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Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers.

Dumville JC, Soares MO, O'Meara S, Cullum N - Diabetologia (2012)

Bottom Line: Whilst there was increased healing associated with hydrogel and foam dressings compared with basic wound contact materials, these findings were based on data from small studies at unclear or high risk of bias.The mixed treatment comparison suggested that hydrocolloid-matrix dressings were associated with higher odds of ulcer healing than all other dressing types; there was a high degree of uncertainty around these estimates, which were deemed to be of very low quality.In addition, evidence pointing to a difference in favour of 'advanced' dressing types over basic wound contact materials is of low or very low quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of York, Area 2, Seebohm Rowntree Building, York YO10 5DD, UK. jo.dumville@york.ac.uk

ABSTRACT

Aims/hypothesis: Foot ulcers in people with diabetes are a common and serious global health issue. Dressings form a key part of ulcer treatment. Existing systematic reviews are limited by the lack of head-to-head comparisons of alternative dressings in a field where there are several different dressing options. We aimed to determine the relative effects of alternative wound dressings on the healing of diabetic foot ulcers.

Methods: This study was a systematic review involving Bayesian mixed treatment comparison. We included randomised controlled trials evaluating the effects on diabetic foot ulcer healing of one or more wound dressings. There were no restrictions based on language or publication status.

Results: Fifteen eligible studies, evaluating nine dressing types, were included. Ten direct treatment comparisons were made. Whilst there was increased healing associated with hydrogel and foam dressings compared with basic wound contact materials, these findings were based on data from small studies at unclear or high risk of bias. The mixed treatment comparison suggested that hydrocolloid-matrix dressings were associated with higher odds of ulcer healing than all other dressing types; there was a high degree of uncertainty around these estimates, which were deemed to be of very low quality.

Conclusions/interpretation: These findings summarise all available trial evidence regarding the use of dressings to heal diabetic foot ulcers. More expensive dressings may offer no advantages in terms of healing than cheaper basic dressings. In addition, evidence pointing to a difference in favour of 'advanced' dressing types over basic wound contact materials is of low or very low quality.

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Related in: MedlinePlus

A network summary of all comparisons informed by direct trial data for wound dressings for diabetic foot ulcer healing. The lines link dressings that have been compared (in the treatment of diabetic foot ulcers) using a randomised controlled trial. (n=x) refers to the number of trials making this comparison. One three-arm trial was included that randomised to hydrocolloid (fibrous), iodine-impregnated and basic wound contact
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Fig2: A network summary of all comparisons informed by direct trial data for wound dressings for diabetic foot ulcer healing. The lines link dressings that have been compared (in the treatment of diabetic foot ulcers) using a randomised controlled trial. (n=x) refers to the number of trials making this comparison. One three-arm trial was included that randomised to hydrocolloid (fibrous), iodine-impregnated and basic wound contact

Mentions: A summary of the network of dressing trials that measured healing in participants with diabetic foot ulcers is illustrated in Fig. 2. Ten direct treatment comparisons were made in the 15 included trials; only five comparisons were informed by more than one trial where standard meta-analysis could be conducted (all fixed effect). The overall quality of evidence for each direct link was assessed using the GRADE quality of evidence scale (Table 1): four links were formed by low quality evidence and six by moderate quality evidence. It is important to note that three of these four links were informed by the same three-arm trial assessed as being at low risk of bias.Fig. 2


Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers.

Dumville JC, Soares MO, O'Meara S, Cullum N - Diabetologia (2012)

A network summary of all comparisons informed by direct trial data for wound dressings for diabetic foot ulcer healing. The lines link dressings that have been compared (in the treatment of diabetic foot ulcers) using a randomised controlled trial. (n=x) refers to the number of trials making this comparison. One three-arm trial was included that randomised to hydrocolloid (fibrous), iodine-impregnated and basic wound contact
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369130&req=5

Fig2: A network summary of all comparisons informed by direct trial data for wound dressings for diabetic foot ulcer healing. The lines link dressings that have been compared (in the treatment of diabetic foot ulcers) using a randomised controlled trial. (n=x) refers to the number of trials making this comparison. One three-arm trial was included that randomised to hydrocolloid (fibrous), iodine-impregnated and basic wound contact
Mentions: A summary of the network of dressing trials that measured healing in participants with diabetic foot ulcers is illustrated in Fig. 2. Ten direct treatment comparisons were made in the 15 included trials; only five comparisons were informed by more than one trial where standard meta-analysis could be conducted (all fixed effect). The overall quality of evidence for each direct link was assessed using the GRADE quality of evidence scale (Table 1): four links were formed by low quality evidence and six by moderate quality evidence. It is important to note that three of these four links were informed by the same three-arm trial assessed as being at low risk of bias.Fig. 2

Bottom Line: Whilst there was increased healing associated with hydrogel and foam dressings compared with basic wound contact materials, these findings were based on data from small studies at unclear or high risk of bias.The mixed treatment comparison suggested that hydrocolloid-matrix dressings were associated with higher odds of ulcer healing than all other dressing types; there was a high degree of uncertainty around these estimates, which were deemed to be of very low quality.In addition, evidence pointing to a difference in favour of 'advanced' dressing types over basic wound contact materials is of low or very low quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of York, Area 2, Seebohm Rowntree Building, York YO10 5DD, UK. jo.dumville@york.ac.uk

ABSTRACT

Aims/hypothesis: Foot ulcers in people with diabetes are a common and serious global health issue. Dressings form a key part of ulcer treatment. Existing systematic reviews are limited by the lack of head-to-head comparisons of alternative dressings in a field where there are several different dressing options. We aimed to determine the relative effects of alternative wound dressings on the healing of diabetic foot ulcers.

Methods: This study was a systematic review involving Bayesian mixed treatment comparison. We included randomised controlled trials evaluating the effects on diabetic foot ulcer healing of one or more wound dressings. There were no restrictions based on language or publication status.

Results: Fifteen eligible studies, evaluating nine dressing types, were included. Ten direct treatment comparisons were made. Whilst there was increased healing associated with hydrogel and foam dressings compared with basic wound contact materials, these findings were based on data from small studies at unclear or high risk of bias. The mixed treatment comparison suggested that hydrocolloid-matrix dressings were associated with higher odds of ulcer healing than all other dressing types; there was a high degree of uncertainty around these estimates, which were deemed to be of very low quality.

Conclusions/interpretation: These findings summarise all available trial evidence regarding the use of dressings to heal diabetic foot ulcers. More expensive dressings may offer no advantages in terms of healing than cheaper basic dressings. In addition, evidence pointing to a difference in favour of 'advanced' dressing types over basic wound contact materials is of low or very low quality.

Show MeSH
Related in: MedlinePlus