Systematic Review and Mixed Treatment Comparison Dressings to Heal Diabetic Foot Ulcers
Dressings for treating human foot ulcers in people with diabetes: an overview of systematic reviews
References
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Figures and Tables -
Figure 1
Study flow diagram.
Tabular array ane.Overview of dressing types
| Basic wound contact dressings |
| Low adherence dressings and wound contact material |
| Advanced wound dressings |
| Hydrogel dressings |
| Anti‐microbial dressings |
| Honey PHMB (polyhexamethylene biguanide or polihexanide) |
| Specialist dressings |
| Protease‐modulating matrix |
Figures and Tables -
Table 1.Overview of dressing types
Tabular array ii.Summary of included reviews
| Review ID | Cochrane Review? | Number of databases searched | Search date | Interventions included | Included wound types | Other outcomes reported in the review that are relevant to this overview | Method of chance of bias/quality assessment used in the review |
| Dumville 2013d | Y | 6 | 2013 | Included any RCT in which the presence or absenteeism of a hydrogel dressing was the only systematic divergence between treatment groups | Foot ulcers in people of any age with DM | Health‐related quality of life; amputations; adverse events, including pain; price | Standard Cochrane 'Adventure of bias' assessment as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) |
| Dumville 2013c | Y | six | 2013 | Included any RCT in which the presence or absence of a cream dressing was the only systematic deviation between treatment groups | Foot ulcers in people of any age with DM | Wellness‐related quality of life; amputations; agin events, including pain; cost | Standard Cochrane 'Risk of bias' assessment as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) |
| Dumville 2013b | Y | 6 | 2013 | Included any RCT in which the presence or absence of a hydrocolloid dressing was the only systematic difference betwixt treatment groups | Foot ulcers in people of whatsoever historic period with DM | Wellness‐related quality of life; amputations; adverse events, including pain; price | Standard Cochrane 'Risk of bias' cess as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) |
| Dumville 2013a | North | vi | 2013 | Included any RCT in which the presence or absenteeism of a alginate dressing was the only systematic difference between handling groups | Human foot ulcers in people with DM | N/A | Standard Course cess for direct estimates. Estimates from the MTC was assessed using an advert hoc modified version of GRADE developed by the study authors |
| Dumville 2012 | Y | six | 2012 | Included whatsoever RCT comparing i dressing handling with another | Foot ulcers in people of whatever age with DM | Wellness‐related quality of life; amputations; adverse events, including hurting; cost | Standard Cochrane 'Risk of bias' cess as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) |
| Edwards 2010 | Y | 6 | 2011 | Included any RCT comparison hydrogel dressing with adept wound care or gauze | Pes ulcers in people with DM (neuropathic, neuroischaemic or ischaemic aetiology) | Number of complications/adverse events; quality of life | Standard Cochrane 'Gamble of bias' assessment as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) |
| Game 2012 | North | 6 | 2010 | Included whatsoever RCT comparing:
| Human foot ulcers in people with DM | Amputation | Each study was scored for methodological quality using scoring lists specific for each study design and based on checklists adult by the Dutch Cochrane Center (www.cochrane.nl/index.html) |
| Voigt 2012 | North | 2 | 2011 | Included whatever RCT comparing Hyalofill dressing with basic wound contact dressing | Foot ulcers in people with DM down to and including bone (Wagner class iv), diabetic and neuropathic lower extremity ulcers, venous leg ulcers, fractional or full skin thickness burns, and surgical removal of the epithelial layer of skin | None | Standard Cochrane 'Chance of bias' assessment as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) |
| Tempest‐Versloot 2010 | Y | 6 | 2009 | Included any RCT comparing silvery‐hydrofibre dressing with alginate dressing | Preventing infection or promoting the healing, or both, of uninfected wounds of whatsoever aetiology. People aged 18 years and over with any type of wound | Adverse events; hurting; | Standard Cochrane 'Risk of bias' assessment as outlined in Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). |
| Hinchliffe 2008b | N | 4 | 2006 | Included whatever RCT comparing: basic wound contact dressing with alginate dressing or hydrofibre dressing or foam dressing | Chronic human foot ulcers in people anile | N/A | Each report was scored for methodological quality using design‐specific scoring, based on checklists adult past the |
| Nelson 2006 | N | xvi | 2002 | Included whatsoever RCT comparison hydrogel dressing with basic wound contact dressing | Human foot ulcers in adults with DM | Number and elapsing of hospital admissions for diabetic foot problems | The methodological quality of RCTs was assessed using the |
