(EBP-011) A meta-review of the impact of compression therapy on venous leg ulcer healing
Co-Author(s):
Zena Moore, PhD – Professor, School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences; Tom O'Connor, PhD – Professor, School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences
Introduction: Venous leg ulcers (VLUs) are chronic wounds that occur within the lower region of the leg between the knee and ankle as a consequence of venous insufficiency. They distress patients, cause pain, increase the risk of infection and severely impact patients’ mobility and quality of life. Compression represents the standard of care for conservative treatment of VLU. Compression works by generating external pressure on the superficial veins and tissues, assisting venous return. Improved venous return promotes lower limb wound healing. Whilst systematic reviews exist in this area, this is the first time they have been subjected to a meta-review.
Methods: This meta-review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcer healing. We searched five databases to identify potential papers; three authors extracted data, and a fourth author adjudicated the findings. The AMSTAR-2 tool was used for quality appraisal and the certainty of the evidence was appraised using GRADEpro. Data analysis was undertaken using RevMan.
Results: We identified 12 systematic reviews published between 1997 and 2021. Seven comparisons were reported, with a meta analysis undertaken for 5 of these comparisons: compression versus no compression (Risk Ratio [RR]: 1.55; 95% Confidence Interval [CI] 1.34-1.78; p< 0.00001; moderate-certainty evidence); elastic compression versus inelastic compression (RR: 1.02; 95% CI: 0.96-1.08; p< 0.61 moderate-certainty evidence); 4 layer versus < 4 layer bandage systems (RR: 1.07; 95% CI: 0.82-1.40; p< 0.63; moderate-certainty evidence); comparison between different 4 layer bandage systems (RR: 1.08; 95% CI: 0.93-1.25; p=0.34; moderate-certainty evidence); compression bandage versus compression stocking (RR 0.95; 95% CI 0.87-1.03; p=0.18; moderate-certainty evidence).
Discussion: The main conclusion from this review is that there is a statistically significant difference in healing rates when compression is used compared to no compression, with moderate certainty evidence. Otherwise, there is no statistical difference in healing rates using elastic compression versus inelastic compression, 4 layer versus < 4 layer bandage systems, different 4 layer bandage systems, or compression bandages versus compression stockings.
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