Engineering performance as the foundation for support surface selection.

OBJECTIVE: To describe a performance-based framework for support surface selection that integrates contemporary understanding of pressure injury aetiology with standardised engineering performance testing, and to demonstrate its clinical application using engineering performance data from commercially available support surfaces. Method: Current evidence describing pressure injury (PI) aetiology, support surface biomechanics and standardised engineering performance testing was synthesised to develop a framework for individualised support surface selection. Seven commercially available full-body support surfaces representing technologies commonly used in acute care were evaluated using American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America Support Surfaces-1 (ANSI/RESNA SS-1) standardised engineering test methods. Engineering performance characteristics, including pressure redistribution, immersion, envelopment, shear management and microclimate management, were compared and interpreted in representative clinical scenarios. RESULTS: Engineering testing demonstrated substantial variability among support surfaces across all measured performance characteristics, despite similarities in product category, construction or marketed features. Support surfaces with comparable design intent frequently exhibited markedly different performance profiles, while products using different technologies on occasion demonstrated similar biomechanical performance. No support surface demonstrated superior performance across all engineering domains, illustrating that support surface performance is multidimensional and cannot be reliably inferred from product construction, operating principles or marketing terminology. Clinical interpretation of these findings demonstrated how standardised engineering performance data can be integrated with contemporary understanding of pressure ulcer aetiology to support individualised support surface selection. CONCLUSION: Support surface selection should be based on measurable engineering performance characteristics rather than product categories or construction alone. Standardised engineering testing provides an objective basis for comparing support surfaces, and matching performance characteristics to the biomechanical and physiological needs of the individual user. This performance-based framework offers clinicians a practical approach for selecting the right support surface for the right user and provides a foundation for future studies relating engineering performance to clinical outcomes.