Search this resource

Clinical rationale

Pressure care mattresses (support surfaces) are designed to reduce the interface pressure through increasing the body surface area or alternating the area in contact with the support surface.

Main types of mattresses

Reactive (constant low pressure, static, pressure redistributing) support surface

  • Powered or non-powered
  • Has the ability to change its load distribution properties in response to a pressure load
  • Moulds to the person’s shape through immersion and envelopment in order to redistribute body weight over a larger contact area
  • Interface pressure remains constant while the person remains in one position but is redistributed over a wider surface area.

Active (alternating pressure, pressure relieving) support surface

  • Produces alternating pressure through mechanical means regardless of the pressure load
  • Achieved through alternation of air pressure in support surface air cells on a programmed cycle time
  • Mechanism continually changes the part of the body experiencing higher pressure loads.

Individual characteristics

  • Pressure injury history
  • Level of injury including sensory and motor function
  • Height and weight
  • Bed mobility: Can the person change position independently?
  • Method of transferring into bed: Can the person transfer independently or is a hoist required?
  • Continence management
  • Pain
  • Spasm.


An adequate trial of at least a week is essential in determining the suitability of a mattress.

If the trial occurs in hospital, ensure that conditions at home are simulated e.g. turns or no turns overnight.

Once a mattress has been selected for trial:

  1. The person should lie on it for an hour or two.
  2. Undertake a thorough skin check prior to sleeping on it overnight.

Considerations when assessing the suitability of a mattress


  • Has skin integrity been maintained?
    • Pink or red skin over bony prominences indicates that the mattress is not effective.
  • Does the person bottom out?
    • Assess by doing a hand check under the lowest point of the body on the mattress when the person is lying and sitting to check for mattress compression.
  • Does the mattress control friction and shear?


  • Is it comfortable?
  • Was there any effect on sleeping patterns?


  • Is functional status maintained? (e.g. bed mobility, ability to dress and self-catheterise)


  • What is the impact on transfers?
  • Is the surface stable enough to maintain safe transfers?
  • Does the floor to top of mattress height interfere with transferring ability?


  • Does the mattress control moisture and temperature?

Noise and power source

  • If there is a pump, can the person tolerate the noise of the pump?
  • Is there a reliable power source? Consider use of uninterrupted power supply in remote areas.


  • Is the mattress type and height compatible with partner’s sleeping arrangements?


  • Is there any impact on carers?

Further information

Clinical guidelines and information

Clinical practice tool

Back to top