Trial and Trial evaluation: pressure redistribution mattresses

In this phase, the trained health professional should facilitate the person with a spinal cord injury (SCI) to complete appropriate trial/s before prescribing or ordering any item of assistive technology (AT).

Trial environment

Where possible, the trained health professional should plan the AT trials to be conducted in an environment that closely reflects the intended setting of use. Where this is not feasible, the trained health professional should reasonably simulate the intended environment and assess how the AT will integrate within it.

Ideally, pressure redistribution mattress (mattress) trials are completed:

• In the persons home environment, in the room they intend to use as their bedroom,
• Using their intended bed base (if trialling a bed base, align the trials to occur simultaneously),
• In conjunction with interface equipment (e.g., hoist, bed rails, manual wheelchair, power wheelchair, mobile shower commode etc.),
• With sufficient space around the bed to complete required transfers and activities of daily living,
• With consideration of hallway and doorway access for delivery and set up,
• In a room with adequate access to power outlets if required,
• In a space with sufficient ventilation to reflect the usual temperature and airflow of the intended sleeping environment,
• With the room configured in its usual layout to ensure the mattress integrates with existing furniture and pathways,
• With access to an alternative pressure redistribution mattress should the trial need to cease early,
•  If a home trial is not feasible, in a simulated environment configured to closely match the person’s usual bedroom setup as much as possible.

Trial period

To fully evaluate the suitability of the AT, the trained health professional should determine what length of time would constitute an adequate trial period.

The trial period includes consideration of the frequency, intensity and length of the trial. Factors influencing the trial period may include previous AT user experience, availability of trial products, supplier agreement, availability and compatibility with other AT in use, and the specific goals and preferences of the AT user.

Considerations for pressure redistribution mattress trial period is given to:

• What pressure redistribution mattress the person with SCI is currently using,
• How recent their SCI is,
• Whether this is their first scripted pressure redistribution mattress before leaving primary rehabilitation,
• Any current pressure injuries,
• Product availability as negotiated with the product specialist,
• Whether the free trial period is sufficient, and if not, consider hiring the mattress for a 2-week trial,
• If downgrading the mattress surface, allowing adequate time for adjustment and observation of skin tolerance that aligns with expected community-based repositioning frequency,

Trial attendees

Where possible, the trained health professional should conduct the AT trial involving the:

• AT user
• Additional bed companion (e.g., partner, children),
• AT user’s support network (formal and informal carers / support workers) to promote engagement, feedback and education
• product specialist to ensure safe product demonstration, optimise setup and assist with education and training.

Trial education

To promote a safe and effective trial of the AT, the trained health professional should provide the key information for the AT user and their support network. This includes: 

• Information on how, when and where the trial and selection process will occur,
• Recommendations on safe use and how / when to progress versus cease the trial,
• Explanations about features, adjustments and maintenance requirements,
• How other equipment interfaces with mattressand associated risks,
• Who to contact if issues arise during the trial (e.g., equipment concerns or malfunction, or skin concerns),
• What feedback the AT user and support network will be asked to provide during the trial. 

Considerations for pressure redistribution mattress trial education:

• Multiple trials may be required to evaluate different mattress features and accessories,
• It may not be feasible to trial the exact size or setup of the mattress (e.g., bed box, long king single),
• Functional abilities of the AT user may change over time — reassessment may be required to ensure ongoing suitability,
• AT users posture and tone can change, affecting the suitability of the mattress,
• Body weight and habitus may change over time, affecting the suitability of the mattress and any accessories or features required,
•  Education should be targeted to those operating the mattress and compatible bed base,
• AT users may require clarification on what comfort changes are expected during a trial and what concerns should be reported,
• A typical adjustment period for a new mattress is around 2-4 weeks, with full comfort and body adaptation sometimes taking up to 30–90 days depending on the mattress type,
• The AT user and support network should be informed of the typical adjustment period when trialling a new mattress,
• The AT user and support network should understand what aspects they will be asked to observe and provide feedback on,
• The AT user and support network should know who to contact if issues arise during the trial (e.g., equipment concerns, comfort issues, malfunctions),
• Instructions should be provided regarding safe positioning of bedding or accessories so they do not interfere with mattress performance.

Trial evaluation and documentation

The trained health professional should evaluate each AT trial using both qualitative and quantitative methods. This may incorporate informal observations from all stakeholders, as well as more formal data.

Trial findings should be documented using evaluation forms that capture subjective and objective information. The trained health professional may also use the Mattress Assessment & Evaluation Tool to support standardised assessment, consistent documentation, and comparison across all pressure redistribution mattress trials.

For pressure redistribution mattresses this may include:

• Mattress assessment and evaluation tool, 
• Documenting baseline bed mobility, skin integrity, transfer performance, comfort, and ADLs to support direct comparison with trial outcomes,
• Repeating relevant outcome measures before and after each mattress trial to compare performance, safety, comfort, and functional outcomes,
• Assessing functional performance (bed mobility, transfers, ADLs) with each mattress and documenting whether tasks improved, remained the same, or deteriorated,
• Evaluating and documenting the ability of the user and carers to safely operate the mattress and associated equipment (e.g., controls, lockouts, max inflate function),
• Recording detailed skin integrity findings for each trial, including any areas of redness, pressure, or skin changes, using consistent anatomical terminology,
• Identifying required mattress features (e.g., low air loss, cell size, profiling compatibility, foam surrounds) based on trial outcomes and documenting these to support prescription rationale,
• Clearly documenting the duration of each mattress trial, including total nights and hours of use,
• Summarising AT user and relevant stakeholder preferences across all mattresses trialled, including comfort, usability, temperature, noise, and perceived support,
• Interface pressure mapping.
• Photographs and/or videos (if used) should clearly capture the mattress setup, bed base, interface equipment, transfer approach, and any specific functional tasks being evaluated, ensuring the angle and lighting allow for accurate comparison across trials,
• Feedback to the product specialist outlining trial outcomes, concerns and queries, including guidance about alternative products to explore,
• Repeated trials, if required with a suitable action plan including clearly identified goals and adequate trial history.

Comprehensive documentation of each pressure redistribution mattress trial and its evaluation is essential. These records provide justification for prescription and funding, support clinical transitions, and serve as a reference for future trials if reassessment becomes necessary.