Introduction

Background Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. Most leg ulcers are the result of venous diseases. First‐line treatment options often include the use of compression bandages or stockings. Objectives To assess the effects of using compression bandages or stockings, compared with no compression, on the healing of venous leg ulcers in any setting and population. Search methods In June 2020 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In‐Process & Other Non‐Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta‐analyses and health technology reports to identify additional studies. There were no restrictions by language, date of publication or study setting. Selection criteria We included randomised controlled trials that compared any types of compression bandages or stockings with no compression in participants with venous leg ulcers in any setting. Data collection and analysis At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, and risk‐of‐bias assessment using the Cochrane risk‐of‐bias tool. We assessed the certainty of the evidence according to GRADE methodology. Main results We included 14 studies (1391 participants) in the review. Most studies were small (median study sample size: 51 participants). Participants were recruited from acute‐care settings, outpatient settings and community settings, and a large proportion (65.9%; 917/1391) of participants had a confirmed history or clinical evidence of chronic venous disease, a confirmed cause of chronic venous insufficiency, or an ankle pressure/brachial pressure ratio of greater than 0.8 or 0.9. The average age of participants ranged from 58.0 to 76.5 years (median: 70.1 years). The average duration of their leg ulcers ranged from 9.0 weeks to 31.6 months (median: 22.0 months), and a large proportion of participants (64.8%; 901/1391) had ulcers with an area between 5 and 20 cm 2 . Studies had a median follow‐up of 12 weeks. Compression bandages or stockings applied included short‐stretch bandage, four‐layer compression bandage, and Unna's boot (a type of inelastic gauze bandage impregnated with zinc oxide), and comparator groups used included 'usual care', pharmacological treatment, a variety of dressings, and a variety of treatments where some participants received compression (but it was not the norm). Of the 14 included studies, 10 (71.4%) presented findings which we consider to be at high overall risk of bias. Primary outcomes There is moderat...

Section: Assessment Of Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…For trials using cluster randomisation, we planned to consider the risk of bias in relation to: recruitment bias, baseline imbalance, loss of clusters, incorrect analysis and comparability with individuallyrandomised trials (Higgins 2017; Eldridge 2016) (Appendix 2). However, we did not include any studies with a cluster design.…”

Section: Librarymentioning

confidence: 99%

Compression bandages or stockings versus no compression for treating venous leg ulcers

Shi

Dumville

Cullum

et al. 2021

“…We evaluated six domains: sequence generation, allocation concealment, blinding (subdivided into blinding of participants, treating physicians, and outcome assessors), incomplete outcome data, selective outcome reporting and other sources of bias. We judged the risk of bias in each category as high risk, low risk or unclear risk according to guidance on use of the risk of bias tool within The Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2017). We approached the contact authors of all included trials to ask for clarification of trial methods and to request the trial protocols (where available).…”

Section: Assessment Of Risk Of Bias In Included Studiesmentioning

confidence: 99%

Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury

Chen

Song

Dennis

2019

“…One RCT in the network meta-analyses had not previously undergone risk of bias assessment. Two overview authors (CS and ELG) independently undertook this using Cochrane's risk of bias tool (Higgins 2017).…”

Section: Assessment Of Risk Of Bias In Included Studies For Network Meta-analysesmentioning

confidence: 99%

Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis

Shi

Dumville

Cullum

et al. 2021

Background Pressure ulcers (also known as pressure injuries, pressure sores and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Specific kinds of beds, overlays and mattresses are widely used with the aim of preventing and treating pressure ulcers. Objectives To summarise evidence from Cochrane Reviews that assess the effects of beds, overlays and mattresses on reducing the incidence of pressure ulcers and on increasing pressure ulcer healing in any setting and population. To assess the relative effects of different types of beds, overlays and mattresses for reducing the incidence of pressure ulcers and increasing pressure ulcer healing in any setting and population. To cumulatively rank the different treatment options of beds, overlays and mattresses in order of their effectiveness in pressure ulcer prevention and treatment. Methods In July 2020, we searched the Cochrane Library. Cochrane Reviews reporting the effectiveness of beds, mattresses or overlays for preventing or treating pressure ulcers were eligible for inclusion in this overview. Two review authors independently screened search results and undertook data extraction and risk of bias assessment using the ROBIS tool. We summarised the reported evidence in an overview of reviews. Where possible, we included the randomised controlled trials from each included review in network meta‐analyses. We assessed the relative effectiveness of beds, overlays and mattresses for preventing or treating pressure ulcers and their probabilities of being, comparably, the most effective treatment. We assessed the certainty of the evidence using the GRADE approach. Main results We include six Cochrane Reviews in this overview of reviews, all at low or unclear risk of bias. Pressure ulcer prevention: four reviews (of 68 studies with 18,174 participants) report direct evidence for 27 pairwise comparisons between 12 types of support surface on the following outcomes: pressure ulcer incidence, time to pressure ulcer incidence, patient comfort response, adverse event rates, health‐related quality of life, and cost‐effectiveness. Here we focus on outcomes with some evidence at a minimum of low certainty. (1) Pressure ulcer incidence: our overview includes direct evidence for 27 comparisons that mostly (19/27) have very low‐certainty evidence concerning reduction of pressure ulcer risk. We included 40 studies (12,517 participants; 1298 participants with new ulcers) in a network meta‐analysis involving 13 types of intervention. Data informing the network are sparse and this, together with the high risk of bias in most studies informing the network, means most network contrasts (64/78) yield evidence of very low certainty. There is low‐certainty evidence that, compared with foam surfaces (reference treatment), r...