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. 2018 Jan 10;13(1):e0190045.
doi: 10.1371/journal.pone.0190045. eCollection 2018.

Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care

Janice Christie  1 , Trish A Gray  1 , Jo C Dumville  1 , Nicky A Cullum  1   2
Affiliations

Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care

Janice Christie et al. PLoS One. .

Abstract

Background: Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals.

Methods: We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence.

Results: The most common uncertainty type was 'interventions' 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence.

Conclusions: Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research addresses important clinical uncertainties and is of sufficient rigour to inform practice.

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Conflict of interest statement

Competing Interests: NC receives funding from the NIHR to run Cochrane Wounds, she is the coordinating editor and JD is the Joint Co-ordinating editor. NC, JD, TG and JC have authored Cochrane reviews. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Evaluation process and criteria.
We present the total number of review records screened, the four criteria used for screening abstracts/full papers, and the number of reviews meeting/not meeting each criterion. a,NHS centre for reviews and dissemination (2002) The Database of abstracts of reviews of effects (DARE). Effectiveness Matters: 6:1–4. b,Hemingway P, Brereton N (2009) What is a systematic review?. What is? series: Hayward Medical Communcations. c,Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6: e1000097. d,Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7: 10.
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