| O'Meara 2000 | N | 19 | 2000 | Included whatsoever RCT comparing:
| Chronic wounds, pes ulcers in people with diabetes, pressure level ulcers, chronic leg ulcers (caused by venous, arterial or mixed insufficiency), pilonidal sinuses, non‐healing surgical wounds and chronic crenel wounds | N/A | Details of study quality assessment were provided in appendix 6. However the run a risk of bias assessment tool used in this review was not reported explicitly |
| Mason 1999a | N | 8 | Searched from 1983, but search date was not reported | Included whatsoever RCT comparison:
| Foot ulcers in people with DM | Due north/A | Method of risk of bias/quality assessment was not reported explicitly in this report |
| Abbreviations MTC: Mixed Treatment comparison | |||||||
Figures and Tables -
Table 2.Summary of included reviews
Table 3.AMSTAR assessment of included Cochrane reviews
| AMSTAR criteria (for all included Cochrane reviews) | Storm‐Versloot 2010 | Edwards 2010 | Dumville 2013a | Dumville 2013b | Dumville 2013c | Dumville 2013d |
| A priori blueprint | Y | Y | Y | Y | Y | Y |
| Duplicate selection and extraction* | Y | N | Y | Y | Y | Y |
| Comprehensive literature search | Y | Y | Y | Y | Y | Y |
| Searched for reports regardless of publication type or linguistic communication | Y | Y | Y | Y | Y | Y |
| Excluded/included list provided | Y | Y | Y | Y | Y | Y |
| Characteristics of included studies provided | Y | Y | Y | Y | Y | Y |
| Quality assessment of included studies assessed and presented | Y | Y | Y | Y | Y | Y |
| Quality used accordingly in formulating conclusions | Y | Y | Y | Y | Y | Y |
| Methods used to combine studies appropriate | Y | Y | Y | Y | Y | Y |
| Publication bias assessed | Y | Due north/A | N/A | N/A | North/A | N/A |
| Disharmonize of interest stated | Y | Y | Y | Y | Y | Y |
| Total score (out of a maximum of 11) | 11 | 9 | x | ten | ten | 10 |
| * In the AMSTAR assessment we coded "YES" where checking of study selections and data extraction was reported; we coded "NO" where only study exclusions were checked. Abbreviations Due north: no | ||||||
Figures and Tables -
Table 3.AMSTAR assessment of included Cochrane reviews
Table 4.AMSTAR assessment of included not‐Cochrane reviews
| AMSTAR criteria (for all included non‐Cochrane reviews) | O'Meara 2000 | Hinchliffe 2008b | Bricklayer 1999a | Game 2012 | Nelson 2006 | Dumville 2012 | Voigt 2012 |
| A priori design | Y | Y | Y | Y | Y | Y | Y |
| Duplicate selection and extraction *one | Y | Y | Y | Y | Y | Y | Y |
| Comprehensive literature search | Y | Y | Y | Y | Y | Y | Y |
| Searched for reports regardless of publication blazon or linguistic communication | Y | Y | Y | Y | Y | Y | Y |
| Excluded/included listing provided | Y | Northward | Northward | Due north | N | Due north | Y |
| Characteristics of included studies provided | Y | Y | Y | Y | Y | Y | Y |
| Quality assessment of included studies assessed and presented | Y | Y | Y | Y | Y | Y | Y |
| Quality used accordingly in formulating conclusions | Y | Y | Y | Y | Y | Y | Y |
| Methods used to combine studies appropriate *2 | Y | N/A | Due north/A | N/A | N/A | Due north/A | Y |
| Publication bias assessed | N/A | North/A | N/A | N/A | NA | Y | Y |
| Conflict of interest stated *iii | N | Due north | Due north | Northward | Northward | Y | Northward |
| Total score (out of a maximum of 11) | nine | 7 | 7 | 7 | vii | 9 | ten |
| *1. In the AMSTAR assessment nosotros coded "Yep" where checking of written report selections and information extraction was reported; nosotros coded "NO" where just study exclusions were checked *2. In the AMSTAR cess we coded the synthesis criterion every bit non applicable (N/A) for reviews where no meta‐analysis was conducted *3. For the AMSTAR assessment we coded the funding criterion "NO" if funding for individual studies not reported Abbreviations N: no | |||||||
Figures and Tables -
Table 4.AMSTAR assessment of included non‐Cochrane reviews
Table 5.Comparison i: review data for basic wound contact dressing versus alginate dressing
| Comparison ane Basic wound contact dressing versus alginate dressing | ||||||
| Review | Included trials (trials that reported secondary consequence information are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resources employ | Dressing functioning |
| Dumville 2013a Principal outcomes: time to ulcer healing; proportion of ulcers healed inside specific time Cochrane review | RCTs: 3 Full Northward = 191 Alginate: northward = 109 BWC: n = 82 Ahroni 1993(n = 39)* Follow‐upward: minimum iv weeks Alginate: due north = 20 BWC: due north = 19 Donaghue 1998 (n = 75)* Follow‐up: 8 weeks Alginate: north = 50 BWC: north = 25 Lalau 2002 (due north = 77) Follow‐upwardly: half dozen weeks, unclear if only 4‐week data analysed Alginate: n = 39 BWC: due north = 38 | % ulcers healed Pooled analysis (fixed‐upshot) from 2 RCTs: RR 1.09 (95% CI 0.66 to i.80); I² 27%; Chi² P value 0.24 Trial data reported Ahroni 1993 Alginate 5/twenty (25%) vs BWC 7/19 (37%); RR 0.68 (95% CI 0.26 to 1.77) Donaghue 1998 Alginate 24/50 (48%) vs 9/25 (26%); RR 1.33 (95% CI 0.73 to 2.42) Mean time to healing (weeks) Trial data reported Donaghue 1998 Alginate vi.2 (SD 0.4) vs BWC five.viii (SD 0.4) | NR | Trial data reported Amputations Ahroni 1993 4 (ii/group) all afterward the 4‐week follow‐up Other AEs Ahroni 1993 Alginates: 6 (4 antibiotic treatment, ane death, 1 septicaemia) vs BWC: 4 (3 antibiotic handling, 1 expiry) AEs Donaghue 1998 half-dozen events, not described, grouping allocation unclear Hospitalisation Ahroni 1993 Alginate 2; BWC 1 | NR | NR |
