Delivery, setup and adjustment: pressure redistribution mattresses
In this phase, the trained health professional will monitor the proposed assistive technology (AT) delivery timeframe with the product specialist, facilitate correct setup at the time of delivery, and ensure any necessary adjustments and education have been completed. This is essential to ensure the correct AT has been provided as prescribed and for it to function as intended.
Delivery
When ready, delivery is arranged to occur when the trained health professional, the person with spinal cord injury (SCI) and their support network (where relevant) are present.
Considerations for delivery of pressure redistribution mattresses
- Confirm the prescription: check that the delivered mattress model, size, pressure‑redistribution type/mechanism, and any accessories (e.g., pumps, covers, power cords, mounting hardware) correspond exactly to what was prescribed and approved in the quote/funding application.
- Review the person’s most recent physical and skin integrity assessment: ensure the mattress prescription remains appropriate, particularly when there has been a delay between assessment and delivery, or when the person’s weight, mobility, posture, or skin condition may have change.
- Suitable delivery environment: confirm adequate space around the bed for installation, safe manual-handling access, and appropriate flooring and power outlets (if applicable).
- Equipment required for safe transfer: if other AT (e.g., hoist, slide board, slide sheets) or additional assistance is required to transfer the person on/off the mattress for setup, ensure these are available and ready at the time of delivery.
- Education: provide thorough education on safe use, daily care, pump operation (if applicable), cleaning, troubleshooting, and maintenance requirements. Supply written instructions or manufacturer user guides where possible and involve the person’s support network.
- Contact information: confirm the person and their support network know how to contact the supplier/product specialist for technical support, warranty issues, or future review needs.
- Determine whether a follow-up is required: identify if and when a follow-up appointment is needed to review comfort, function, skin integrity, and mattress performance once the person has trialled the mattress in their typical environment.
The trained health professional should finalise documentation to include:
- the setup completed, including any adjustments made.
- the context of the delivery, including all attendees
- the AT supplied versus any errors or omissions, including a plan for the product specialist to correct
Setup and adjustment
To facilitate optimal performance, the trained health professional should ensure the AT is setup and adjusted for the person.
Consideration should be given to the person’s:
- body dimensions
- comfortable and optimal posture
- function
- environment
- skin integrity
- previous experience using AT
- support network requirements.
Considerations for set-up and adjustment of pressure redistribution mattress
Common adjustments to optimise pressure redistribution mattress setup and performance may include:
| General Adjustments (applies to all mattresses) | Clinical Considerations |
| Positioning on the mattress | – Ensure the person with SCI is positioned in the correct therapeutic zones for optimal pressure redistribution e.g., head – body – feet |
| Bed base fit and integration | – No overhang, correct alignment, entrapment gap checks, secure fastening/straps if applicable -Mattress articulation zones should align with the bed’s hinge points to maintain consistent support during head and leg elevation. |
| Cover fit and tension | – Correct cover orientation; ensure it is not overly tight or loose to maintain immersion and reduce shear – Particularly important if custom size or bed box /surround in situ |
| Edge / perimeter stability | – Confirm sufficient boundary support for sitting, activities of daily living, and bed mobility |
| Cable/hose management | – Ensure cords/tubing are safely positioned and not kinked, twisted, creating hazards or pressure points |
| Transfer related adjustments | – Confirm mattress stability for slide board, pivot, or hoist transfers – Use transfer optimising functions if available (e.g., max inflate) |
| Weight calibration (if applicable) | – Some systems require manual entry of the user’s weight to optimise pressure settings |
| Microclimate considerations | Use appropriate covers; ensure airflow around the mattress; adjust environmental factors (room temp, bedding) |
| Air mattress specific adjustments | Clinical Considerations |
| Initial setup and safety considerations | – Fully inflate the mattress (e.g. max inflate function) before supporting the person to transfer onto it. – Conduct a bottoming‑out (hand check) after positioning and after all firmness, mode, weight and Fowler boost settings are applied. – If bottoming‑out is detected, readjust settings or liaise with the product specialist. – Where clinically appropriate, complete a short daytime trial (1–2 hours) with skin checks before overnight use. |
| Mode selection | – Ensure the person with SCI is utilising the mattress on the optimal mode for their current requirements eg. Alternating air for continuous overnight use, max inflate for repositioning or transfers etc |
| Comfort / firmness settings | – Adjust firmness to balance immersion, envelopment, and functional stability |
| Alternating cycle timing | – Many alternating air mattresses allow adjustment of the cycle time or the inflation/deflation intensity – Shorter cycles may be appropriate for individuals with high pressure injury risk, while longer cycles may improve comfort for those sensitive to movement/noise |
| Heel offloading / protection settings | – Activate or adjust heel relief features to reduce risk at the heels |
| Auto adjust / auto detect features | – Activate autocalibration after the person is correctly positioned |
| Fowler boost | – Activate when the head of bed is elevated >30° to prevent bottoming out |
| Pump setup and orientation | – Ensure pump is correctly sited, secure, and not causing excessive noise or vibration |
| Hose orientation and strain relief | – Avoid bends, kinks, or tension that could compromise airflow to mattress cells |
If a user manual is provided with supply of the AT, it should always be used for information specific to setting up and adjusting that item.
Education
The following education should be provided at the time of pressure redistribution mattress delivery, setup and adjustment:
- Confirm the prescription: check that the delivered mattress model, size, pressure‑redistribution type/mechanism, and any accessories (e.g., pumps, covers, power cords, mounting hardware) correspond exactly to what was prescribed and approved in the quote/funding application.
