs with constant-low-air mattresses resulted in conflicting evidence. There was also no clear evidence as to which type of APAM performed better. All RCTs had methodological flaws. The use of contact interface pressure and blood perfusion measurements to evaluate the effectiveness of APAMs is questionable. Comfort of APAMs was the primary outcome measure in only four studies. Different methods for assessment were used and different types of APAMs were evaluated. Better measures for comfort are needed. A few studies discussed technical problems associated with APAMs. Educating nurses in the correct use of APAMs is advisable.
Conclusion Taking into account the methodological issues, we can conclude that APAMs are likely to be more effective than standard hospital mattresses. Contact interface pressure and blood perfusion give only a hypothetical conclusion about APAMs’ effectiveness. Additional large, high-quality RCTs are needed. No conclusions can be drawn regarding the comfort of APAMs. A number of technical problems associated with APAMs are related to nurses’ improper use of the devices.
Study Name

An exploration of nursing home residents’ experiences of a non‐powered static air mattress overlay to prevent pressure ulcers

Publication International Wound Journal
Purpose This explorative, qualitative study aimed to explore the true meaning of elderly nursing home residents’ perspectives and critical success factors when implementing a new non‐powered static air mattress overlay to prevent pressure ulcers.
Methods Individual, loosely structured interviews were conductedin 12 nursing homes in Flanders, the Northern region of Belgium, a convenience sampling of 14 nursing home residents were selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair‐bound, aged >65 years, and use of an alternating air pressure mattress previous to the application of the non‐powered static air mattress overlay. Interviews were conducted in the participants’ personal rooms between June 2017 and March 2018. Interviews included broad, open‐ended questions, to invite and encourage participants to openly discuss their perspectives and experiences. Participants were interviewed once during the 14‐day observation period between day 3 and day 14. All interviews were audio‐recorded and fully transcribed by an experienced transcriber. Interviews were read several times to reveal emerging patterns and were marked with codes into NVivo 10 qualitative data analysis software. During the process, (sub) themes were discussed by the authors until a consensus was reached. Three main themes emerged from the analysis process: rest and sleep; mobility; and discomfort and pain associated with the use of the support surface. Themes were divided into multiple subthemes: motion, noise, sensation, repositioning, and transfer in and out of bed. Through interviews, critical success factors associated with the implementation were identified, including the lack of information and time needed to evaluate the functionality and effects of a new mattress overlay.
Results Implementation of a non‐powered static air mattress overlay to prevent pressure ulcers has a far‐reaching impact on nursing home residents’ experiences. This study provides insight into the true meaning of patients’ perspectives by focusing on learning from the patients’ experiences that provide valuable information for healthcare professionals and other stakeholders.
Conclusion Support surfaces that prevent pressure ulcers have an impact on the experiences of nursing home residents. The decision to select pressure reduction support surfaces is commonly based on comparative effectiveness research. Besides quantitative indicators (e.g. incidence, prevalence, cost), the impact on the quality of life (e.g. influence on rest and sleep, mobility, pain) should also be considered. This explorative study provides insight into the true meaning of patients’ perspectives by focusing on learning from the patients’ experiences that provide valuable information for healthcare professionals and other stakeholders. The healthcare manufacturing industry, commerce, policymakers, and professionals might also base their decisions on quantitative and qualitative indicators before production or introduction of such products or services into daily practice.
Study Name Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT
Publication Health Technology Assessment
Purpose PRIMARY OBJECTIVE: Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM).
Methods DESIGN: A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). SETTING: The trial was set in 42 secondary and community inpatient facilities in the UK.
PARTICIPANTS: Adult inpatients with evidence of acute illness and at a high risk of PU development. INTERVENTIONS AND FOLLOW-UP: APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up.
MAIN OUTCOME MEASURES: Time to event.
Results From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase.

There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns.

Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness.

LIMITATIONS: A lower than anticipated event rate.

Conclusion In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU.
Study Name

The Cost-Effectiveness of Pressure Redistribution Mattresses for Early Prevention of Pressure Ulcers In Patients Admitted to Hospitals via the Emergency Departments

