Negative Pressure Wound Therapy

In providing quality patient outcomes, current evidence based research has to be an important part of this process. With every new research proposal, a solid foundation has to be the basis for that specific research. The following paper is a literature analysis of current studies that support the use of negative pressure wound therapy (NPWT) in healing diabetic foot ulcers in adults. This paper will also discuss what search methods were used, strengths and weaknesses of each study, and the validity and relevancy of the research on the issue of non-healing diabetic foot ulcers in healthcare today.
Strategies Used in Literature Analysis
This is a literature analysis of evidence based articles that studied the effects of NPWT on people with diabetic

foot ulcers. A search was done using online databases that included CINAHL, MEDLINE, and Cochrane Database for a more selective unbiased result. Data searches that are more search specific have better results in the material needed (Heitzman, 2011). Search strategies used included words that related to this specific topic: diabetic foot ulcer treatments, negative pressure wound therapy, and moist therapy treatment. Inclusion material included adult with diabetes (ages 18-90) that had non-healing foot ulcers that showed improvement with the use of NPWT. The multiple articles were narrowed down to eleven evidence based articles published in the last eight years that were relevant to this proposed study. There were seven randomized control trials (RCT), three systematic review studies, and one meta-analysis RCT study. Strengths for each study according to the hierarchy was noted to be Level II for the RCT studies, and Level I for the systematic review studies. These articles support the proposed clinical question and have been utilized in the development of current protocol in the healthcare setting. There were six articles excluded from this analysis due to not supporting the specific needs of this proposed study. For example, one study focus was on NPWT on all types of wounds and not specifically to diabetic foot ulcers.
Literature Review/Analysis
The eleven studies chosen focused on NPWT’s positive effects of treating diabetic foot ulcers. Each of these studies resulted in improved wound healing, less hospital time, and decrease cost with the use of NPWT to participants. According to Jarrett (2013), some studies state that the placement of this NPWT was a key element in the healing process. For example, if the wound vac was not attached and maintained properly, the results could be less effective. So, it is important to use the combination of placement and maintaining the wound vac to create a positive outcome for these patients.
The review of this literature dating from 2008 to 2016, indicated the need for continued research and monitoring of clinical practice changes based on best practice in nursing. In all the articles, the dependent variable was diabetic foot ulcers in adults with the independent variable of the application of NPWT. The seven RCT studies, the three systematic review studies, and the one meta-analysis RCT study sample size varied ranging from 23 to 669 participants.
The article by Aalaa et al. (2012) studied 360 participants in a random placebo controlled double-blind test that assessed the foot ulcers every three days for one year. Participants were divided into two groups equally. The purpose of this research was “to determine if chronic foot ulcers healed faster when treated with NPWT than with SMWT” (Aalaa et al., 2012). Data found that there was a 65% decrease of complications related to foot ulcers with NPWT compared to SMWT. This random study shows a relevance to the PICOT proposal and the results show no bias.
The article by Aslam et al. (2015) studied 120 participants in a RCT that divided patients equally into two groups 60 with wound vacs and 60 without wound vac. The results concluded the participants with wound vacs showed a 78% improved granulation of tissue and 80% faster healing time than the participants without the wound vacs. The process was recorded at each visit through measurements and pictures on an electronic database. This study shows validity in its process and supports the proposal study presented.
Blumes et al.

(2008) study is of a multicenter RCT comparison of 342 participants with a mean age of 58 and 79% were male. Methods of assessment and tracings were done to monitor the progress of the wound of each participant. The study concluded 73 of 169 participants healed in approximately 96 days by using NPWT whereas, participants without the NPWT took longer or did not heal completely. There was no difference in the healing time if the participant had complications such as infection, cellulitis or osteomyelitis but NPWT was more efficacious than SMWT. There can be some bias as the results are based on a higher count of males than females but the strength of the results support the proposal

presented.
Dumville et al. (2013) RCT study reviewed both published and nonpublished results from five random studies that had a total of 605 participants. Two authors independently performed study selection that concluded NPWT was more effective treatment. Even though this results showed positive results, there is a risk of bias and extraction that will need to be considered.
Game et al. (2016), Veldhoen et al. (2014), and Guffanti (2014) articles were systematic reviews of studies done between the years 2000-2010. The records of patients with diabetic foot ulcers were reviewed. The focus of these three studies was on wound granulation to determine if NWPT had better results than other conventional methods. Information retrieved from the records also showed the patient’s age, gender, previous treatment, current treatment, wound assessment, progress reports, and discontinuation date of treatment. The results concluded that NWPT had a 60% faster healing time that led to less hospitalization time. The strength of these articles results correlate with my proposed PICO question of people with diabetes who have foot ulcers have improved results with NPWT. Limitations of these studies’ results include bias of the researcher and studies selected. Overall, the reviews summarized the results in an organized manner to provide key findings of evidence based practice in the intervention of NPWT on participants.
Ravari et al. (2013), Sajid et al. (2015), and Seidel et al. (2014) articles were RCT researches done to determine the effects of NPWT on people with diabetic foot ulcers. Each study discovered the healing rate of diabetic foot ulcers increased 79% with the use of wound vacs. There was also a shorter healing time of an average of 110 days compared to no wound vac treatment.
Conclusion
In summary, the research articles reviewed for this proposed study showed to have scientific merit to be included in this proposal.

Each study had a combination of strengths to support the importance of NPWT in healing diabetic foot ulcers. It was also shown that each article was valid, relevant, and peer-reviewed in the support of this need of new methods (NPWT) in improving the patients’ quality of life. The majority of the literature reviewed had a high degree on internal validity through the use of randomized control studies. According to Jarrett (2013), “a high degree of internal validity can be achieved through random control studies because of the decrease in bias that could develop is decreased”. Even though the three systematic reviews supported NPWT, there could possibly be internal threats if the researchers had any personal bias in the selection of studies reviewed. All the articles met the inclusion criteria needed for this proposal. Six studies were excluded due to either being too broad or too inconclusive and could potentially cause errors in the data. Selection bias does not appear to be a factor as the research methods used shows no history of bias in any of the random groups made. Overall, the internal validity is strong. The external validity of this research (NPWT) can be used with all patients’ that have diabetic foot ulcers. Steps were taken to control characteristics that could impact outcomes when considering the sample group such as bias by the

researchers. The results of the chosen research studies will prove that NPWT is beneficial to patients having a better quality of life, decrease foot ulcers, and less hospitalizations.