Physician Adoption of Hyperbaric Oxygen Therapy in the Treatment of Chronic Wounds

Shien Guo, PhD, MHA; Michael A. Counte, PhD; Homer Schmitz, PhD; and Horng-Shiuann Wu, PhD, RN

Statistical analysis. Descriptive statistics were used to provide an overview of the distribution of scores on each measure. In the descriptive statistics, particular emphasis was placed on assessing the current status of physician knowledge of and attitudes toward HBOT. Second, the chi-square test of independence was used to determine the bivariate association between each independent factor and the dependent variable. Finally, multiple logistic regression analysis was used to estimate the strength of association while controlling for the effects of other individual factors. The significance level for all statistical analyses was set at .05. SPSS 10.0 for Windows (SPSS Inc., Chicago, Ill.) was used to conduct all statistical analyses.


A total of 653 surveys were distributed; 44 were returned as undeliverable. Of the remaining 609 potential respondents, 260 (43%) physicians answered the study questionnaire during the data collection period. Of those, 14 were excluded from analysis because the physicians no longer practiced wound care. Respondents were unevenly distributed across 42 states in the US (see Table 1). Most practiced wound care in Florida, Pennsylvania, New York, and Texas, accounting for 109 (44%) of the respondents. No respondents practiced in Minnesota, West Virginia, Idaho, North Dakota, South Dakota, and Montana. The difference in geographic distribution of the respondents and non-respondents was examined using the chi-square test. No significant difference (P = .061) in geographic distribution was found between these two groups.

Descriptive statistics of respondent characteristics are shown in Table 2. Most (211, 86%) of the respondents were men, age 40 years or older (183, 74%), who specialized in podiatric medicine (89, 36%), practiced wound care in a community with a population size of >100,000 residents (168, 69%), and treated <30 wound patients per week (178, 73%). Table 2 also displays the distribution of each independent variable stratified by the dependent variable (adopters versus non-adopters) and the results of the chi-square tests of bivariate relationships between the dependent and independent variables — 167 (68%) of the respondents reported they have used HBOT to treat their patients or referred their patients to other facilities for HBOT over the past 12 months. In addition, the results of the chi-square analyses indicate that several factors were significantly associated with the adoption of HBOT in the treatment of chronic wounds. These factors include: gender (P = .008), medical specialty (P <.001), type of wound care facility (P =.001), size of community (P = .002), geographic location (P <.001), patient volume (P <.001), voluntary patient request of HBOT (P <.001), physician attitude toward (P <.001) and physician knowledge of (P <.001) HBOT, and reliance on peers (P = .022) as a communication channel. No significant differences between groups were found with respect to physician age, years of medical practice, type of facility ownership, level of local wound care competition, and type of communication channels.

More than 60% of the respondents reported a relatively high level of familiarity with HBOT with respect to its therapeutic mechanisms, potential risks, and applications. The average scores on each knowledge item ranged from 3.71 to 4.02. When the respondents’ subjective knowledge was stratified into two groups (adopters and non-adopters), a larger percentage (71% to 84%) of the respondents in the adopter group expressed a higher level of familiarity with HBOT across the four items than the non-adopter group (32% to 47%). Results also indicate that some (16% to 29%) of the respondents who adopted HBOT still had inadequate knowledge of this therapy (see Table 3).


