Journal_1_2014_final_WEB

Cochrane Reviews
or adhesive tape.The dressing can act as a physical barrier to
protect the wound until the continuity of the skin in restored
(within about 48 hours). It can also absorb exudate from the
wound, keeping it dry and clean, and preventing bacterial contamination
from the external environment. Some studies have
found that the moist environment created by some dressings
accelerates wound healing, although others believe that it is a
disadvantage, as excessive exudate can cause softening and
deterioration of the wound and surrounding healthy tissue.
We reviewed the medical literature up to July 2013 and identified
four randomised controlled trials that investigated early (permanent
removal of dressings within 48 hours of surgery) versus
delayed removal of dressings (permanent removal of dressings
after 48 hours of surgery with interim changes of dressing
allowed) in people with surgical wounds. The levels of bias
across the studies were mostly high or unclear, i.e. flaws in the
conduct of these trials could have resulted in the production of
incorrect results. A total of 280 people undergoing planned surgery
were included in this review. One-hundred and forty people
had their dressings removed within 48 hours following surgery
and 140 people had their wounds dressed beyond 48 hours.
The choice of whether the dressing was removed early (within
48 hours) or retained for more 48 hours was made randomly by
a method similar to the toss of a coin. No significant differences
were reported between the two groups in terms of superficial
surgical site infection (infection of the wound), superficial wound
dehiscence (partial disruption of the wound that results in it reopening
at the skin surface) or the number of people experiencing
serious adverse events. There were no deep wound infections or
complete wound dehiscence (complete disruption of wound
healing, when the wound reopens completely) in the studies that
reported these complications. However, the studies were not
large enough to identify small differences in complication rates.
None of the studies reported quality of life. Participants in the
group that had early removal of dressings had significantly
shorter hospital stays and incurred significantly lower treatment
costs than those in the delayed removal of dressings group, but
these results were based on very low quality evidence from one
small randomised controlled trial. We recommend further randomised
controlled trials are performed to investigate whether
dressing of wounds beyond 48 hours after surgery is necessary,
since the current evidence is based on very low quality evidence
from three small randomised controlled trials.
Interventions for helping people adhere to compression
treatments for venous leg ulceration
Carolina D Weller, Rachelle Buchbinder, Renea V Johnston
Weller CD, Buchbinder R, Johnston RV. Interventions for helping
people adhere to compression treatments for venous leg ulceration.
Cochrane Database of Systematic Reviews 2013, Issue 9.
Art. No.: CD008378. DOI: 10.1002/14651858.CD008378.
pub2.
Copyright © 2013 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.
ABSTRACT
Background: Chronic venous ulcer healing is a complex clinical
problem that requires intervention from skilled, costly, multidisciplinary
wound-care teams. Compression therapy has been
shown to help heal venous ulcers and to reduce the risk of recurrence.
It is not known which interventions help people adhere to
compression treatments.
Objectives: To assess the benefits and harms of interventions
designed to help people adhere to venous leg ulcer compression
therapy, and thus improve healing of venous leg ulcers and prevent
their recurrence after healing.
Search methods: In May 2013 we searched The Cochrane
Wounds Group Specialised Register; The Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library);
Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-
Indexed Citations); Ovid EMBASE; EBSCO CINAHL; trial registries,
and reference lists of relevant publications for published
and ongoing trials. There were no language or publication date
restrictions.
Selection criteria: We included randomised controlled trials
(RCTs) of interventions that help people with venous leg ulcers
adhere to compression treatments compared with usual care, or
no intervention, or another active intervention. Our main outcomes
were number of people with ulcers healed, recurrence,
time to complete healing, quality of life, pain, adherence to
compression therapy and number of people with adverse events.
Data collection and analysis: Two review authors independently
selected studies for inclusion, extracted data, assessed the risk of
bias of each included trial, and assessed overall quality of evidence
for the main outcomes in ‘Summary of findings’ tables.
Main results: Low quality evidence from one trial (67 participants)
indicates that, compared with home-based care, a community-based
Leg Club ® clinic that provided mechanisms for
peer-support, assistance with goal setting and social interaction
did not result in superior healing rates at three months (12/28
people healed in Leg Club clinic group versus 7/28 in homebased
care group; risk ratio (RR) 1.71, 95% confidence interval
(CI) 0.79 to 3.71); or six months (15/33 healed in Leg Club
group versus 10/34 in home-based care group; RR 1.55, 95%
CI 0.81 to 2.93); or in improved quality of life outcomes at six
months (MD 0.85 points, 95% CI -0.13 to 1.83; 0 to 10 point
scale). However, the Leg Club resulted in a statistically significant
reduction in pain at six months (MD -12.75 points, 95%
CI -24.79, -0.71; 0 to 100 point scale), although this was not
considered a clinically important difference. Time to complete
healing, recurrence of ulcers, adherence and adverse events
were not reported.
Low quality evidence from another trial (184 participants)
indicates that, compared with usual care in a wound clinic, a
community-based and nurse-led self-management programme
of six months’ duration promoting physical activity (walking and
leg exercises) and adherence to compression therapy via counselling
and behaviour modification (Lively Legs ® ) may not result
in superior healing rates at 18 months (51/92 healed in Lively
Legs group versus 41/92 in usual care group; RR 1.24 (95% CI
0.93 to 1.67)); may not result in reduced rates of recurrence of
venous leg ulcers at 18 months (32/69 with recurrence in Lively
Legs group versus 38/67 in usual care group; RR 0.82 (95% CI
0.59 to 1.14)); and may not result in superior adherence to
compression therapy at 18 months (42/92 people fully adherent
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