Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries: A Network Meta-analysis

Luis Furuya-Kanamori, Rachel M Walker, Brigid M Gillespie, Justin Clark, Suhail A R Doi, Lukman Thalib

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Abstract

OBJECTIVES: Pressure injuries (PIs) are one of the most common types of complex wounds and impose a huge economic burden on the healthcare system and the patients. A plethora of topical treatments is widely available for PI treatment, yet there is a paucity of evidence with regard to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing.

DESIGN: Systematic review and network meta-analysis.

SETTING AND PARTICIPANTS: All published randomized controlled trials that compared the effectiveness of 2 or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings.

MEASURES: The outcome was the relative risk (RR) of complete healing following treatment and the generalized pairwise modeling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates.

RESULTS: 40 studies (1757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (ie, saline gauze or similar inert dressing). The foam [RR 1.18; 95% confidence interval (CI) 0.95-1.48] and active wound dressing (RR 1.16; 95% CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group.

CONCLUSIONS/IMPLICATIONS: There was substantial uncertainty around the point estimates; however, evidence from our analysis supports the use of hydroactive wound dressings to replace basic dressings. Foam and active wound dressing groups seem promising and therefore need further investigation. High-quality, rigorously conducted research about the clinical effectiveness of the topical treatments in these 2 groups developed in consultation with health professionals, patients, and their carers is needed to identify if indeed foam and active wound dressings provide advantages over hydroactive dressings.

Original languageEnglish
Pages (from-to)399-407
Number of pages9
JournalJournal of the American Medical Directors Association
Volume20
Issue number4
Early online date21 Nov 2018
DOIs
Publication statusPublished - 1 Apr 2019

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Bandages
Pressure
Wounds and Injuries
Therapeutics
Network Meta-Analysis
Confidence Intervals
Caregivers
Uncertainty
Referral and Consultation
Randomized Controlled Trials
Economics

Cite this

Furuya-Kanamori, Luis ; Walker, Rachel M ; Gillespie, Brigid M ; Clark, Justin ; Doi, Suhail A R ; Thalib, Lukman. / Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries : A Network Meta-analysis. In: Journal of the American Medical Directors Association. 2019 ; Vol. 20, No. 4. pp. 399-407.
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title = "Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries: A Network Meta-analysis",
abstract = "OBJECTIVES: Pressure injuries (PIs) are one of the most common types of complex wounds and impose a huge economic burden on the healthcare system and the patients. A plethora of topical treatments is widely available for PI treatment, yet there is a paucity of evidence with regard to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing.DESIGN: Systematic review and network meta-analysis.SETTING AND PARTICIPANTS: All published randomized controlled trials that compared the effectiveness of 2 or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings.MEASURES: The outcome was the relative risk (RR) of complete healing following treatment and the generalized pairwise modeling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates.RESULTS: 40 studies (1757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (ie, saline gauze or similar inert dressing). The foam [RR 1.18; 95{\%} confidence interval (CI) 0.95-1.48] and active wound dressing (RR 1.16; 95{\%} CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group.CONCLUSIONS/IMPLICATIONS: There was substantial uncertainty around the point estimates; however, evidence from our analysis supports the use of hydroactive wound dressings to replace basic dressings. Foam and active wound dressing groups seem promising and therefore need further investigation. High-quality, rigorously conducted research about the clinical effectiveness of the topical treatments in these 2 groups developed in consultation with health professionals, patients, and their carers is needed to identify if indeed foam and active wound dressings provide advantages over hydroactive dressings.",
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Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries : A Network Meta-analysis. / Furuya-Kanamori, Luis; Walker, Rachel M; Gillespie, Brigid M; Clark, Justin; Doi, Suhail A R; Thalib, Lukman.

In: Journal of the American Medical Directors Association, Vol. 20, No. 4, 01.04.2019, p. 399-407.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries

T2 - A Network Meta-analysis

AU - Furuya-Kanamori, Luis

AU - Walker, Rachel M

AU - Gillespie, Brigid M

AU - Clark, Justin

AU - Doi, Suhail A R

AU - Thalib, Lukman

N1 - Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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N2 - OBJECTIVES: Pressure injuries (PIs) are one of the most common types of complex wounds and impose a huge economic burden on the healthcare system and the patients. A plethora of topical treatments is widely available for PI treatment, yet there is a paucity of evidence with regard to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing.DESIGN: Systematic review and network meta-analysis.SETTING AND PARTICIPANTS: All published randomized controlled trials that compared the effectiveness of 2 or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings.MEASURES: The outcome was the relative risk (RR) of complete healing following treatment and the generalized pairwise modeling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates.RESULTS: 40 studies (1757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (ie, saline gauze or similar inert dressing). The foam [RR 1.18; 95% confidence interval (CI) 0.95-1.48] and active wound dressing (RR 1.16; 95% CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group.CONCLUSIONS/IMPLICATIONS: There was substantial uncertainty around the point estimates; however, evidence from our analysis supports the use of hydroactive wound dressings to replace basic dressings. Foam and active wound dressing groups seem promising and therefore need further investigation. High-quality, rigorously conducted research about the clinical effectiveness of the topical treatments in these 2 groups developed in consultation with health professionals, patients, and their carers is needed to identify if indeed foam and active wound dressings provide advantages over hydroactive dressings.

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