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Table 5 Summary of evidence for pressure ulcer management

From: Seeking effective interventions to treat complex wounds: an overview of systematic reviews

Outcome Intervention Systematic reviews with MA Systematic reviews without MA
High-quality* Low/moderate quality High-quality** Low/moderate quality
Wound area/size reduction (MAs: NA; non-MAs: 3) [78,87,94] Air-fluidized support NA NA NA +
Alternating pressure mattress, low-air-loss mattress, air-fluidized mattress NA NA NA
  Collagenase NA NA NA +/−
  Collagenase, hydrogel dressings NA NA NA
  Electric current, electromagnetic therapy NA NA NA
  Foam, calcium alginate, radiant heat dressing, dextranomer powder dressings NA NA NA
  Hydrocolloid dressings NA NA NA +
  Hydrocolloid, hydrogel wafer, hydrogel, occlusive polyurethane, transparent moisture-permeable dressings NA NA NA
  Hydrogel, cadexomer iodine, semelil gel, radiant heat, zinc salt spray, aluminum hydroxide, vitamin A ointment, streptokinase-streptodornase, dialysate, topical insulin, moist saline gauze and whirlpool, semelil dressings NA NA NA
  Low level laser therapy, laser and standard care NA NA NA
  Polarized light, monochromatic light and cadexomer iodine or hydrocolloid NA NA NA
  Ultrasound NA NA NA
  Vacuum therapy NA NA NA
  Vitamin C and ultrasound, consistent wound care and controlled nutritional support, vitamin C, zinc sulfate NA NA NA
Time to healing or rate of healing (MAs: NA; non-MAs: 3) [68,78,94] Ascorbic acid, high-protein diet, concentrated, fortified, collagen protein hydrolysate supplement, disease-specific nutrition treatment NA NA NA +/−
  Amorphous hydrogel dressing derived from Aloe vera wound dressings NA NA +/− NA
  Electromagnetic therapy, low-intensity direct current, negative-polarity and positive-polarity electrotherapy, and alternating-polarity electrotherapy NA NA NA +/−
  Hydrocolloid dressings NA NA NA +/−
  Low air-loss beds NA NA NA +/−
  Low level laser therapy NA NA NA +/−
  Low-tech constant low-pressure supports NA NA NA +/−
  Phenytoin ointment (topical) NA NA NA +/−
  Seat cushions NA NA NA +/−
  Topical negative pressure NA NA NA +/−
  Triple antibiotic ointment, active cream dressings NA NA NA
  Ultrasound NA NA NA
Ulcer healing (MAs: 8 [16,43,60,62,64]; non-MAs: 11 [75,76,78,85,90,92,94,97,99,104,106]) Air-fluidized bed/supports + + +/− NA
Air-fluidized beds, air suspension beds, foam replacement mattress NA NA NA
  Alternating pressure surfaces NA NA   +/−
  Alternating pressure surfaces (alternating pressure mattress + pressure relief cushion) NA NA +/− NA
  Ascorbic acid, zinc sulfate NA NA +/− NA
  Collagen protein, standard hospital diet and high protein, standard hospital diet and high protein and zinc and arginine and vitamin C NA NA NA
  Collagenase (topical) NA NA NA +
  Fibroblast-derived dermal replacement NA NA NA +
  Hydrocolloid, polyurethane, dextranomer, hydrogel, polyhydroxyethyl methacrylate, amino acid copolymer dressings NA NA NA
  Low air-loss mattress, alternating pressure mattress, air-fluidized mattress NA NA NA
  Phenytoin solution, antibiotics dressings NA NA NA
  Protease-modulating matrix, recombinant platelet-derived growth factor BB, nerve growth factor, transforming growth factor beta, granulocyte-macrophage/colony stimulating factor, basic fibroblast growth factor (topical) NA NA NA +
  Saline spray containing Aloe vera, silver chloride and decyl glucoside, saline, whirlpool NA NA NA
  Topical negative pressure NA NA NA
  Topical negative pressure (vacuum assisted wound closure) NA NA NA
  Alternative foam mattress + NA NA NA
  Electrotherapy + NA NA NA
  High protein, oral nutritional support, enteral tube feeding NA NA NA
  Hydrocolloid dressings + NA NA NA
  Polyurethane dressings NA NA NA
Proportion of patients with healed wounds (MAs: 25 [43,54,62]; non-MAs: 2 [78,94]) Collagenase debridement (topical) NA NA NA
Dextranomer (beads + dry dressing) NA NA NA
Electrical stimulation NA NA NA
  Electrotherapy NA NA
  Growth Factors (topical) NA NA  
  Hydrocolloid dressings NA +/− NA
  Hydrogel (gel) NA + NA
  Hydropolymer dressing NA NA NA
  Low air-loss beds NA NA
  Low level laser therapy NA NA NA
  Alternating pressure mattress NA +/− NA NA
  Non-contact normothermic dressing NA NA NA
  Polyurethane dressings NA NA
  Ultrasound NA +/−
  Zinc supplement (oral) NA NA  
  Collagenase, dressings NA NA NA
  Laser therapy + moist saline gauze NA NA NA
  Monochromatic phototherapy, UV light NA NA NA
  Oxyquinoline, radiant heat, soft silicone, hydrogel or foam, active ointment with live yeast derivative, topical insulin (dressings) NA NA NA
  Resin salve absorbent dressings NA NA NA
  Specialized foam mattress, alternating pressure mattress NA NA NA
  1. *At least one systematic review with meta-analysis and AMSTAR score ≥8.
  2. **At least one systematic review without meta-analysis and AMSTAR score ≥8.
  3. + Effective (statistically significant difference between interventions and comparators); – No difference (no statistically significant difference between interventions and comparators); +/− Unknown (conflicting evidence between meta-analysis or indeterminate results); NA, No studies available; MA, Meta-analysis.