Effect of Stress on Wound Healing - Literature review Example

Effect of Stress on Wound Healing Aims and objectives The aim of this study is to examine the relationship between stress and wound healing through review of appropriate literature. The objectives are to ascertain the relationship between stress and wound healing so that appropriate interventions can be advised to enhance wound healing. Hypothesis The hypothesis of this study is that increased stress is associated with delayed wound healing. Background information Wound healing is a complex, but yet a dynamic process by which restoration of various cellular structures and tissue layers occurs. There are basically 3 distinct phases of wound healing, the inflammatory phase, followed by proliferative phase and remodeling phase. Wound healing is influenced by several factors which either enhance or prolong wound healing. While rest, good nutrition, exercise and physiotherapy enhance wound healing, steroids, diabetes, wound infection, anti-inflammatory drugs and stress delay healing of wound (Mercandetti and Cohen, 2008). In this literature review, the effects of stress on wound healing will be examined. Search strategy To consider what articles must be included in the review to make the review more authentic and reliable, knowledge on the different levels of accorded studies is essential. The different levels of studies are called hierarchy. Hierarchy provides a confidence measure to the end-user (Evans, 2003). According to Evans (2003), random control trials can be considered of good standard and they are infact labeled as the gold standard of research for providing optimal research designs to answer pertinent questions. However, systemic reviews and meta-analysis have topped the hierarchy list. In this, study, all types of studies have been included due to limitation of articles within 6 years. The commencement of search in electronic databases was based on the inclusion/exclusion criteria. The inclusion criteria in the study were all studies pertaining to stress and wound healing, articles in English and those translated into English, articles written between 2004 and 2010 and abstracts and full text articles. The exclusion criteria were articles not related to the topic, articles not in English and articles posted anonymously in the internet. The articles were retrieved from PUB MED using the MESH terms "Stress" and "Wound healing." About 178 articles were retrieved After scanning through the abstracts of all the articles, the following eight articles were selected for review. Literature review 1. Effect of psychological stress on wound healing Several factors influence the rate of healing of any wound, one of which is psychological stress. This is evident from several studies conducted in recent years. In a study by Wisely et al (2010), the researchers examined the hypothesis that patients with high levels of psychological distress following burns, without any pre-existing psychological disorder, have delayed recovery of the burns wound similar to those with pre-existing psychiatric illness as demonstrated from another small retrospective study. The researchers also examined mechanisms that cause delay in wound recovery. The study was conducted on 107 patients with burns admitted to Burns wards. Data collected on admission were pertaining to psychiatric history and psychological distress secondary to burns. The outcomes of the study which were examined and compared were number of days in the hospital and the number of procedures that had to be performed on the patient. Statistical analysis was done and the results of revealed that patients with psychological distress following burns but with no preexisting psychiatric disease had prolonged duration of stay in the hospital and similar number of procedures when compared to those with pre-existing psychiatric illness. Thus the authors concluded that psychological stress during stay in the hospital delays wound healing in patients with burns. Walburn et al (2009) conducted a systematic review and meta-analysis of studies which examined the relationship between psychological stress and wound healing. The search was conducted systematically using electronic databases until October 2007. Studies pertaining o the impact of stress on healing of different types of wounds in different contexts were reviewed. The clinical wounds that were studied were acute and chronic wounds, punch biopsy wounds, blister wounds and minor skin damage caused by stripping of tape bandage. The metaanalysis revealed that stress was significantly associated with impaired wound healing or caused dysregulation of a biomarker related to healing of wound [r=-0.42 (95% CI=-0.51 to -0.32) (P Read More