The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis

Abstract

Objectives: This study had three objectives. First, to conduct a systematic review to identify the available evidence for the use of pressure garment therapy (PGT); second, to assess the quality of the available evidence; and third, to conduct a meta-analysis to quantify the effectiveness of PGT for the prevention of abnormal scarring after burn injury.

Background: Standard care for the prevention of abnormal scarring after burn injury includes pressure garment therapy (PGT); however, it is associated with potential patient morbidity and high costs. We hypothesise that an assessment of the available evidence supporting the use of pressure garment therapy will aid in directing clinical care and future research.

Methods: Randomised control trials were identified from CINHAL, EMBASE, MEDLINE, CENTRAL, the 'grey literature' and hand searching of the Proceedings of the American Burn Association. Primary authors and pressure garment manufacturers were contacted to identify eligible trials. Bibliographies from included studies and reviews were searched. Study results were pooled to yield weighted mean differences or standardised mean difference and reported using 95% confidence intervals.

Results: The review incorporated six unique trials involving 316 patients. Original data from one unpublished trial were included. Overall, studies were considered to be of high methodological quality. The meta-analysis was unable to demonstrate a difference between global assessments of PGT-treated scars and control scars [weighted mean differences (WMD): -0.46; 95% confidence interval (CI): -1.07 to 0.16]. The meta-analysis for scar height showed a small, but statistically significant, decrease in height for the PGT-treated group standardised mean differences (SMD): -0.31; 95% CI: -0.63, 0.00. Results of meta-analyses of secondary outcome measures of scar vascularity, pliability and colour failed to demonstrate a difference between groups.

Conclusions: PGT does not appear to alter global scar scores. It does appear to improve scar height, although this difference is small and of questionable clinical importance. The beneficial effects of PGT remain unproven, while the potential morbidity and cost are not insignificant. Given current evidence, additional research is required to examine the effectiveness, risks and costs of PGT.