背景:数字健康干预(DHIs)已显示出治疗慢性伤口的有希望的结果。然而,与常规护理相比,其有效性以及干预类型的差异是否会影响伤口结局尚不清楚.
目的:主要目的是确定DHIs对成年慢性伤口患者伤口愈合结果的有效性。次要目标是评估各种类型的DHI之间的伤口愈合结果是否存在任何变化。
方法:总共,截至2023年8月1日,共检索了9个数据库的文献。随机对照试验(RCT),队列研究,纳入了比较DHIs与对照组在改善慢性伤口成年患者伤口结局方面的功效的准实验研究。研究选择,数据提取,偏倚风险评估由2名评审员独立进行.我们评估了每个RCT的质量,队列研究,分别使用Cochrane偏差风险工具进行准实验研究,Robins-I,和JoannaBriggs研究所关键评估工具清单。使用随机效应模型将相对风险(RR)和95%CI合并,异质性由I2统计量评估。同时进行亚组分析和敏感性分析。
结果:本系统综述共纳入25项研究,共8125例患者,而只有20项包含6535例患者的研究被纳入荟萃分析.RCT的疗效结果显示,DHI组和对照组在伤口愈合(RR1.02,95%CI0.93-1.12;P=.67)和1年左右的全因死亡率(RR1.08,95%CI0.55-2.12;P=.83)方面没有显着差异。与对照组相比,DHIs的使用与不良事件的显著变化相关(RR0.44,95%CI0.22-0.89;P=.02).亚组分析表明,数字平台在改善伤口愈合方面具有积极作用(RR2.19,95%CI1.35-3.56;P=.002)。尽管在伤口大小方面无法进行荟萃分析,成本分析,患者满意度,和伤口报告率,大多数研究仍然表明,DHI在处理慢性伤口方面并不逊色于常规护理。
结论:我们的研究结果证明了采用DHI治疗慢性伤口的可行性。然而,更突出,需要高质量的RCT来加强证据,需要更详细的临床疗效研究。
背景:PROSPEROCRD42023392415;https://tinyurl.com/4ybz6bs9。
BACKGROUND: Digital health interventions (DHIs) have shown promising results for the management of chronic wounds. However, its effectiveness compared to usual care and whether variability in the type of intervention affects wound outcomes are unclear.
OBJECTIVE: The main objective was to determine the effectiveness of DHIs on wound healing outcomes in adult patients with chronic wounds. The secondary objectives were to assess if there was any variation in wound healing outcomes across the various types of DHIs.
METHODS: In total, 9 databases were searched for the literature up to August 1, 2023. Randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies comparing the efficacy of DHIs with controls in improving wound outcomes in adult patients with chronic wounds were included. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 reviewers. We assessed the quality of each RCT, cohort study, and quasi-experimental study separately using the Cochrane risk of bias tool, ROBINS-I, and the Joanna Briggs Institute Critical Appraisal tools checklists. Relative risks (RRs) and 95% CIs were pooled using the random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed.
RESULTS: A total of 25 studies with 8125 patients were included in this systematic review, while only 20 studies with 6535 patients were included in the meta-analysis. Efficacy outcomes in RCTs showed no significant differences between the DHIs and control groups in terms of wound healing (RR 1.02, 95% CI 0.93-1.12; P=.67) and all-cause mortality around 1 year (RR 1.08, 95% CI 0.55-2.12; P=.83). Compared with the control group, the use of DHIs was associated with significant changes in adverse events (RR 0.44, 95% CI 0.22-0.89; P=.02). Subgroup analysis suggested a positive effect of the digital platforms in improving wound healing (RR 2.19, 95% CI 1.35-3.56; P=.002). Although meta-analysis was not possible in terms of wound size, cost analysis, patient satisfaction, and wound reporting rates, most studies still demonstrated that DHIs were not inferior to usual care in managing chronic wounds.
CONCLUSIONS: The findings of our study demonstrate the viability of adopting DHIs to manage chronic wounds. However, more prominent, high-quality RCTs are needed to strengthen the evidence, and more detailed clinical efficacy research is required.
BACKGROUND: PROSPERO CRD42023392415; https://tinyurl.com/4ybz6bs9.