Publication THETA Report
Purpose Objectives: To evaluate the cost-effectiveness of pressure-redistribution mattresses (PRMs) compared to standard mattresses (SMs) on emergency room stretchers and beds for the prevention of pressure ulcers (PrUs) in patients admitted to hospitals via emergency departments.
Methods Design: A Markov history model of PrUs was developed. Input data for prevalence of hospital-acquired (H-A) PrUs, health utility and costs were derived from population-based data sources. A cost-utility analysis was conducted according to the Ontario health system perspective and 1-year time horizon.
Setting & Participants: Hypothetical cohort of patients admitted to acute-care hospitals via ERs.
Intervention: PRMs versus SMs on ER stretchers and beds
Measurements: Prevalence of H-A PrUs, incremental quality-adjusted life years, incremental costs, and incremental cost-effectiveness ratios.
Results Approximately 1 in 6 emergency-admitted patients experienced H-A PrUs. PRMs reduced the prevalence of H-A PrUs by 2.2% (range: 1.7%, 2.6%); on average, 47 patients need to be on PRMs to prevent one H-A PrU. The mean cost saving associated with PRMs was $74 per patient for the 258,000 targeted cases per year in Ontario. PRMs had a 68% chance of improving health while saving costs. The aggregate direct cost saving to hospitals’ budgets would be $17 million per year.
Conclusion The use of PRMs for ER stretchers and beds reduces the incidence of PrUs, alleviates the associated morbidity, saves direct costs to hospitals, and has a modest preventive effect on a large volume of patients at perhaps one of the highest risk periods of their hospital experience.
Study Name

Evaluation of patient outcomes: pressure ulcer prevention mattresses

Publication British Journal of Nursing
Purpose This article reports the findings of a small evaluation audit which compares the Dyna-Form Mercury Advance Mattress to that of the Softform Premier Active Mattress (a foam mattress with dynamic underlay).
Methods A small group of patients with similar co-morbidities who were an emergency admission were recruited to an evaluation audit. Their median age and Waterlow score indicated that these patients were at high risk of pressure ulcer development. All patients were given the same nursing care on the two mattresses and all were moved, handled and repositioned 2-4 hourly.
Results Of the patients nursed on the Dyna-Form Mercury Advance mattress, three did not develop pressure ulcers. The two who already had pressure ulcers when they were recruited appeared to have healed within four days. Of the patients nursed on the Softform Premier Active mattress, three patients did not develop ulcers and two did. Although the sample size was small, the comprehensive assessment gave interesting results, particularly on the Dyna-Form Mercury Advance. A larger study may be of benefit to demonstrate efficacy of these products further.
Conclusion Although the results given in this audit demonstrate that Dyna-Form Mercury Advance mattress helps to prevent the development of pressure ulcers as well as healing superficial pressure ulcers, a large trial would further substantiate these results.

The prevention of pressure ulcers and reducing incidence is a quality indicator and access to appropriate equipment is essential.
Health organization expenditure is high in association with preventing pressure ulcers and with equipment costs, treatment and litigation.
The Dyna-Form Mercury Advance Mattress gave interesting results on the prevention and treatment of pressure ulcers.
Holistic assessment of the skin, repositioning, nutrition and nursing care by knowledgeable staff make a significant contribution to the overall care that the patient receives.

Study Name

Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home

Publication Journal of Tissue Viability
Purpose At present, the evidence regarding the type of mattress that is the best for preventing pressure ulcers is not convincing. In a single center, prospective, controlled trial we compared a static air overlay mattress (no electric pump needed) on top of a cold foam mattress with a cold foam mattress alone on pressure ulcer incidence in nursing home residents.
Methods 83 Patients were included in the study with a score lower than 12 points on the Norton scale and no pressure ulcer at the start of the study. 42 Patients received a cold foam mattress and 41 patients received a static air overlay on top of that cold foam mattress. Out of bed we standardized the pressure reduction in sitting position by using a static air cushion in both groups. Patients were checked weekly in both groups for pressure ulcers.
Only when there were signs of developing a pressure ulcer grade 2 or higher, repositioning by our nursing home pressure ulcer protocol (PU protocol) was put into practice.
Results Seven patients (17.1%) on a cold foam mattress and two (4.8%) on a static air mattress developed a pressure ulcer grade 2 or more. There was no difference regarding pressure ulcer incidence between patients with a high risk (Norton 5–8) and patients with a medium risk (Norton 9-12). In 5 out of 7 patients who developed a pressure ulcer on a foam mattress the ulcers showed no healing using our PU protocol. In the static air group all pressure ulcers healed by regular treatment according to our PU protocol.
Conclusion In this study, static air overlay mattresses provided a better prevention than cold foam mattresses alone (4.8% versus 17.1%). The Norton scores of the patients in both groups did not change during the 6 month trial period. Our decision to use repositioning only when there were signs of a pressure ulcer seems to be acceptable when a static air overlay is in position. However, the score of 17.1% development (incidence) of pressure ulcers in the foam group may stress the need of repositioning when using only this type of mattress.

Sleep Apnea

Study Name

Mattress and pillow for prone positioning for treatment of obstructive sleep apnoea.

