Seven Factors to Consider When Choosing a Support Surface for Patients

By Jasmine Joly-Dumont and Jay Hennig, MPT, Certified Safe Patient Handling Associate and Umano Medical Clinical Specialist

Originally published on January 4, 2023 and updated on July 10th 2025.

We know that you and your healthcare team want to ensure that every patient who enters your facility receives the highest level of comfort and clinical care during their stay. However, with limited time and the multitude of support surface types available, selecting the appropriate support surfaces for each unique situation can be challenging. While this complex process is not limited to the aspects we list in this article, we hope the following seven factors can serve as a starting point for selecting a support surface for your patients.

1. Patient’s Level for Risk of Developing Pressure Injuries

A patient’s level of risk of developing pressure injuries is one of the first factors to keep in mind when selecting a support surface. The specific level of risk of a patient developping a -pressure injury (PI) may be assessed using a standardized, evidence-based assessment tool such as the Braden Scale. This scale evaluates six different factors: sensory perception, moisture, activity, mobility, nutrition as well as friction and shear.

A higher Braden score is associated with a lower risk of developing pressure injuries (PI). For a patient who is less at risk of developing this type of injury, you may want to consider using a preventive surface. On the other hand, for patients who present with a higher risk of developing pressure injuries, a therapeutic surface might be more appropriate.

2. Condition and Location of Existing Pressure Injuries

If a patient already suffers from pressure injuries, the location of those wounds may influence the choice of a therapeutic support surface. For example, if the pressure injuries are located on the patient’s heels, you might look for a surface designed to reduce pressure on that part of the body. Appropriate surfaces may present features such as a lower Indention Force Deflection (IFD) rating in the heel area, providing a softer foam to immerse and envelop the heels, hence reducing the pressure on that area.

3. Microclimate Management Needs

Microclimate management is another factor to consider when deciding on a support surface. Support surface design, construction and technology have advanced significantly over the years so now more than ever the specific type of material used in the top cover for “breathability”, the internal construction materials used such as foams and gels with varying densities and consistencies and the specific placement of those materials all contribute to microclimate management conditions for a patient’s skin care needs. Still, for those times when moisture is of high concern, many clinicians choose a surface which provides a microclimate management with airflow (low air loss-LAL) feature.

A microclimate management airflow (low air loss -LAL) feature may play a vital role in assisting patients with incontinence, excessive sweating or wound drainage by helping to keep a patient’s skin cooler and dryer. Specifically using the Braden Scale Moisture sub score can assist in determining when this might be a more appropriate feature to consider.

Microclimate management with airflow (low air loss-LAL) is typically administered underneath the patient through a vapor-permeable top cover on the support surface. A support surface that offers microclimate management with airflow (low air loss-LAL)may therefore contribute to the prevention of pressure injury by managing heat buildup and humidity.

4. Mobility, Physical Activity, and Positioning Limitations

A patient’s mobility level, their physical activity capability, and their ability or inability to reposition themselves are also important factors to consider when choosing a support surface. Again, using the specific Braden Scale Mobility sub score may assist in determining which type of support surface can be most appropriate based on your available options.

Depending on their condition, some patients may be unable to change their position independently. In these cases, a support surface with a lateral rotation feature (LR or Continuous Lateral Rotation Therapy-CLRT) may help reduce skin damage as well as help to hemodynamically accommodate to small amounts of increasing movement.

In addition, this therapy is often chosen for patients at risk of developing pulmonary complications due to immobility. Some studies have demonstrated that when introduced early in these patients’ treatment, the use of a lateral rotation feature (LR or Continuous Lateral Rotation Therapy-CLRT) could potentially reduce critical care length of stay (LOS) and ultimately reduce treatment costs.

5. Fall and Entrapment Risk

The risk of falls and entrapment is yet another factor to consider when selecting a support surface. Patients who retain some or all of their mobility, or those who are able to get out of bed on their own, might be at risk of falling or getting trapped between the edge of the surface and the siderails of the bed.

To address this, some support surfaces offer firm foam borders while others have air borders set at a high level of pressure to keep them very firm. A support surface with lateral borders may increase safety during bed egresses, ingresses, and sit-to-stand transfers. Similarly, firm side edges can reduce the risk of patient entrapment.

It's also important to note that typically surfaces used for severe pressure injury risk patients (e.g. patients that are usually either highly or completely immobile) tend to be higher or deeper to allow for improved pressure redistribution through increased immersion and envelopment and also tend to have top covers that significantly reduce friction and shear. This means that placing more mobile patients or patients who will be mobilizing frequently on these types of surfaces may lead to safety concerns. This again highlights the need for us as clinicians to make sure we are providing the appropriate surface for the individual patient’s needs and abilities. Again, using the Braden Scale Mobility Sub score as a guide, can assist in this area.

6. Patient Weight

Another factor to evaluate when deciding on a support surface is to ensure that the weight capacity of the equipment matches the patient’s needs. Support surfaces usually have two types of weight capacity: the safe working load and the therapeutic weight capacity.

The safe working load corresponds to the maximum weight a support surface can support. Therapeutic weight capacity, on the other hand, refers to the weight capacity of the support surface to sustain the therapeutic performance characteristics (immersion, envelopment, microclimate, shear and friction) in an

optimal manner. Note that these two values sometimes differ. For instance, a particular support surface might indicate a safe working load of 500 lb but a therapeutic weight capacity of 350 lb for lateral rotation (LR or Continuous Lateral Rotation Therapy-CLRT).

Depending on a patient’s weight and body characteristics, such as where they carry their weight, you might want to consider a surface with a higher therapeutic weight capacity or a bariatric surface.

7. Previous Support Surface Usage

The type of support surface previously used may be another factor to consider when selecting support surfaces. Members of your care team are likely to have preferences regarding specific surfaces, features or therapies that they consider more appropriate for their patients. This also depends on which surfaces your facility owns or has the ability to rent if needed. Thus, when selecting the type of support surfaces to provide at your facility, it is helpful to involve members of the entire care team. This may include the clinical team, cleaning staff, maintenance team, and your facility administrators.

Patients may also have preferences based on previous experiences. For example, if a patient had a good outcome with a particular model during their last visit, they may prefer that model to be used during a subsequent hospitalization. A patient who uses such technology at home could potentially have preferences in this regard as well.

Choosing a Support Surface: A Multi-Factorial Decision

As we stated at the beginning of this article, while this seven-factor assessment is fairly comprehensive, it is not exhaustive. Choosing support surfaces remains difficult, as this is a multi-factorial decision. However, a careful analysis of the available technology and the needs of your facility, patients, and care teams can help you provide high-quality continuous care while simplifying the decision-making of your care team.

Moreover, manufacturers of support surfaces are continually working to improve and develop support surface technologies to help prevent and treat pressure injuries and other complications associated with patient immobility. As such, be sure to use your support surface vendors as consultants to provide guidance and insight to you as you explore your options in choosing the right support surfaces for

your care team and patients. Our support surface specialists are dedicated to helping you identify your facility’s specific needs. We work every day to make sure that our line of support surfaces meets your requirements and ensures your satisfaction.