Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients

O'Meara, Susan, Tierney, Jayne, Cullum, Nicky, Bland, Martin, Franks, Peter J., Mole, Trevor and Scriven, Mark (2009) Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients. British Medical Journal, 338 . doi:10.1136/bmj.b1344


Author O'Meara, Susan
Tierney, Jayne
Cullum, Nicky
Bland, Martin
Franks, Peter J.
Mole, Trevor
Scriven, Mark
Title Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients
Journal name British Medical Journal
ISSN 0007-1447
0959-8154
Publication date 2009
Sub-type Article (original research)
DOI 10.1136/bmj.b1344
Open Access Status
Volume 338
Total pages 9
Place of publication London, United Kingdom
Publisher B M J Group
Language eng
Formatted abstract
Objective To compare the effectiveness of two types of compression treatment (four layer bandage and short stretch bandage) in people with venous leg ulceration.

Design Systematic review and meta-analysis of patient level data.

Data sources Electronic databases (the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register, Medline, Embase, CINAHL, and National Research Register) and reference lists of retrieved articles searched to identify relevant trials and primary investigators. Primary investigators of eligible trials were invited to contribute raw data for re-analysis.

Review methods Randomised controlled trials of four layer bandage compared with short stretch bandage in people with venous leg ulceration were eligible for inclusion. The primary outcome for the meta-analysis was time to healing. Cox proportional hazards models were run to compare the methods in terms of time to healing with adjustment for independent predictors of healing. Secondary outcomes included incidence and number of adverse events per patient.

Results Seven eligible trials were identified (887 patients), and patient level data were retrieved for five (797 patients, 90% of known randomised patients). The four layer bandage was associated with significantly shorter time to healing: hazard ratio (95% confidence interval) from multifactorial model based on five trials was 1.31 (1.09 to 1.58), P=0.005. Larger ulcer area at baseline, more chronic ulceration, and previous ulceration were all independent predictors of delayed healing. Data from two trials showed no evidence of a difference in adverse event profiles between the two bandage types.

Conclusions Venous leg ulcers in patients treated with four layer bandages heal faster, on average, than those of people treated with the short stretch bandage. Benefits were consistent across patients with differing prognostic profiles.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number b1344.

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
 
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Created: Tue, 20 May 2014, 15:07:46 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work