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Meta-Analysis
. 2009 Apr 17:338:b1344.
doi: 10.1136/bmj.b1344.

Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients

Susan O'Meara  1 , Jayne Tierney, Nicky Cullum, J Martin Bland, Peter J Franks, Trevor Mole, Mark Scriven
Affiliations
Meta-Analysis

Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients

Susan O'Meara et al. BMJ. .

Abstract

Objective: To compare the effectiveness of two types of compression treatment (four layer bandage and short stretch bandage) in people with venous leg ulceration.

Design: Systematic review and meta-analysis of patient level data.

Data sources: Electronic databases (the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register, Medline, Embase, CINAHL, and National Research Register) and reference lists of retrieved articles searched to identify relevant trials and primary investigators. Primary investigators of eligible trials were invited to contribute raw data for re-analysis. Review methods Randomised controlled trials of four layer bandage compared with short stretch bandage in people with venous leg ulceration were eligible for inclusion. The primary outcome for the meta-analysis was time to healing. Cox proportional hazards models were run to compare the methods in terms of time to healing with adjustment for independent predictors of healing. Secondary outcomes included incidence and number of adverse events per patient.

Results: Seven eligible trials were identified (887 patients), and patient level data were retrieved for five (797 patients, 90% of known randomised patients). The four layer bandage was associated with significantly shorter time to healing: hazard ratio (95% confidence interval) from multifactorial model based on five trials was 1.31 (1.09 to 1.58), P=0.005. Larger ulcer area at baseline, more chronic ulceration, and previous ulceration were all independent predictors of delayed healing. Data from two trials showed no evidence of a difference in adverse event profiles between the two bandage types.

Conclusions: Venous leg ulcers in patients treated with four layer bandages heal faster, on average, than those of people treated with the short stretch bandage. Benefits were consistent across patients with differing prognostic profiles.

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Conflict of interest statement

Competing interests: NC was principal investigator for the VenUS I trial included in this meta-analysis, for which Beiersdorf provided free trial related bandaging education for trial nurses. The research trial authored by PJF was sponsored by Molnlycke Healthcare and Activa Healthcare. PJF has received research funding in the past from Smith & Nephew. TM is employed by Smith & Nephew, who manufacture compression bandages, and he also holds shares in Smith & Nephew.

Figures

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Fig 1 Search strategy used for CENTRAL
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Fig 2 Kaplan-Meier survival curves (unstratified analysis)
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Fig 3 Hazard ratio plot for time to healing with pooled and individual estimates adjusted for baseline ulcer area and ulcer duration
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Fig 4 Pooled odds ratio for incidence of any type of adverse event
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Fig 5 Pooled effect size for number of adverse events (any type)
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References

    1. Moffatt C. Compression therapy in practice. Trowbridge: Wounds UK Publishing, 2007.
    1. Callam M. Prevalence of chronic leg ulceration and severe chronic venous disease in Western countries. Phlebology 1992;7(suppl 1):6-12.
    1. Healthcare Commission. National audit of the management of venous leg ulcers. 2008. www.healthcarecommission.org.uk.
    1. Bosanquet N. Costs of venous ulcers: from maintenance therapy to investment programmes. Phlebology 1992;7(suppl 1):44-6.
    1. Ellison DA, Hayes L, Lane C, Tracey A, McCollum CN. Evaluating the cost and efficacy of leg ulcer care provided in two large UK health authorities. J Wound Care 2002;11:47-51. - PubMed