Publication Acta Oto-Laryngologica
Purpose The aim of the present study was to evaluate the effect of the prone body and head sleep position on severity of disease in patients with OSA after 4 weeks of adaptation to a mattress and pillow facilitating prone positioning.
Methods Fourteen patients with mild to severe OSA, 11 men and 3 women with a mean AHI of 26 (min, 6; max, 53) and mean ODI of 21 (min, 6; max, 51) were evaluated. Two polysomnographic (PSG) studies were performed. The first PSG study was without any treatment and the second was after 4 weeks of adaptation to the MPP for prone positioning of the body and the head.
Results Mean AHI and ODI decreased from 26 and 21 to 8 and 7, respectively (p < 0.001) with treatment. The mean time spent in the supine position was reduced from 128 to 10 min (p = 0.02) and the prone time increased from 42 to 174 min (p = 0.02) with the MPP. The mean total sleep time was 390 min during the first PSG study night without treatment and 370 min during the second night with the MPP (p = 0.7). Ten patients (71%) reduced their AHI by at least 50% and reached a value < 10 during treatment. All patients managed to sleep on the MPP for > 4 h per night during the 4-week study.
Conclusion The new mattress and pillow for prone positioning (MPP) is efficient in reducing the apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) in most patients with obstructive sleep apnoea (OSA), with satisfactory compliance.

Mattress Toppers

Study Name

Better combination of thickness and hardness of mattress topper for supine sleeping posture: A physiological measurements evaluation

Publication International Journal of Industrial Ergonomics
Purpose The aim of this study was to determine the thickness and hardness effect of a mattress topper by measuring the four physiological measurements from 40 healthy males.
Methods Forty healthy males were recruited for this study. To avoid the effects of different body shapes, participants were distributed evenly across four body shape groups (underweight, normal, overweight, and obese), according to body mass index (BMI).

The experimental mattress (King Koil Licensing Company, Inc. Hinsdale, IL) was the same as the one used by DeVocht et al. (2006). The experimenter randomly placed a topper on the mattress before evaluation. The experiment was conducted in a climatic chamber (HT-9745A, Hung Ta Instrument Co., LTD., Taiwan). The experimental ambient environment was specified at a temperature of 26+/- 0.5 degrees C and a relative humidity (R.H.) of 60 +/- 3% R.H. The temperature and relative humidity level specified in the chamber were to simulate a comfortable sleeping environment.

Participants were requested to wear two-piece pajamas (65% polyester and 35% cotton). Three pajamas of different sizes (M, L, and XL) were provided for participant selection. To simulate a real sleeping situation, pillows made of hydrophilic polyurethane were used in this study.

In total, three hardness levels (hard, medium, and soft) and four thicknesses (30, 50, 70, and 100 mm) were evaluated. The size of the toppers was 1820 mm x 1880 mm. The material of the hard topper was made of polyester with a hardness between 20 and 30 degrees F. The memory foam and polyurethane for medium-hard toppers had a hardness of 15–20 degrees F and those for soft toppers had a hardness of 10–15 degrees F. Polyester, memory foam, and polyurethane are the most common materials used for mattress manufacturing. Other than the materials, the toppers used in the study had the same physical properties, such as dimensions and hygroscopicity.

However, the thicknesses of the commercially available toppers varied. Most of the commercially available toppers were produced with a minimal thickness of 30 mm and a maximum thickness of 100 mm. This study selected toppers with 30-, 50-, 70-, and 100-mm thicknesses for evaluation. The 12 toppers were covered with identical thin 100% cotton sheets to avoid extraneous influences. During the experiment, the participants were not aware of the particular sleeping system they were laying on merely from the appearance of the forming surface of each topper.

Body pressure distribution data were collected using a body pressure measurement system (BPMS™ Model 5400N, Tekscan, Inc., USA) and were analyzed by its software (BPMS Research 7.00).

A real-time tactile temperature analysis system (Tactilus, Sensor Product Inc., USA) was used to measure body temperatures.
The Biopac MP 150 system (Biopac System Inc., USA) was used to collect Electromyography (EMG) responses.

Spinal alignment measurement: Eight markers were placed on the participant’s back, including near the vertebrae C7, T1, T4, T6, T8, T12, L1, and L4 (Verhert et al., 2012). The experimenter was trained at a hospital program to palpate the participant’s spine, so as to identify and mark the tips of these selected positions. When all eight landmarks were placed, each participant was instructed to lie comfortably in the lateral position on different experimental combinations. A camera (Model NEX-VG10, Sony Corporation) was placed on a tripod and was used to record spinal alignment data.

Results A proper sleeping system should have the characteristics of (1) minimizing and distributing body pressures, (2) maintaining a straight spine, (3) avoiding muscle fatigue, and (4) maintaining a suitable body temperature (Chiba et al., 2018; Califano et al., 2017; Chen et al., 2014; Verhaert et al., 2013).