| Dumville 2012 Main upshot: proportion of ulcers healed within specific time Mixed treatment comparing Non‐Cochrane review | Direct estimate RCTs: 2 Total N = 114 Alginate: n = seventy BWC: n = 44 Ahroni 1993(north = 39)* Alginate: n = 20 BWC: northward = nineteen Donaghue 1998 (n = 75)* Alginate: n = 50 BWC: n = 25 | % ulcers healed Pooled analyses (stock-still‐issue) from 2 RCTs Direct approximate OR one.26 (95% CrI 0.55 to ii.46) MTC estimate OR ane.29 (95% CrI 0.57 to ii.51) | NR | NR | NR | NR |
| Hinchliffe 2008b Primary upshot: proportion of ulcers healed Non‐Cochrane review | RCTs: ii Full N = 152 Alginate: n = 89 BWC: n = 63 Donaghue 1998 (north = 75)* Alginate: n = l BWC: northward = 25 Lalau 2002 (northward = 77) Alginate: n = 39 BWC: n = 38 | % ulcers healed Trial data reported Donaghue 1998 Alginate: 48% of n = 50 BWC: 36% of due north = 25 Lalau 2002 NR | NR | NR | NR | NR |
| O'Meara 2000 Primary outcome: % ulcers healed Non‐Cochrane review | RCTs: 1 Total North = 75 Donaghue 1998 (due north = 75)* Alginate: due north = 50 BWC: north = 25 | % ulcers healed Trial information reported Donaghue 1998 Alginate:24/44, BWC:9/17 OR 1.07(95% CI 0.36 to three.25) Mean fourth dimension to healing Trial data reported Donaghue 1998 Alginate: 43.four ± xix.eight days BWC: 40.6 ± 21 days | NR | Trial data reported Donaghue 1998 No difference in the number or severity of reported adverse reactions between groups | NR | Trial data reported Donaghue 1998 Patients' assessment of perceived efficacy favoured alginate compared to previous handling |
| Mason 1999a Primary outcome: % ulcer healed Non‐Cochrane review | RCTs: 2 Total N = 114 Alginate: northward = lxx BWC: northward = 44 Ahroni 1993 (north = 39) Alginate: n = 20 BWC: n = 19 Donaghue 1998 (north = 75)* Alginate: n = 50 BWC: n = 25 | % ulcers healed Trial data reported Ahroni 1993 Alginate 5/twenty (25%) vs BWC vii/nineteen (37%) % wounds healed eventually (unspecified time) Ahroni 1993 Alginate: 12/20 (60%) BWC: 14/19 (74%) Donaghue 1998 Alginate: 24/44 (55%), BWC: nine/17 (53%) Mean time to healing Trial data reported Donaghue 1998 Alginate 43.4 ± xix.8 days BWC: 40.half dozen ± 21 days | NR | Trial data reported Withdrawals Donaghue 1998 Alginate 12% vs BWC 32% | NR | NR |
| Abbreviations AE: agin event | ||||||
Figures and Tables -
Table 5.Comparison 1: review data for basic wound contact dressing versus alginate dressing
Table half dozen.Comparison 2: review data for basic wound contact dressing versus hydrogel dressing
| Comparison 2 Bones wound contact dressing versus hydrogel dressing | ||||||
| Review | Included trials (trials that reported secondary outcome information are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resource use | Dressing functioning |
| Dumville 2013d Primary consequence: number of ulcers healed Cochrane review | RCTs: 3 Total North = 198 Hydrogel: due north = 89 BWC: northward = 63 D'Hemecourt 1998 (north = 138)* Follow‐upwards: twenty weeks Hydrogel: n = 70 BWC: due north = 68 Jensen 1998 (n = 31)* Follow‐upwards: 16 weeks Hydrogel: n = 14 BWC: n = 17 Vandeputte 1997 (n = 29)* Follow‐up: 12 weeks Hydrogel: n = 15 BWC: northward = 14 | Ulcers healed Pooled analysis (stock-still‐result) from 3 RCTs: RR i.80 (95% CI 1.27 to 2.56); I² 0%; Chi² P value 0.77 Trial data reported D'Hemecourt 1998 Hydrogel: 25/lxx vs BWC fifteen/68; RR one.62 (95% CI 0.94 to 2.80) Jensen 1998 Hydrogel 11/xiv vs BWC half dozen/17; RR ii.23 (95% CI 1.11 to iv.48) Vandeputte 1997 Hydrogel 14/15 vs BWC 7/14; RR 1.87 (95% CI 1.09 to 3.21) | NR | Trial data reported Participants with AEs D'Hemecourt 1998 Hydrogel: 19/seventy (27%) vs BWC 25/68 (37%); RR 0.74 (95%CI 0.45 to ane.21) Jensen 1998 Hydrogel iii vs BWC 4 Amputations Jensen 1998 Hydrogel 1 vs BWC 0 Infection‐related complications Vandeputte 1997 Hydrogel: ane/fifteen (vii%) vs BWC seven/14 (50%); RR 0.14 (95% CI 0.02 to 1.01) NB unblinded cess* | Trial data reported Cost/twenty-four hour period (USD) Jensen 1998 Hydrogel vii.01 versus BWC 12.28. Costs not collected/compared as part of full economical evaluation | NR |
| Dumville 2012 Primary outcomes: time to ulcer healing; ulcers healed within specific time Not‐Cochrane review | Direct estimate RCTs: 3 Total N: 198 Hydrogel: northward = 89 BWC: northward = 63 D'Hemecourt 1998 (n = 138)* Hydrogel: n = 70 BWC: n = 68 Jensen 1998 (north = 31)* Hydrogel: n = 14 BWC: n = 17 Vandeputte 1997 (n = 29)* Hydrogel: n = fifteen BWC: north = 14 | % ulcers healed Pooled analyses Direct estimate: OR 3.x (95% CrI ane.51 to 5.50) MTC gauge: OR iii.33 (95% CrI i.65 to 6.11) | NR | NR | NR | NR |
