Huang Yao, Hu Jiale, Xie Ting, Jiang Zhaoqi, Ding Wenjing, Mao Beiqian, Hou Lili
Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Graduate, Shanghai Jiao Tong University School of Nursing, Shanghai, China.
Int Wound J. 2023 Nov;20(9):3802-3820. doi: 10.1111/iwj.14219. Epub 2023 Jun 5.
We aimed to review and synthesise the evidence of the interventions of patients' and informal caregivers' engagement in managing chronic wounds at home. The research team used a systematic review methodology based on an updated guideline for reporting systematic reviews (PRISMA) and recommendations from the Synthesis Without Meta-analysis. Cochrane Central Register of Controlled Trial of the Cochrane Library, Pubmed, Embase, CINAHL, Wanfang (Chinese), and CNKI database (Chinese) were searched from inception to May 2022. The following MESH terms were used: wound healing, pressure ulcer, leg ulcer, diabetic foot, skin ulcer, surgical wound, educational, patient education, counselling, self-care, self-management, social support, and family caregiver. Experimental studies involving participants with chronic wounds (not at risk of wounds) and their informal caregivers were screened. Data were extracted and the narrative was synthesised from the findings of included studies. By screening the above databases, 790 studies were retrieved, and 16 met the inclusion and exclusion criteria. Studies were 6 RCTs and ten non-RCTs. Outcomes of chronic wound management included patient indicators, wound indicators, and family/caregiver indicators. Home-based interventions of patients or informal caregivers' engagement in managing chronic wounds at home may effectively improve patient outcomes and change wound care behaviour. What's more, educational/behavioural interventions were the primary type of intervention. Multiform integration of education and skills training on wound care and aetiology-based treatment was delivered to patients and caregivers. Besides, there are no studies entirely targeting elderly patients. Home-based chronic wound care training was important to patients with chronic wounds and their family caregivers, which may advance wound management outcomes. However, the findings of this systematic review were based on relatively small studies. We need more exploration of self and family-oriented interventions in the future, especially for older people affected by chronic wounds.
我们旨在回顾和综合有关患者及非正式照护者在家中参与慢性伤口管理干预措施的证据。研究团队采用了基于报告系统评价的最新指南（PRISMA）和非荟萃分析综合法建议的系统评价方法。从创刊至2022年5月，检索了Cochrane图书馆的Cochrane对照试验中心注册库、PubMed、Embase、CINAHL、万方（中文）和中国知网数据库（中文）。使用了以下医学主题词：伤口愈合、压疮、腿部溃疡、糖尿病足、皮肤溃疡、手术伤口、教育、患者教育、咨询、自我护理、自我管理、社会支持和家庭照护者。筛选了涉及慢性伤口患者（无伤口风险）及其非正式照护者的实验研究。提取数据并根据纳入研究的结果进行叙述性综合。通过筛选上述数据库，检索到790项研究，其中16项符合纳入和排除标准。研究包括6项随机对照试验和10项非随机对照试验。慢性伤口管理的结果包括患者指标、伤口指标和家庭/照护者指标。患者或非正式照护者在家中参与慢性伤口管理的家庭干预措施可能有效改善患者结局并改变伤口护理行为。此外，教育/行为干预是主要的干预类型。对患者和照护者提供了伤口护理和基于病因治疗的教育与技能培训的多种形式整合。此外，没有完全针对老年患者的研究。家庭慢性伤口护理培训对慢性伤口患者及其家庭照护者很重要，这可能会改善伤口管理结果。然而，这项系统评价的结果基于相对较小的研究。未来我们需要更多地探索以自我和家庭为导向的干预措施，尤其是针对受慢性伤口影响的老年人。