The results showed that the use of a thin mattress topper (30 mm) significantly induced lower body pressure and temperature, higher muscle activities in the biceps femoris, and a straighter spinal alignment in the T12–L4 vertebrae. The use of a hard mattress topper significantly induced a higher body pressure, a lower body temperature in the lower extremities, a higher EMG (%MVC) in the trapezius, but a lower EMG (%MVC) in the biceps femoris, and a straighter spinal alignment at T1–T4, T4–T6, and T6–T8. Overall, a soft topper of 30-mm thickness was suggested as the best combination. The findings can provide very useful information for topper design and selection.

Conclusion Based on the majority of the results of the study, a soft topper with 30-mm thickness was suggested. Moreover, applying a hard material in the thigh area could improve muscle activities in the biceps femoris and body temperature performances. Thus, using a 30-mm soft topper as the base and replacing the thigh region with a 100-mm hard material would be the best arrangement considering the results of all measurements in this study. The findings of this study can provide useful information for the design and selection of an ergonomic mattress topper.

  • The thickness and hardness of mattress topper had significant effects on the physiological measurements.
  • A thin mattress topper (30 mm) caused significantly lower body pressure and temperature distribution.
  • A soft topper with 30 mm thickness was suggested as the best combination.
Study Name

High rebound mattress toppers facilitate core body temperature drop and enhance deep sleep in the initial phase of nocturnal sleep

Publication PLOS ONE
Purpose In the current study, we have evaluated effects of a high rebound mattress topper [HR] on sleep and its associated physiology, and the effects were compared to those of a low rebound mattress toppers (LR) in healthy young (n = 10) and old (n = 20) adult males.
Methods Design: a randomized, single-blind, cross over design. PSG and evaluation of sleep related physiology; EMG activity measures during rolling over
Subjects: Two subject groups, one consisting of ten healthy young adults (study I) and another of twenty health old adults (study II), were included for sleep evaluation. In a separate study, eight healthy young adult male subjects were evaluated for muscle activity during roll over motions during the daytime.
Intervention: sleeping on a high rebound mattress topper [HR] and a low rebound mattress toppers (LR).
Materials: For HR, polyethylene fiber-resin-based mattress toppers (airweave® toppers, airweave inc., Tokyo, Japan) and for LR, urethane-based memory foam mattress toppers (Topper Deluxe 3.5, TEMPUR-SEALY Japan Ltd., Kobe, Japan) were used. Both toppers were commercially available in Japan. The topper sizes were approximately the same (HR: 195x100x3.5 cm, LR: 195x97x3.5 cm), and HR was 16% lighter than LR (HR: 6.7 kg, LR: 8.0kg). The toppers were placed on top of regular mattresses/beds equipped at the Ota Memorial Sleep Center, Kawasaki, Japan, where the PSG was carried out (S1 Fig).
Results Design: a randomized, single-blind, cross over design. PSG and evaluation of sleep related physiology; EMG activity measures during rolling over
Subjects: Two subject groups, one consisting of ten healthy young adults (study I) and another of twenty health old adults (study II), were included for sleep evaluation. In a separate study, eight healthy young adult male subjects were evaluated for muscle activity during roll over motions during the daytime.
Intervention: sleeping on a high rebound mattress topper [HR] and a low rebound mattress toppers (LR).
Materials: For HR, polyethylene fiber-resin-based mattress toppers (airweave® toppers, airweave inc., Tokyo, Japan) and for LR, urethane-based memory foam mattress toppers (Topper Deluxe 3.5, TEMPUR-SEALY Japan Ltd., Kobe, Japan) were used. Both toppers were commercially available in Japan. The topper sizes were approximately the same (HR: 195x100x3.5 cm, LR: 195x97x3.5 cm), and HR was 16% lighter than LR (HR: 6.7 kg, LR: 8.0kg). The toppers were placed on top of regular mattresses/beds equipped at the Ota Memorial Sleep Center, Kawasaki, Japan, where the PSG was carried out (S1 Fig).
Conclusion These results suggest that sleeping with HR in comparison to with LR, may facilitate restorative sleep at the initial phase of sleep.

In conclusion, we found that sleeping with HR induced a large decline in core body temperature in the initial phase of nocturnal sleep both in young and old subjects, and declines in the core temperature were associated with increase in deep sleep/delta power after sleep onset. The sleep improvement we observed with HR was relatively small, but this effect may still contribute significantly for the restorative roles of sleep, as experimental evidences have suggested that the first NREM sleep cycle is of importance for functions of sleep. The smaller muscle activity required to roll over in a daytime experiment is another feature of HR that likely contributes to the restoration during sleep.
Regardless of these limitations, our results suggest the possibility that types of bedding significantly affect sleep and its associated physiology, and bedding material/structures selection would likely improve sleep quality, therefore, further research is warranted.

 

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