| Edwards 2010 Primary outcome: number of wounds healed Cochrane review | RCTs: 3 Full Northward: 198 Hydrogel: n = 89 BWC: n = 63 D'Hemecourt 1998 (n = 138)* Hydrogel: n = 70 BWC: n = 68 Jensen 1998 (n = 31)* Hydrogel: n = 14 BWC: n = 17 Vandeputte 1997 (n = 29)* Hydrogel: northward = 15 BWC: n = 14 | % ulcers healed Pooled analysis (fixed‐consequence) from 3 RCTs: RR 1.84 (95% CI one.30 to 2.61) Trial data reported D'Hemecourt 1998 Hydrogel: 25/70 vs BWC 15/68 Jensen 1998 Hydrogel 12/14 (85%) vs BWC 8/17 (46%)** Vandeputte 1997 Hydrogel 14/15 vs BWC 7/14 | Pooled estimate of complications/AE from all 3 trials Hydrogel 22 events vs BWC 36 events. Fixed‐effect RR 0.60 (95% CI 0.38 to 0.95); random‐effects RR 0.56 (95% CI 0.25 to 1.25). I² 31% Trial data reported Infections D'Hemecourt 1998 Hydrogel 19/70 (27%) vs 25/68 (37%) RR 0.74 (95%CI 0.45 to 1.21)* Infection‐related complications Vandeputte 1997 Hydrogel: 1/xv (vii%) vs BWC vii/14 (50%); RR 0.xiii (95% CI 0.02 to 0.95)** Complications Jensen 1998 Hydrogel 2/14(14%) vs BWC four/17 (24%); RR 0.61 (95% CI 0.thirteen to two.84). Included events: amputation, increased eschar formation, cellulitis, worsened with increased eschar formation Pain D'Hemecourt 1998 Hydrogel: 11/70 (sixteen%) vs BWC x/68 (15%); RR 0.74 (95% CI 0.45 to i.21 favouring BWC) unclear how hurting reported | |||
| Hinchliffe 2008b Primary result: number of wounds healed Non‐Cochrane review | Jensen 1998 (n = 31) Hydrogel: n = xiv BWC: n = 17 | % wounds healed Trial information reported Jensen 1998 Hydrogel 12/xiv (85%) vs BWC 8/17 (46%) | NR | NR | NR | NR |
| Nelson 2006 Main outcome: number of wounds healed Non‐Cochrane review | Vandeputte 1997 (due north = 29)* Hydrogel: due north = 15 BWC: northward = fourteen | % wounds healed Trial data reported Vandeputte 1997 Hydrogel 14/15 (93%) vs BWC 5/xiv (36%); RR two.61 (95% CI 1.45 to 5.76) | Trial information reported Vandeputte 1997 Amputation required Hydrogel i/15 (vii%) vs BWC 5/14 (36%); RR v.4 (95% CI 0.98 to 32.7) Infection Hydrogel 1/15 (7%) vs BWC vii/14 (7%); RR 7.5 (95% CI 1.47 to 44.1) Antibiotics needed Hydrogel ane/15 (7%) vs BWC fourteen/14 (100%); RR 0.067 (95% CI 0.01 to 0.31) | |||
| *What Dumville defined equally AE was all covered by infections in Edwards. Edwards noted that it was unclear how infection had been defined **Events from the Jensen trial reported in Edwards differed from those reported in Dumville; so RR differs slightly. Checking the trial report showed that Dumville information seem accurate Abbreviations AE: adverse event | ||||||
Figures and Tables -
Table 6.Comparison ii: review data for basic wound contact dressing versus hydrogel dressing
Tabular array vii.Comparison 3: review data for basic wound contact dressing versus hydrofibre dressing
| Comparison 3 Basic wound contact dressing versus hydrofibre dressing | ||||||
| Review | Included trials (trials that reported secondary outcome data are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resource apply | Dressing operation |
| Dumville 2013b Primary outcomes: time to ulcer healing; ulcers healed within specific time Cochrane review | RCTs: 2 Total N: 229 Hydrofibre: n = 113 BWC: north = 116 Jeffcoate 2009 (northward = 209)* Follow‐up: 24 weeks Hydrofibre: due north = 103 BWC: n = 106 Piaggesi 2001 (n = 20)* Follow‐up: NR; maximum fourth dimension reported approximately 350 days Hydrofibre: n = 10 BWC: n = x | % ulcers healed Pooled assay (random‐effects) from 2 RCTs: RR i.01 (95% CI 0.74 to 1.38); I² 54%; Chi² P value 0.xiv Trial information reported Jeffcoate 2009 Hydrofibre 46/103 (45%) vs BWC 41/106 (39%); RR ane.15 (95% CI 0.84 to 1.59) Piaggesi 2001 Hydrofibre nine/10 (xc%) vs BWC 10/10 (100%); RR 0.90 (95% CI 0.69 to i.18) Mean fourth dimension to healing (days) Trial data reported Jeffcoate 2009 Hydrofibre 125.viii (SD 55.5) vs BWC 130.7 (SD 52.4) Piaggesi 2001 Hydrofibre 127 (SD 46) vs BWC 234 (SD 61) | Trial information reported Jeffcoate 2009 No difference in affliction‐specific or generic QoL | Trial information reported Amputations Jeffcoate 2009 Hydrofibre 4 vs BWC 2 Piaggesi 2001 Hydrofibre v vs BWC 3 Serious AEs Jeffcoate 2009 Hydrofibre 28 vs BWC 35 Non‐serious AEs Jeffcoate 2009 Hydrofibre 227 vs BWC 244 AEs reported Piaggesi 2001 Hydrofibre two vs BWC 5 | Trial information reported Cost per healed ulcer (GBP) Jeffcoate 2009 Hyrofibre 836 vs BWC 362 Days between dressing changes (mean) Piaggesi 2001 Hydrofibre 21 vs BWC 2.4 | NR |
| Dumville 2012 Primary outcomes: time to ulcer healing; ulcers healed within specific time Non‐Cochrane review | Straight gauge RCTs: 2 Total North: 229 Hydrofibre: n = 113 BWC: due north = 116 Jeffcoate 2009 (due north= 209)* Hydrofibre: due north = 103 BWC: n = 106 Piaggesi 2001 (n = twenty)* Hydrofibre: n = x BWC: northward = x | % ulcers healed Pooled analyses Direct estimate: OR one.28 (95% CrI 0.71 to 2.14) MTC estimate: OR 1.28 (95% CrI 0.72 to two.xiii) | NR | NR | NR | NR |
