Management of a Chronic Wound in an Elderly Female Patient with Diabetes - Research Paper Example

Ethne L. Nussbaum authored in 2010 an article entitled “Evidence-Based Management of a Chronic Wound in an Elderly Female Patient with Type II Diabetes.” It is published by Physiotherapy Canada in their Volume 62, Number 2 issue with page number 129-133.

            APA Format: Nussbaum, E.L. (2010). Evidence-Based Management of a Chronic Wound in an Elderly Female Patient with Type II Diabetes. Physiotherapy Canada, 62(2): 129-133.

Database and Accession Number

            The article was accessed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with Full-Text Databases with accession number 2010644352. Keywords such as “evidence-based, “chronic wound,” and “type II Diabetes” were used to locate the article.

Summary

            The article identified the role of physical agents such as ultrasound, electrical stimulation, ultraviolet radiation, low-level laser therapy, and pulsed short-wave therapy in the management of chronic wounds (Nussbaum, 2010, 129). The clinical problem in question is whether there are supportive evidence and studies that would prove that ultrasound alone will be effective in wound healing and management of chronic wounds or supportive evidence and studies will suggest the non-significant effect of ultrasound in wound healing and management of chronic wounds.

            Based on the clinical problem, the PICO question formulated is: “In elderly patients with Type II diabetes, how does wound treatment with ultrasound vs. wound treatment with all the physical agents affect wound healing and wound management?” The PICO question is formulated in a way that would emphasize the effect of ultrasound only in wound healing.

             Evidence from literature is inconclusive of the effect of ultrasound to wound healing. A meta-analysis, Cochrane Group Reviews, and Randomized-Controlled Trials (RCTs) were the framework, model, or systematic approach used by the author to evaluate, compare and critique the available literature. Critique from meta-analyses and reviews suggests that available evidence is inconclusive because of methodological limitations in terms of a small number of trials and participants, heterogeneous methods, and limited pooling results (Nussbaum, 2010, 130). Meta-analysis of RCTs from 1998 and 2002 showed benefits of an uncertain degree in reduction of ulcer area; however, it was not clear whether the reduction was a result of low-frequency (30 kHz) ultrasound or of water footbath. In the 2008 Cochrane Update using gel coupling instead of water footbath, pooling trials are interpreted using statistical measures of risk ratio and weighted mean difference, wherein, the outcome showed that more ulcers were healed from using ultrasound and that using ultrasound was beneficial (Nussbaum, 2010, 130). Available literature lack RCTs using ultrasound on non-venous origin. In general, there was no evidence of benefit from using ultrasound on wound healing and methodological limitations did not rule out the possibility of benefit or harm.

            The outcome of the clinical problem is measured, compared, and evaluated using an acetate sheet, a free image software, a cotton-tipped probe and ruler, and Bates-Jensen Wound Assessment Tool. The acetate sheet was used for tracking the patient’s ulcer, the free image software for calculating the area of the wound, the cotton-tipped probe, and ruler for approximating maximum wound depth and undermining, and the Bates-Jensen Wound Assessment Tool for the assessment of healing and ensuring validity and reliability (Nussbaum, 2010, 131). The biweekly photographic documentation must show a reduction of at least 30% over a 4-week period to consider ultrasound as an effective physical agent for wound healing.

            The critique of the evidence concluded that the efficacy and benefit of ultrasound for chronic wounds have not yet to be established due to methodological limitations. A small number of trials and participants, heterogeneous methods, and limited pooling results must be addressed in future research endeavors to support small-group findings which suggest that ultrasound was effective in the reduction of ulcer area.