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Overview of adjunct therapies

Research evidence
1−Topical negative pressure treatment was only assessed in one trial with a small sample size and methodological limitations. While the trial results suggested that topical negative pressure treatment may increase healing rates of pressure ulcers compared with saline gauze dressings, the findings must be viewed with extreme caution. Practitioners ought to make patients aware of the limited trial-based evidence for the effectiveness of topical negative pressure for pressure ulcer healing and that further research is required to validate the preliminary findings.
1+There is no evidence of a benefit of using ultrasound therapy in the treatment of pressure ulcers. The possibility of a beneficial or a harmful effect cannot be ruled out, however, due to the small number of trials with methodological limitations and small numbers of participants.
1+The meta-analysis of the results of three trials which assessed the effect of electrotherapy on pressure ulcer healing showed no evidence of benefit for this treatment. However this suggestion is drawn from three studies with a total of only 137 patients. Therefore the results should be viewed with caution as it is difficult to determine clinically important effects from such small samples. Further research is required into this potentially beneficial treatment before definitive recommendations for practice can be made.
1+There is no reliable evidence of benefit of using electromagnetic therapy in the treatment of pressure ulcers. The possibility of benefit or harm cannot be ruled out due to the small number of trials with methodological limitations and small numbers of participants.
1++Overall, while adjunct therapies are increasingly being used in clinical practice, there is currently little good-quality evidence to support their use.

Cost-effectiveness
The effectiveness evidence on which the two economic evaluations were based was moderate to low, primarily due to lack of data. The two studies compare different treatments so it was not appropriate to synthesise the data. The economic evaluation presented by Macario et al. is the stronger of the two studies and it appears that noncontact normothermic wound therapy may be more cost-effective than current standard care. Although the Philbeck et al. (1999) study suggests that negative pressure wound therapy might be a more cost-effective option than saline-soaked gauze dressings applied to patients placed on either a low air loss mattress or a foam mattress bed for grade 3 or 4 pressure ulcers, the internal validity and generalisability of the findings is questionable.

One partial economic evaluation compared (TNP) to standard care and found that TNP was more cost-effective.

From: 6, Evidence reviews with guideline recommendations

Cover of The Management of Pressure Ulcers in Primary and Secondary Care
The Management of Pressure Ulcers in Primary and Secondary Care: A Clinical Practice Guideline [Internet].
NICE Clinical Guidelines, No. 29.
Royal College of Nursing (UK).
London: Royal College of Nursing (UK); 2005 Sep 22.
Copyright © 2005, Royal College of Nursing.

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