| Game 2012 Primary outcome: number of wounds healed Non‐Cochrane review | RCTs: ane Total Northward: 209 Hydrofibre: n = 103 BWC: northward = 106 Jeffcoate 2009 (n = 209)* Hydrofibre: n = 103 BWC: n = 106 | % ulcers healed Trial data reported Jeffcoate 2009 Hydrofibre 44.vii% vs BWC 38.7% Hateful fourth dimension to heal (days) Trial data reported Jeffcoate 2009 Hydrofibre: 72.4 (SD twenty.half dozen) vs BWC 75.1 (SD 18.1) | NR | Trial data reported Secondary infection Jeffcoate 2009 Hydrofibre 54 vs BWC 48. 3‐manner comparing reported as P value < 0.001 | Trial data reported Mean dressing cost per patient (GBP) Jeffcoate 2009 Hydrofibre 43.threescore vs BWC 14.85. Three‐fashion comparison reported equally P value < 0.05 | NR |
| Hinchliffe 2008b Primary outcome: number of wounds healed Non‐Cochrane review | RCTs: 1 Total North: 20 Hydrofibre: n = 10 BWC: due north = ten Piaggesi 2001 (n = 20) Hydrofibre: north = x BWC: n = 10 | Fourth dimension to heal (days) Trial data reported Piaggesi 2001 Hydrofibre: 127 (SD 46) vs BWC 234 (SD 25?) | NR | NR | NR | NR |
| Abbreviations AE: agin event | ||||||
Figures and Tables -
Table 7.Comparison 3: review data for basic wound contact dressing versus hydrofibre dressing
Table eight.Comparison 4: review data for bones wound contact dressing versus Hyalofill dressing
| Comparison 4 Bones wound contact dressing versus Hyalofill dressing | ||||||
| Review | Included trials | Wound healing | HRQoL | Adverse events | Resource employ | Dressing performance |
| Voigt 2012 Main outcome: number of ulcers healed Non‐Cochrane review | RCTs: 1 Full North: 30 Hyalofill: northward = 15 BWC: n = 15 Edmonds 2000 (northward = thirty) Follow‐up: 12 weeks Hyalofill: northward = 15 BWC: n = 15 | % ulcers healed Trial data reported Edmonds 2000 Hyalofill 10/15 (67%) vs BWC three/15 (xx%) P value < 0.05 | NR | NR | NR | NR |
| Abbreviations BWC: basic wound contact dressing | ||||||
Figures and Tables -
Table 8.Comparison 4: review data for basic wound contact dressing versus Hyalofill dressing
Tabular array 9.Comparison 5: review data for basic wound contact dressing versus iodine‐impregnated dressing
| Comparing v Bones wound contact dressing versus iodine‐impregnated dressing | ||||||
| Review | Included trials (trials that reported secondary result data are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resources apply | Dressing performance |
| Dumville 2012 Primary outcomes: time to ulcer healing; ulcers healed within specific time Non‐Cochrane review | Direct estimate RCTs: 1 Total N: 214 Iodine: n = 108 BWC: n = 106 Jeffcoate 2009 (n = 214)* Follow‐upward: 24 weeks Iodine: n = 108 BWC: due north = 106 | % ulcers healed Pooled analyses Straight estimate: OR 1.27 (95% CI 0.74 to 2.19) MTC estimate: OR i.28 (95% CrI 0.71 to two.12) | NR | NR | NR | NR |
| Game 2012 Main effect: number of wounds healed by 24 weeks Non‐Cochrane review | RCTs: one Total Northward: 214 Iodine: north = 108 BWC: n = 106 Jeffcoate 2009 (northward = 214)* Iodine: n = 108 BWC: n = 106 | % ulcers healed Trial information reported Jeffcoate 2009 Iodine 44.4% vs BWC 38.7% Mean time to healing Jeffcoate 2009 Iodine 74.1 (SD 20.6) days vs BWC 75.ane (SD xviii.one) days | NR | Trial data reported Secondary infection Jeffcoate 2009 Iodine 71 vs BWC 48 Three‐style comparison reported as P value < 0.001 | Trial information reported hateful dressing cost per patient (GBP) Jeffcoate 2009 Iodine 17.48 vs BWC 14.85. Three‐way comparison reported every bit P value < 0.05 | NR |
| Abbreviations BWC: bones wound contact dressing SD: standard deviaiton | ||||||
Figures and Tables -
Tabular array 9.Comparison 5: review data for basic wound contact dressing versus iodine‐impregnated dressing
Table 10.Comparison 6: review information for basic wound contact dressing versus foam dressing
| Comparison 6 Basic wound contact dressing versus foam dressing | ||||||
| Review | Included trials (trials that reported secondary outcome information are marked with an asterisk*) | Wound healing | HRQoL | Agin events | Resource use | Dressing performance |
| Dumville 2013c Master outcome: number of ulcers healed Cochrane review | RCTs: iii Total N: 67 Foam: n = 36 BWC: due north = 31 Blackman 1994 (n = 18)* Follow‐upwards: 6 months but 2 months reported here due to cross‐over Foam: n = 11 BWC: northward = 7 Mazzone 1993 (northward = 19)* Follow‐up: 8 weeks Foam: n = 11 BWC: n = viii Roberts 2001 (n = thirty)* Follow‐upwards: 13 weeks Foam: n = xiv BWC: n = 16 | % ulcers healed Pooled analysis (fixed‐event) from two RCTs: RR: 2.03 (95% CI 0.91 to iv.55); I² 0%; Chi² P value 0.64 Trial reported information Blackman 1994 Foam three/11 (27%) vs BWC 0/7 (0%); RR iv.67 (95% CI 0.28 to 78.68) Mazzone 1993 Foam 7/11 (64%) vs BWC two/8 (25%); RR 2.55 (95% CI 0.71 to 9.xvi) Roberts 2001 Foam 6/14 (43%) vs BWC iv/16 (25%); RR 1.71, (95% CI 0.60 to 4.86) | NR | None of the iii included trials reported any data for whatever secondary outcome evaluated | NR | NR |