- Review the person’s most recent physical and skin integrity assessment: ensure the mattress prescription remains appropriate, particularly when there has been a delay between assessment and delivery, or when the person’s weight, mobility, posture, or skin condition may have changed.
- Suitable delivery environment: confirm adequate space around the bed for installation, safe manual-handling access, and appropriate flooring and power outlets (if applicable).
- Equipment required for safe transfer: if other AT (e.g., hoist, slide board, slide sheets) or additional assistance is required to transfer the person on/off the mattress for setup, ensure these are available and ready at the time of delivery.
- Education: provide thorough education on safe use, daily care, pump operation (if applicable), cleaning, troubleshooting, and maintenance requirements. Supply written instructions or manufacturer user guides where possible and involve the person’s support network.
- Contact information: confirm the person and their support network know how to contact the supplier/product specialist for technical support, warranty issues, or future review needs.
- Determine whether a follow-up is required: identify if and when a follow-up appointment is needed to review comfort, function, skin integrity, and mattress performance once the person has trialled the mattress in their typical environment.
Mattress Assessment and Evaluation Tool
QSCIS
Includes an evaluation tool – important for obtaining client feedback.
Prescribe Daily Living Aids [Funding]
Medical Aids Subsidy Scheme (MASS)
Pressure Equipment – Correct Use (Video) [Video] (Queensland Health login required)
MASS Education
Bottoming out test for pressure mattresses [Video]
Novis Healthcare
Pressure equipment alternating [Video] (Queensland Health login required)
MASS Education
Assistive Technology & Home Modifications Scheme [Funding]
My Aged Care
Occupational Therapists & Assistive Technologies > Functional mobility > Activity: Bed mobility
Elearn SCI (free log in) [Tool]
International Spinal Cord Society
Occupational Therapists and Assistive Technologies > Functional mobility > Activity: Functional transfers
Elearn SCI (free log in) [Tool]
International Spinal Cord Society
Pressure redistribution mattress trial process: Information for prescribers [Form] (Queensland Health login required)
QSCIS – SPOT
Includes set up advice and considerations for mattress trials.
Foam surround scripting – How to guide [Tool] (Queensland Health login required)
Queensland Spinal Cord Injury Service, Spinal Outreach Team (SPOT)
Pressure Injury Toolkit for Spinal Cord Injury and Spina Bifida
Agency for Clinical Innovation – NSW Health
Australian standards for wound prevention and management – 4th ed.
Australian Health Research Alliance, Wounds Australia, & WA Health Translation Network
Skin Integrity & Pressure Injuries – Evidence Module
Spinal Cord Injury Research and Evidence (SCIRE) Professional
Occupational Therapists Supporting People with Assistive Technology [Tool]
Occupational Therapy Australia
Capability framework for prescription of assistive technology
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2019). Prevention and treatment of pressure ulcers/injuries (3rd ed.). https://www.internationalguideline.com/2019
Hsieh, J. T. C., Benton, B., Titus, L., Gabison, S., McIntyre, A., Wolfe, D., & Teasell, R. (2020). Skin integrity and pressure injuries following spinal cord injury. In J. J. Eng et al. (Eds.), Spinal Cord Injury Research Evidence (pp. 1–135). https://scireproject.com/evidence/skin-integrity-and-pressure-injuries/introduction/impact-of-pressure-injuries/
MASS Education. (2023). Pressure equipment – Alternating [Video]. https://healthqld.sharepoint.com/sites/MSHHS-QSCIS/_layouts/15/stream.aspx?id=%2Fsites%2FMSHHS-QSCIS%2FShared%20Documents%2FAT%20photos%2FMattress%2Fpressure-equip-alternating.wmv
MASS Education. (2023). Pressure equipment – Correct use [Video]. https://healthqld.sharepoint.com/sites/MSHHS-QSCIS/_layouts/15/stream.aspx?id=%2Fsites%2FMSHHS-QSCIS%2FShared%20Documents%2FAT%20photos%2FMattress%2Fpressure-equip-correct-use.wmv
National Disability Insurance Scheme. (2026). Assistive technology explained. https://www.ndis.gov.au/participants/assistive-technology-explained
National Disability Insurance Scheme. (2026). Providing assistive technology: Provider guidance. https://www.ndis.gov.au/providers/housing-and-living-supports-and-services/providing-assistive-technology
National Injury Insurance Scheme Queensland. (2026). Assistive technology and consumables guideline. https://niis.qld.gov.au/guidelines/tcs-guidelines/assistive-technology-and-consumables-guideline/
National Institute for Health and Care Excellence. (2014). Pressure ulcers: Prevention and management (CG179). https://www.ncbi.nlm.nih.gov/books/NBK248068/pdf/Bookshelf_NBK248068.pdf
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2025). Full body support surfaces for prevention of pressure injuries. In E. Haesler (Ed.), Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline (4th ed.). https://internationalguideline.com
National Pressure Injury Advisory Panel. (2015). Bottoming out test for pressure mattresses: Position statement. https://cdn.ymaws.com/npuap.site-ym.com/resource/resmgr/position_statements/hand-check-position-statemen.pdf
Somers, M. F., McClure, I., Morris, A., & Hutchinson, S. A. (2024). Skin care. In M. F. Somers & J. J. Bender Burnett (Eds.), Spinal cord injuries: Functional rehabilitation (4th ed., pp. 95–119). F. A. Davis.
Wounds Canada. (2017). Best practice recommendations for the prevention and management of pressure injuries. https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/172-bpr-prevention-and-management-of-pressure-injuries-2/file