Department of Psychological Medicine, The University of Auckland, New Zealand.
Department of Health Psychology, King's College London, UK.
Br J Health Psychol. 2017 Nov;22(4):805-835. doi: 10.1111/bjhp.12257. Epub 2017 Jul 3.
Psychological stress has been shown to delay wound healing. Several trials have investigated whether psychological interventions can improve wound healing, but to date, this evidence base has not been systematically synthesized. The objective was to conduct a systematic review of randomized controlled trials in humans investigating whether psychological interventions can enhance wound healing.
A systematic review was performed using PsychINFO, CINAHL, Web of Science, and MEDLINE. The searches included all papers published in English up until September 2016. The reference lists of relevant papers were screened manually to identify further review articles or relevant studies. Nineteen studies met inclusion criteria and were included in the review.
Fifteen of nineteen studies were of high methodological quality. Six studies were conducted with acute experimentally created wounds, five studies with surgical patients, two studies with burn wounds, two studies with fracture wounds, and four studies were conducted with ulcer wounds. Post-intervention standardized mean differences (SMD) between groups across all intervention types ranged from 0.13 to 3.21, favouring improved healing, particularly for surgical patients and for relaxation interventions. However, there was some evidence for publication bias suggesting negative studies may not have been reported. Due to the heterogeneity of wound types, population types, and intervention types, it is difficult to pool effect sizes across studies.
Current evidence suggests that psychological interventions may aid wound healing. Although promising, more research is needed to assess the efficacy of each intervention on different wound types. Statement of contribution What is already known on this subject? Psychological stress negatively affects wound healing. A number of studies have investigated whether psychological interventions can improve healing. However, no systematic reviews have been conducted. What does this study add? Synthesis and review of 19 trials conducted on psychological interventions and wound healing. Most evidence supports improved healing, particularly for surgical wounds and relaxation interventions. More research is needed on different intervention types with clinical wounds and into mechanisms of action.
心理压力已被证明会延迟伤口愈合。有几项试验研究了心理干预是否可以改善伤口愈合，但迄今为止，这一证据基础尚未得到系统综合。本研究旨在对人类的随机对照试验进行系统综述，以调查心理干预是否可以促进伤口愈合。
使用 PsychINFO、CINAHL、Web of Science 和 MEDLINE 进行系统综述。搜索包括截至 2016 年 9 月以英文发表的所有论文。通过手动筛选相关论文的参考文献列表，以确定进一步的综述文章或相关研究。有 19 项研究符合纳入标准，并被纳入综述。
19 项研究中有 15 项具有较高的方法学质量。其中 6 项研究是在急性实验性创伤中进行的，5 项研究是在外科患者中进行的，2 项研究是在烧伤患者中进行的，2 项研究是在骨折患者中进行的，4 项研究是在溃疡患者中进行的。所有干预类型的组间术后标准化均数差值（SMD）范围为 0.13 至 3.21，有利于改善愈合，特别是对外科患者和放松干预。然而，有一些证据表明存在发表偏倚，提示可能没有报告负面研究。由于伤口类型、人群类型和干预类型的异质性，难以在研究间汇总效应大小。
目前的证据表明，心理干预可能有助于伤口愈合。尽管前景看好，但仍需要更多的研究来评估每种干预措施对不同类型伤口的疗效。
本研究对心理干预和伤口愈合进行了 19 项试验的综合和综述。
大多数证据支持愈合改善，特别是对手术伤口和放松干预。
需要对不同类型的干预措施进行更多研究，包括临床伤口和作用机制。