| Dumville 2012 Master outcomes: time to ulcer healing; ulcers healed inside specific time Non‐Cochrane review | Straight estimate RCTs: 3 Total North: 67 Foam: 36 BWC: 31 Blackman 1994 (n = 18)* Cream: n = xi BWC: n = 7 Mazzone 1993 (n = 19)* Cream:n = eleven BWC: n = 8 Roberts 2001 (n = xxx)* Cream: north = xiv BWC: n = sixteen | % ulcers healed Pooled analyses Straight guess: OR four.10 (95% CrI ane.07 to 10.07) MTC gauge: OR 4.32 (95% CrI 1.56 to 9.85) | NR | NR | NR | NR |
| Hinchliffe 2008b Principal effect: number of wounds healed Non‐Cochrane review | Blackman 1994 (n = xviii) Foam: n = 11 BWC: n = 7 | % ulcers healed by 2 months Trial reported data Blackman 1994 Foam 3/11 vs BWC 0/7 | NR | NR | NR | NR |
| O'Meara 2000 Principal outcome: % ulcers healed Not‐Cochrane review | Blackman 1994 (n = eighteen) Cream: n = eleven BWC: northward = seven | % ulcers healed by 2 months Trial reported data Blackman 1994 Foam 3/11 vs BWC 0/7; OR 6.39 (95% CI 0.54 to 75.62) As well reported: change in ulcer area (reduction) Foam 35 ± 16% vs BWC 105 ± 26%; OR ‐lxx.00 (95% CI 2.01 to 99.78) | NR | NR | NR | NR |
| Mason 1999a Master upshot: % ulcers healed Not‐Cochrane review | Blackman 1994 (n = 18) Cream: n = eleven BWC: n = seven | % ulcers healed by 2 months Trial reported data Blackman 1994 Foam 3/11 vs BWC 0/seven Also reported: alter in ulcer expanse (reduction) Cream 35 ± 16% vs BWC 105 ± 26%; P value < 0.03 | NR | NR | NR | NR |
| Abbreviations BWC: basic wound contact dressing | ||||||
Figures and Tables -
Tabular array 10.Comparing 6: review data for basic wound contact dressing versus foam dressing
Table eleven.Comparison 7: review data for basic wound contact dressing versus protease‐modulating matrix dressing
| Comparing 7 Basic wound contact dressing versus protease‐modulating matrix dressing | ||||||
| Review | Included trials | Wound healing | HRQoL | Adverse events | Resources use | Dressing performance |
| Dumville 2012 Chief outcomes: time to ulcer healing; ulcers healed within specific fourth dimension Not‐Cochrane review | Direct estimate RCTs: 1 Full N: 276 Protease‐matrix: n = 138 BWC: n = 138 Veves 2002(n = 276) Follow‐up: 12 weeks Protease‐matrix: n = 138 BWC: north = 138 | % ulcers healed Pooled analyses Direct estimate: OR 1.49 (95% CI 0.90 to two.47) MTC judge: OR 1.54 (95% CrI 0.89 to ii.47) | NR | NR | NR | NR |
| Abbreviations BWC: basic wound contact dressing | ||||||
Figures and Tables -
Table 11.Comparison seven: review data for bones wound contact dressing versus protease‐modulating matrix dressing
Table 12.Comparing 8: review information for foam dressing versus alginate dressing
| Comparison viii Cream dressing versus alginate dressing | ||||||
| Review | Included trials (trials that reported secondary outcome data are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resource use | Dressing operation |
| Dumville 2013a Primary outcomes: fourth dimension to ulcer healing; ulcers healed within specific time Cochrane review | RCTs: 2 Full N: 50 Foam: n = 25 Alginate: northward = 25 Foster 1994(northward = 30)* Follow‐upward: eight weeks Cream: n = 15 Alginate: due north = 15 Baker 1993(unpublished; n = twenty) Follow‐up: 12 weeks Foam: northward = 10 Alginate: n = ten | % ulcers healed Pooled analyses (fixed‐effect) based on two RCTs: RR 0.67 (95% CI 0.41 to 1.08); I² 45%; Chi² P value 0.18 Trial reported data Foster 1994 Alginate 8/15 (53%) vs cream 9/15 (60%); RR 0.89 (95% CI 0.47 to 1.67) Bakery 1993 Alginate four/x (twoscore%) vs foam 9/10 (90%); RR 0.44 (95% CI 0.20 to 0.98) Median time to healing Trial reported data Foster 1994 Alginate 42 vs foam xl (estimated from graph) Baker 1993 Alginate non reached past 84 days vs foam: 28 days | NR | Trial reported data AEs Foster 1994 Foam 0 vs alginate iv (severe pain: 1; plugging of plantar lesion blocking drainage: iii (i cellulitis) | NR | NR |
| Dumville 2013c Primary outcomes: time to ulcer healing; ulcers healed within specific time Cochrane review | RCTs: 2 Full N: 50 Cream: n = 25 Alginate: northward = 25 Foster 1994(n = 30)* Cream: n = 15 Alginate: due north = 15 Baker 1993(unpublished; n = 20) Foam: n = 10 Alginate: n = 10 | % ulcers healed Pooled analysis (fixed‐outcome) based on 2 RCTs: RR one.50 (95% CI 0.92 to 2.44); I² 45%; Chi² P value 0.18 Trial reported data Foster 1994 Alginate 8/fifteen (53%) vs cream nine/fifteen (60%); RR 1.13 (95% CI 0.60 to 2.xi) Baker 1993 Alginate 4/10 (40%) vs foam 9/10; RR 2.25 (95% CI 1.02 to 4.94) | NR | Equally Dumville 2013a above | NR | NR |
| Dumville 2012 Primary outcomes: time to ulcer healing; ulcers healed inside specific time Non‐Cochrane review | Straight estimate RCTs: 2 Total N: 50 Foam: north = 25 Alginate:n = 25 Foster 1994(northward = xxx)* Foam: n = 15 Alginate: n = xv Baker 1993(unpublished; north = 20) Foam: n = 10 Alginate: due north = 10 | % ulcers healed Pooled analyses Straight estimate: OR 2.94 (95% CrI 0.71 to eight.33) MTC judge: OR 3.61 (95% CrI 1.30 to 8.xxx) | NR | NR | NR | NR |
