Digital Health Interventions for Chronic Wound Management: A Systematic Review and Meta-Analysis

Abstract

Background: Chronic wounds have a serious impact on patients' quality of life and place a significant strain on global finances and healthcare systems. Mobile health (mHealth) technology in various forms has been proposed as an important modality for the management of chronic wounds. However, existing studies on the efficacy of mHealth interventions for chronic wound management produce inconclusive results due to the complexity of wound etiology and the diversity of mHealth delivery methods. Objective:The purpose of this study was to conduct a systematic review and meta-analysis of the current evidence on mHealth in the management of patients with chronic wounds, and determine whether mHealth-supported interventions were more beneficial for chronic wound outcomes than conventional care.Methods: Eligible randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies published from the date of inception to December 1,2022, were identified by searching Pubmed, Web of Science, EMBASE, Cochrane Library, CINAHL, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM). Studies were evaluated independently by two researchers and audited by a third researcher. We assessed the quality of each RCTs, cohort study, and quasi-experimental study separately using the Cochrane risk of bias tool, ROBINS-I, and the Joanna Briggs Institute Critical Appraisal tools checklists. Continuous and dichotomous data were extracted for relevant outcomes and analyzed in a random effect meta-analysis model using RevMan5.4.1 software. Results:Twenty-four studies with 7945 patients were included in this systematic review, while only 19 studies with 6355 patients were included in the meta-analysis. The combined effect estimate showed no significant differences between the mHealth and control groups in terms of wound healing (RR 1.15,95% CI 0.94-1.40; P=.17), adverse events (RR 0.54, 95% CI 0.26-1.10; P=.09), or all-cause mortality around one year (RR 1.19,95% CI 0.66-2.14; P=.57). Compared with the control group, the use of mHealth was associated with significant changes in PUSH-score (MD -2.37, 95% CI -2.82 to -1.92; P<.001). Although meta-analysis was not possible in terms of wound size, cost analysis, patient satisfaction, and wound reporting rates, most studies still demonstrated that mHealth was not inferior to conventional care in managing chronic wounds. Conclusions:The findings of our study demonstrate the viability of adopting mHealth to treat chronic wounds. However, larger, high-quality randomized controlled trials are needed to strengthen the evidence, and further clinical effectiveness research needs to be done in greater detail. Clinical Trial: PROSPERO CRD42023392415; https://www.crd.york.ac.uk/prospero/display_record.php?ID=392415