Pressure ulcer prevention and healing using alternating pressure mattress at home: the PARESTRY project

Objective: Specialised pressure-relieving supports reduce or relieve the interface pressure between the skin and the support surface. The comparative effectiveness of dynamic support surfaces is debated. The aim of this study is to examine the impact of using an alternating pressure air mattress (APAM) on pressure ulcer (PU) incidence in patients receiving home-based care. A second aim was to determine the level of patient/family satisfaction with comfort and gain the views of the care team that used the APAM. Method: The PARESTRY study was a prospective observational study conducted in patients with a high risk of PUs (Braden score < 15), discharged to hospital-care at home. The primary prevention groups consisted of patients with no PU at baseline who were in bed for at least 20 hours a day. Patients at baseline with a category 3 or 4 PU or a category 1 or 2 PU in association with poor general health or end-of-life status were included in the secondary prevention group. All patients were laid on an APAM. The primary end point was the % of patients with a worsening skin condition in the pressure area (heel, sacrum, ischium) at day 90 or at the end of the study. The primary analysis was done on the full analysis set (patients included with at least a second assessment), using the last observation carried forward technique to handle missing data, at day 90. A 95% confidence interval was calculated. Results: Analysis was performed on 92 patients (30 in primary prevention and 62 in secondary prevention). The average time spent in bed was 22.7 (SD 2.7) hours a day and 22.6 (SD 2.2) hours in the primary and secondary prevention groups, respectively. At baseline, in the secondary group, 77% of patients had a sacral PU, 63% a heel PU, 8% an ischial tuberosity PU and 45% a PU in another area, a number of patients having multiple PUs. In the primary prevention group, 63% (19/30) of patients dropped out of the study (5 were hospitalised, 9 died, 5 other causes). In the secondary prevention group, 61% (38/62) dropped out (7 were hospitalised, 23 died, 8 others causes). In the primary prevention group, only one patient had worsening skin condition. In the secondary prevention group, 17.7% (11/62: 95% CI: 8.3-27.2) of patients had worsening skin condition. The number of PUs decreased regardless of location. At the end of follow-up, 49% (45/92) of patients had a PU versus 67% (62/92) at baseline Conclusion: This work provides data on the incidence of PUs in patients at high risk, who are using APAMs, and, following inpatient hospitalisation, are taken into home health-care centres. The results of the study highlight the importance of continuity of care across transitions between care settings.