| O'Meara 2000 Primary outcome: % ulcers healed Non‐Cochrane review | RCTs: two Total N: 50 (49 reported) Foam: n = 25 Alginate: n = 25 Foster 1994(n = 30)* Cream: n = 15 Alginate: northward = 15 Baker 1993(unpublished; n = twenty, 19 reported?) Foam: n = ten Alginate: northward = 10 | % ulcers healed Pooled analysis (stock-still‐issue) based on 2 RCTs. Cream 18/25 vs alginate 12/24; OR 2.44 (95% CI 0.78 to 7.57) | Trial reported data AEs Baker 1993 No AE reported from either grouping Foster 1994 As for Dumville 2013a above; all AEs reported as leading to withdrawal | Trial reported information Baker 1993 Cream dressing:
Patient comfort Skilful; no significant divergence between groups | ||
| Mason 1999a Primary event: % ulcers healed Non‐Cochrane review | RCTs: 1 Total Due north: xxx Foam: n = 15 Alginate: north = xv Foster 1994 (north = 30) Foam: due north = 15 Alginate: n = 15 | % ulcers healed Trial reported data Foster 1994 Foam nine/15 vs alginate 8/15; OR i.30 (95% CI 0.31 to 5.38) | NR | NR | NR | NR |
| Abbreviations AE: adverse upshot | ||||||
Figures and Tables -
Table 12.Comparison 8: review data for cream dressing versus alginate dressing
Table thirteen.Comparing nine: review data for foam dressing versus hydrocolloid dressing
| Comparing 9 Foam dressing versus hydrocolloid dressing | ||||||
| Review | Included trials (trials that reported secondary outcome information are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resources use | Dressing performance |
| Dumville 2013b Primary outcomes: time to ulcer healing; ulcers healed within specific time Cochrane review | RCTs: 1 Total N: 40 Foam: n = twenty Hydrocolloid: n = 20 Clever 1995 (n = 40)* Follow‐up: 12 weeks Foam: due north = 20 Hydrocolloid: n = 20 | % ulcers healed Trial reported data Clever 1995 Foam 14/20 (70%) vs hydrocolloid 16/20 (80%); RR 0.88 (95% CI 0.61 to 1.26) Median time to healing (days) Trial reported data Clever 1995 Foam xvi.5 (range 4 to 52) vs hydrocolloid 15.v (range iv to 76 days) | NR | Trial reported information AEs Clever 1995 Foam 5 vs hydrocolloid ane | Trial reported information Mean number of dressing changes between clinical visits Clever 1995 Cream 2.37 vs hydrocolloid two.23 | NR |
| Dumville 2013c Chief outcomes: time to ulcer healing; ulcers healed within specific time Cochrane review | RCTs: one Total N: twoscore Cream: due north = 20 Hydrocolloid: n = 20 Clever 1995 (northward = 40)* Foam: n = twenty Hydrocolloid: due north = xx | % ulcers healed Trial reported data Clever 1995 Hydrocolloid 16/20 (80%) vs foam xiv/20 (lxx%); RR 1.14 (95% CI 0.80 to 1.64) | NR | As for Dumville 2013b above | As for Dumville 2013b above | NR |
| Dumville 2012 Master outcomes: time to ulcer healing; ulcers healed within specific time Non‐Cochrane review | RCTs: one Total N: xl Cream: n = 20 Hydrocolloid: n = 20 Clever 1995 (northward = 40)* Cream: due north = 20 Hydrocolloid: n = 20 | Ulcers healed Direct guess: OR 1.71 (95% CI 0.40 to 7.34) MTC guess: OR ii.forty (95% CrI 0.40 to eight.forty) | NR | NR | NR | NR |
| O'Meara 2000 Master issue: % ulcers healed Non‐Cochrane review | RCTs: 1 Full Northward: 40 Foam: n = twenty Hydrocolloid: northward = 20 Clever 1995 (due north = 40)* Foam: due north = xx Hydrocolloid: n = 20 | Time to healing (days): Trial reported data Clever 1995 Hydrocolloid 25.19 (SD 23.52) vs cream xx.43 (SD fourteen.74); OR iv.76 (95% CI ‐vii.41 to 16.93) | NR | Trial reported information Withdrawals Clever 1995 Foam 4 vs hydrocolloid 2 | NR | No differences in patient comfort based on subjective product evaluation (investigator); showering found slightly easier with hydrocolloid |
| Stonemason 1999a Main outcome: % ulcers healed Non‐Cochrane review | RCTs: 1 Full N: 40 Foam: n = 20 Hydrocolloid: due north = xx Clever 1995 (n = 40)* Foam: due north = twenty Hydrocolloid: n = 20 | Time to healing (days): Trial reported information Clever 1995 Hydrocolloid 25.19 (SD 23.52) vs foam 20.43 (SD 14.74) Too reported reduction in diabetic foot ulcer area (mm²) at iv weeks Hydrocolloid 32.37 (SD 54.12) vs foam 33.46 (SD 75.22) | NR | NR | No differences in frequency of change of dressing | NR |
| Abbreviations AE: adverse event | ||||||
Figures and Tables -
Tabular array thirteen.Comparison 9: review data for foam dressing versus hydrocolloid dressing
Table 14.Comparison 10: review information for iodine‐impregnated dressing versus hydrofibre dressing
| Comparison 10 Iodine‐impregnated dressing versus hydrofibre dressing | ||||||
| Review | Included trials (trials that reported secondary outcome data are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resources utilize | Dressing operation |
| Dumville 2013b Master outcomes: time to ulcer healing; ulcers healed inside specific time Cochrane review | RCTs: 1 Total N: 211 Iodine: n = 108 Hydrofibre: due north = 103 Jeffcoate 2009 (due north = 211)** Follow‐up: 24 weeks Iodine: n = 108 Hydrofibre: northward = 103 | % ulcers healed Trial data reported Jeffcoate 2009 Iodine 48/108 (44%) vs 46/103 (45%); RR 1.00 (95% CI 0.74 to 1.34) Mean time to healing (days) Trial data reported Jeffcoate 2009 Iodine 127.8 (SD 54.2) vs hydrofibre 125.8 (SD 55.nine) | Disease‐specific or generic HRQoL Trial data reported Jeffcoate 2009 No difference in disease‐specific or generic HRQoL | Trial information reported Jeffcoate 2009 Amputations Iodine: ane vs hydrofibre 4 Serious AEs Iodine 37 versus hydrofibre 28 Non‐serious AEs Iodine 239 vs hydrofibre 227 | Trial information reported Jeffcoate 2009 Cost per additional ulcer healed (GBP) for iodine group: 848 | NR |