1. Eaglstein WH, Falanga V. Chronic wounds. Surg Clin North Am. 1997;77:689–700.
2. Mandracchia VJ, John KJ, Sanders SM. Wound healing. Clin Podiatr Med Surg. 2001;181–133.
3. Ragnarson Tennvall G, Apelqvist J. Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000;14:235–241.
4. Williams RL, Armstrong DG. Wound healing. Clin Podiatr Med Surg. 1998;15:117–128.
5. Kindwall EP. A history of hyperbaric medicine. In: Kindwall EP, Whelan HT, eds. Hyperbaric Medicine Practice. Flagstaff, Ariz.: Best Publishing Co.;1999.
6. Ramasastry SS. Chronic problem wounds. Clin Plastic Surg. 1998;25:367–396.
7. Baroni G, Porro T, Faglia E, et al. Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care. 1987;10:81–86.
8. Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in the diabetic foot. J Postgrad Med. 1992;38:112–114.
9. Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care. 1996;19:1338–1343.
10. Lee SS, Chen CY, Chan YS, et al. Hyperbaric oxygen in the treatment of diabetic foot. Chang Geng Med J. 1997;20:17–22.
11. Zamboni WA, Wong HP, Stephenson LL, Pfeifer MA. Evaluation of hyperbaric oxygen for diabetic wounds: a prospective study. Undersea Hyperb Med. 1997;24:175–179.
12. Hammarlund C, Sundberg T. Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double-blind study. Plastic Reconstr Surg. 1994;93:829–833.
13. The Department of Health and Human Services Office of Inspector General. Hyperbaric oxygen therapy: its use and appropriateness. 2000;October. Available at: Accessed: September 20, 2005.
14. Wunderlich RP, Peters EJG, Lavery LA. Systemic hyperbaric oxygen therapy: lower-extremity wound healing and the diabetic foot. Diabetes Care. 2000;23:1551–1555.
15. Rogers EM. Diffusion of Innovations. New York, NY: Free Press;1995.
16. Buban GM, Link BK, Doucette WR. Influences on oncologists’ adoption of new agents in adjuvant chemotherapy of breast cancer. J Clin Oncol. 2001;19:954–959.
17. McKinney MM, Barnsley JM, Kaluzny AD. Organizing for cancer control: the diffusion of dynamic innovation in a community cancer network. Int J Technol Assess Health Care. 1992;8:268–288.
18. Hagen N, Young J, MacDonald N. Diffusion of standards of care for cancer pain. Can Med Assoc J. 1995;152:1205–1209.
19. Freiman MP. The rate of adoption of new procedures among physicians: the impact of specialty and practice characteristics. Med Care. 1985;23:939–945.
20. Gross CP, Cruz-Correa M, Canto MI, et al. The adoption of ablation therapy for Barrett’s esophagus: a cohort study of gastroenterologists. Am J Gastroentrol. 2002;97:279–286.
21. Hlatky MA, Cotugno H, O’Connor C, et al. Adoption of thrombolytic therapy in the management of acute myocardial infarction. Am J Cardiol. 1988;61:510–514.
22. Majumdar SR, Inui TS, Gurwitz JH, et al. Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction. J Gen Intern Med. 2001;16:351–359.
23. Munstedt K, Entezami A, Wartenberg A, Kullmer U. The attitudes of physicians and oncologists toward unconventional cancer therapies. Eur J Cancer. 2000;36:2090–2095.
24. Grilli R, Scorpiglione N, Nicolucci A, et al. Variation in use of breast surgery and characteristics of hospitals’ surgical staff. Int J Qual Health Care. 1994;6:233–238.
25. James PA, Cowan TM, Graham RP, Majeroni BA. Family physicians’ attitudes about the use of clinical practice guidelines. J Fam Pract. 1997;5:341–347.
26. Tziraki C, Graubard BI, Manley M. Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: results of a randomized, controlled study. J Gen Internal Med. 2000;15:155–162.
27. Liberati A, Patterson WB, Biener L, McNeil BJ. Determinants of physicians’ preferences for alternative treatments in women with early breast cancer. Tumori. 1987;73:601–609.
28. Bourgeault IL. Physicians’ attitudes toward patients’ use of alternative cancer therapies. Can Med Assoc J. 1996;155:1679–1685.
29. Freed GL, Freeman AV, Clark SJ, et al. Pediatrician and family physician agreement with and adoption of universal hepatitis B immunization. J Fam Pract. 1996;42:587–592.
30. Guo S, Counte MA, Romeis JR. Hyperbaric oxygen technology: an overview of its applications, efficacy, and cost-effectiveness. Int J Technol Assess Health Care. 2003;19:339–346.
31. Undersea and Hyperbaric Medical Society. A directory of hyperbaric treatment chambers (2001). Available at: Accessed October 2, 2002.

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