Cath Lab Digest

Intermittent pneumatic compression for treating venous leg ulcers (Cochrane Review Abstract)

R Mani, K Vowden, and EA Nelson

Background: Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs. This technique has been used to treat venous leg ulcers and limb swelling due to lymphedema. The effectiveness of IPC and the appropriate duration and frequency of IPC therapy are unknown, as are the differences between various types of IPC. This review analyses the evidence for the effectiveness of IPC as a treatment for venous leg ulcers.

Objectives: To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients.

Search strategy: The Cochrane Wound Group Trials Register was searched for RCTs of intermittent pneumatic compression in February 2001. Journals and relevant conference proceedings were searched by hand. Companies were also contacted for relevant unpublished data or ongoing studies.

Selection criteria: Randomized controlled studies either comparing IPC with control (sham IPC or no IPC) or comparisons between IPC treatment regimens, in venous ulcer management were included.

Data collection and analysis: Data extraction and assessment of study quality were undertaken by two reviewers independently.

Main results: Four randomized controlled trials were identified. One small trial (45 people) found increased ulcer healing with IPC plus compression than with compression alone (relative risk for healing 11.4, 95% Confidence Interval 1.6 to 82). Two small trials with a total of 75 people found no evidence of a benefit for IPC plus compression compared with compression alone. One small trial (16 people) found no difference between IPC (without additional compression) and compression bandages alone.

Reviewers' conclusions: Further trials are required to determine whether IPC increases the healing of venous leg ulcers.

Citation

Mani R, Vowden K, Nelson EA. Intermittent pneumatic compression for treating venous leg ulcers (Cochrane Review). In: The Cochrane Library, 1, 2002. Oxford: Update Software.

(A substantive amendment to this systematic review was last made on 01 July 2001. Cochrane reviews are regularly checked and updated if necessary.)

Patient education for preventing diabetic foot ulceration (Cochrane Review Abstract)

GD Valk, DMW Kriegsman, and WJJ Assendelft

Background: Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus.

Objectives: To assess the effectiveness of patient education on the prevention of foot ulcers in patients with diabetes mellitus.

Search strategy: Eligible studies were identified by searching the Wounds Group Specialized Trials Register, which is compiled from regular searches of the major health care databases including MEDLINE, Cinahl and EMBASE, hand searching of wound care journals and relevant conference proceedings. For this review the Register was searched up to March 2001.

Selection criteria: Prospective randomized controlled trials (RCTs) which evaluated educational programs for the prevention of foot ulcers in people with diabetes mellitus. There was no restriction on language of the publications.

Data collection and analysis: Data extraction and assessment of study quality were undertaken by two reviewers independently.

Main results: The methodological quality of the eight included RCTs was poor. The internal validity score (range 0 - 10) of individual RCTs ranged from 2 to 4.