| Dumville 2012 Primary outcomes: time to ulcer healing; ulcers healed inside specific time Non‐Cochrane review | RCTs: 1 Full N: 211 Iodine: due north = 108 Hydrofibre: n = 103 Jeffcoate 2009 (n = 211)** Iodine: northward = 108 Hydrofibre: n = 103 | % ulcers healed Pooled analyses Direct estimate: OR 0.99 (95% CI 0.58 to 1.71) MTC gauge: OR 1.05 (95% CrI 0.59 to i.75) | NR | NR | NR | NR |
| Game 2012 Primary outcome: number of wounds healed by 24 weeks Not‐Cochrane review | RCTs: 1 Total N: 211 Iodine: n = 108 Hydrofibre: n = 103 Jeffcoate 2009 (due north = 211)** Iodine: northward = 108 Hydrofibre: n = 103 | % ulcers healed Trial data reported Jeffcoate 2009 Iodine 44.4% vs hydrofibre 44.seven% Time to healing (days) Trial data reported Jeffcoate 2009 Iodine 74.1 (SD 20.vi) vs hydrofibre 72.iv (SD 20.6) | NR | Trial data reported Jeffcoate 2009 Secondary infection Iodine 71 vs hydrofibre 51. Three‐fashion comparing reported every bit P value < 0.001 | Trial information reported Mean dressing cost per patient (GBP) Jeffcoate 2009 Iodine 17.48 vs hydrofibre 43.60. Three‐way comparison reported as P value < 0.05 | NR |
| **This comparison appears to be Missing from the Revman tabular array – just included nether other comparisons assessed in Jeffcoate 2009 Abbreviations AE: adverse event | ||||||
Figures and Tables -
Table 14.Comparison 10: review data for iodine‐impregnated dressing versus hydrofibre dressing
Tabular array 15.Comparing 11: review data for alginate dressing versus silver‐hydrofibre dressing
| Comparison 11 Alginate dressing versus silver‐hydrofibre dressing | ||||||
| Review | Included trials (trials that reported secondary outcome information are marked with an asterisk*) | Wound healing | HRQoL | Adverse events | Resource utilize | Dressing operation |
| Dumville 2013a Principal outcomes: time to ulcer healing; ulcers healed within specific fourth dimension Cochrane review | RCTs: i Total North: 134 Alginate: due north = 67 Silver‐hydrofibre: due north = 67 Jude 2007(n =134)* Follow‐up: eight weeks Alginate: due north = 67 Silver‐hydrofibre: n = 67 | % ulcers healed Trial data reported Jude 2007 Silverish‐hydrofibre 21/67 (31%) vs alginate 15/67 (21%); RR i.twoscore (95% CI 0.79 to 2.47) Time to healing (days) Trial data reported Jude 2007 Silver‐hydrofibre 52.six (SD one.eight) vs alginate 57.seven (SD 1.7) | NR | Trial data reported Jude 2007 AEs Alginate 26 including 1 death vs silver‐hydrofibre 25 events including 1 death Infections (type unclear) Alginate eight vs hydrofibre 14 Discontinuation due to AE Alginate xiii vs silvery‐hydrofibre eight | Trial data reported Number of dressing changes (mean) Jude 2007 Alginate 20.8 vs silverish‐hydrofibre 21.9. No measure of variance reported | NR |
| Dumville 2012 Primary outcomes: fourth dimension to ulcer healing; ulcers healed inside specific fourth dimension Non‐Cochrane review | RCTs: 1 Total North: 134 Alginate: northward = 67 Silver‐hydrofibre: n = 67 Jude 2007(north =134)* Follow‐up: 8 weeks Alginate: north = 67 Silver‐hydrofibre: n = 67 | % ulcers healed Pooled analyses Direct estimate: OR 1.58 (95% CI 0.73 to 3.43) MTC judge: OR 1.73 (95% CrI 0.73 to 3.53) | NR | NR | NR | NR |
| Game 2012 Primary result: % ulcers healing Non‐Cochrane review | RCTs: 1 Total Northward: 134 Alginate: n = 67 Silver‐hydrofibre: n = 67 Jude 2007(north =134)* Follow‐up: 8 weeks Alginate: n = 67 Silver‐hydrofibre: n = 67 | % ulcers healed Trial data reported Jude 2007 Alginate 22% vs silver‐hydrofibre 31% Time to healing (days) Trial data reported Jude 2007 Alginate 57.7 (SD 1.vii) vs silver‐hydrofibre 52.half-dozen (SD 1.8) | NR | NR | NR | NR |
| Storm‐Versloot 2010 Primary upshot: wound infection rate and wound healing Cochrane review | RCTs: 1 Full North: 134 Alginate: n = 67 Silver‐hydrofibre: n = 67 Jude 2007(n =134)* Follow‐upwards: viii weeks Alginate: n = 67 Silver‐hydrofibre: northward = 67 | % ulcers healed Trial data reported Jude 2007Silver‐hydrofibre 21/67 vs alginate fifteen/67 (RD 0.09; 95% CI ‐0.06 to 0.24) Time to healing (days) Trial information reported Jude 2007 Silver‐hydrofibre 52.6 (SD 1.eight) vs alginate 57.7 (SD ane.7) | NR | Trial data reported Jude 2007 Participants developing infection Alginate 8/67 vs hydrofibre 11/67** RD 0.04 (95% CI ‐0.07 to 0.sixteen) Participants with AEs (non clearly defined) Alginate 26/67 vs hydrofibre 25/67 RD ‐0.01 (95% CI ‐0.18 to 0.15) | NR | NR |
| **Note discrepancy between Dumville and Storm‐Versloot on number of infections in hydrofibre dressing – unit of assay (infections versus participants) ‐ not clear Abbreviations AE: adverse issue | ||||||
Figures and Tables -
Table fifteen.Comparing 11: review data for alginate dressing versus silver‐hydrofibre dressing
Source: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010471.pub2/references