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Clinical Publications

Article  Description 

Cleves, A et al (2022)  Parafricta bootees compared to standard care to prevent heel pressure ulcers: a multicentre pragmatic randomised controlled trial  Wounds UK Vol 18 No 2

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The objective of this RCT was to determine whether in  inpatients at very high risk of skin breakdown Parafricta bootees , used as an adjunct to standard of care reduce the incidence of heel pressure ulcers after 3 and 14 days. Slow recruitment caused the study to be stopped early.  Only 31 patients out of 450 sample size were treated.  Of these 1 patient in the control group had a pressure ulcer and 0 in the treatment group.  No adverse events related to the bootees were reported.

Smith and Ingram (2010) - Clinical and cost effectiveness evaluation of low friction and shear garments; Journal of Wound Care Vol. 19, no 12, December 2010, pp.535-42.   


Data, including pressure ulcer incidence, location, grading  and final outcome upon discharge was collected from 369 patients alongside locally derived expenditures to assess the role of low friction garments in hospital setting. They found that Parafricta low friction garments have a role to play in the prevention of skin breakdown and appear to be both clinically and cost effective. 

Gleeson, D (2015) “Pressure ulcer reduction using low-friction fabric bootees” British Journal of Nursing (Tissue Viability Supplement) 24 (6)


In reaction to high instances of grade 2 heel pressure ulcers St Helens and Knowsley Trust began using Parafricta bootees. This study found that implementing the use of the Parafricta low-friction fabric bootees has proved a good strategy for the Trust, ensuring a reduction not only in heel pressure ulcer incidence but also in achieving zero harm targets and providing substantial cost benefits

Gleeson, D (2016) “Heel Pressure Ulcer prevention: a 5-year initiative using low-friction bootees in a hospital setting”” Wounds UK Vol12 No4

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This study, evaluates the implementation of Parafricta bootees in a hospital setting 5 years after they were introduced. Parafricta low-friction bootees when used in routine practise are shown to have played a part in reduction of heel pressure ulcers and in particular the decline in the proportion of heel pressure ulcers to pressure ulcers on other sites. The pressure ulcer instance in the Trust was found to be below the national average. The reduction in heel pressure ulcers led to significant savings for the Trust.

Gefen, A (2017) “Why is the heel particularly vulnerable to pressure ulcers” British Journal of Nursing Vol 26 No20 Tissue Viability Supplement 


This article explains the vulnerability of heels to pressure ulcers from a biomechanical engineering perspective taking into account hospital settings. It discusses the growing and solid evidence that low friction fabric garments may provide added benefits in preventing heel ulcers. Managing friction through Parafricta low friction fabric garments is a promising way forward.

Schofield, A (2018) “Mitigating the damaging effects of tissue distortions by using a low-friction heel protector” British Journal of Nursing | Vol. 27 | No. Sup12 | pp S27–S34   https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2018.27.Sup12.S27

This article reports the findings of a small, non-controlled evaluation over a 2 week period in 3 different care settings. The results show Parafricta low friction bootees have a played a significant part in the reduction of heel pressure ulcers, reduced pain and increased comfort. In conclusion, should be regarded as a standard care tool in pressure ulcer care prevention in all care settings. 

Hollen,L et al (2018)  “The SILKIE (Skin graftIng Low friKtIon Environment) study: a non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns”  BMJ Open access  2018;8


This article evaluates the impact of low-friction bedding in an acute burn setting, the study was conducted in 3 burn services in 2 hospitals with a cohort of 131. The article concludes that low-friction bedding is safe for burns victims, with a significant reduction in graft loss. 

Glover, Jones, and von Spreckelsen (2021) Heel pressure ulceration: the perennial clinical and financial problem?, British Journal of Healthcare Management


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Using low-friction fabrics to prevent and treat hospital-acquired pressure ulcers can have considerable cost-saving implications for the NHS. Parafricta low-friction bootees have been successfully implemented in an NHS trust and resulted in a 75% lower prevalence of hospital-acquired pressure ulcers over 8 years compared to the average for NHS England. Using low-friction fabrics is cost-effective and an efficacious method of reducing the burden of hospital-acquired pressure ulcers.
Bree-Aslan, C. and Hampton, S. (2013) 'Parafricta and the prevention of shearing forces: heel ulcers'. Nursing and Residential Care, Vol. 10, No. 01, pp, 78-80   https://www.magonlinelibrary.com/doi/pdf/10.12968/nrec.2008.10.2.28124 A case study that discusses the role that Parafricta fabric can play in reducing and preventing pressure, shear and heel damage.

Stephen-Haynes et al (2011) -  Clinical outcomes using a low friction and shear garment in the care home setting;  Wounds UK, Vol. 7, No 4, pp. 76-84.

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This study evaluated 25 patients in a care home setting with grade 2 pressure ulcers to determine whether Parafricta products were effective in conjunction with current treatment. They found improvement in the skin with less redness, oedema and a reduction in friction and shear. Parafricta is an additional resource that can aid the management of patients at risk of pressure damage.

Sylvie Hampton et al.(2009) Parafricta Fabric: Can it reduce the potential for pressure ulcer damage; Journal of Community Nursing, April, Vol. 23, Issue 4, pp. 28-31


There is a relationship between reduction of oedema and inflammation under the epidermis and the wearing of Parafricta garments. This leads to the conclusion that Parafricta should be considered for any resident or patient that is at risk of pressure damage related to shear and friction.

Kerr, A. (2008). 'Reducing shear and Friction: Parafricta undergarments'. Nursing and Residential Care. Vol. 10, No 01, pp 626-628


This article discusses the role that Parafricta undergarments can play in reducing the potential for pressure ulcers in immobile patients.

Hampton, S. (2007). 'Reducing shearing forces: Parafricta Fabric'. Nursing and Residential Care. Vol. 9, No 12, pp. 580-582 


Pressure sores are a preventable complication for immobile patients and are often caused by shearing and friction. Parafricta, a fabric with low friction properties, reduces the potential for pressure damage.


NICE Medical Technologies Evaluation

NICE's Medical Technologies Evaluation Programme (MTEP) considers technologies that could offer substantial benefits to patients and the health & social care system over current practise. Parafricta Bootees and Undergarments were reviewed by NICE in 2014 and again in 2021. As a result of this evaluation the use of Parafricta products was encouraged by NICE, and Parafricta was incorporated into NICE’s care pathways for both the prevention and treatment of pressure ulcers.

NICE Pressure Ulcer pathway

( http://pathways.nice.org.uk/pathways/pressure-ulcers )

This guideline covers risk assessment, prevention and treatment in children, young people and adults at risk of, or who have, a pressure ulcer (also known as a bedsore or pressure sore).

Pressure Ulcer Prevention Pathways

We have developed this pathway diagram which indicates how Parafricta products may be employed as part of a pressure ulcer prevention strategy.

Scientific Video Presentations

Follow the link to view 

Professor Amit Gefen (University of Tel Aviv) in conversation

Deborah Gleeson (Tissue Viability Lead - St Helens & Knowsley NHS Trust)

Cathie Bree-Aslan (Tissue Viability Expert Witness)

Professor Amit Gefen (University of Tel Aviv) about heel pressure ulcers