Diabetic Ulcer Healing and Closure Interventions Essay

Introduction

Diabetic foot ulcers are among the most widespread complications of diabetes and a major nursing problem, as they are difficult to treat and may lead to amputation. The key problem with diabetic ulcers is that they are the primary reason for non-traumatic amputations (Sarinnapakorn, Sunthorntepwarakul, Deerochanawong, Niramitmahapanya, & Napartivaumnuay, 2016). Negative-pressure wound therapy and hyperbaric oxygen therapy are considered to be beneficial in the management of diabetic foot ulcers (Kavitha et al., 2014).

The purpose of this study is to compare the effectiveness of the two interventions in diabetic ulcer healing and closure. The independent variables for this study are the provision of negative-pressure wound therapy or hyperbaric oxygen therapy, measured in hours. The dependent variable is the healing of ulcers, represented by a reduction in the ulcer area. Diabetic Ulcer Healing and Closure Interventions Essay

Definition of Terms

Primary intervention

The primary intervention for this study is negative-pressure wound therapy, which is a treatment method that uses an open cell structured sponge and a drain to expose the wound to sub-atmospheric pressure, promoting the healing process (Mafi, Malahias, Jordan, & Hindocha, 2014).

Comparison intervention

The comparison intervention is hyperbaric oxygen therapy, which involves placing the patient into a chamber, which is gradually pressurized with pure oxygen. The exposure of the wound to oxygen accelerates healing processes (D’Agostino & Poff, 2012).Diabetic Ulcer Healing and Closure Interventions Essay

Effectiveness

The effectiveness of the intervention is the change in the ulcer area during the follow-up period after the treatment.

The follow-up period is the time after which the effect of the intervention is measured.

Hypotheses and Research Questions

Negative-pressure wound therapy is a well-established method that proved to be effective in treating diabetic foot ulcers (Zhang et al., 2014). In the case of hyperbaric oxygen therapy, less research proving its effectiveness is available. Therefore, the primary hypothesis for this study is that negative-pressure wound therapy will result in a higher reduction in the ulcer area during the follow-up period, compared to hyperbaric oxygen therapy. The secondary hypothesis is that there will be no statistically significant difference in the effectiveness of the two methods. The null hypothesis is that none of the interventions will yield statistically significant results compared to normal wound care.Diabetic Ulcer Healing and Closure Interventions Essay

The research questions that will be addressed as part of the study are as follows:

• What is the percentage reduction in the ulcer area following negative-pressure wound therapy?
• What are the cm2 and percentage reductions in the ulcer area following negative-pressure wound therapy?
• What are the cm2 and percentage reductions in the ulcer area following hyperbaric oxygen therapy?
• What is the comparative effectiveness of negative-pressure wound therapy and hyperbaric oxygen therapy, as indicated by the research outcomes?
• Were there any patients that showed no statistically significant results after the primary or alternative intervention?
• If so, what are the patient factors that could have affected the effectiveness of the chosen treatment in individual patients?Diabetic Ulcer Healing and Closure Interventions Essay

Theoretical Framework

The theoretical framework utilized in the proposed study is largely based on two studies on the effectiveness of the chosen methods in treating diabetic foot ulcers. First, a meta-analysis by Zhang et al. (2014) provides evidence in support of the primary theory. Zhang et al. (2014) show that there is a strong evidence of the effectiveness of negative-pressure wound therapy in the treatment of diabetic foot ulcers: according to the results of the studies examined, this method of therapy was associated with higher healing rates, lower recovery time, and more reduction of the ulcer area.

However, a study by Stoekenbroek et al. (2014) indicates that some evidence is available in support of the effectiveness of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers. Both studies provide a comprehensive overview of the current research regarding the two interventions; moreover, they identify the need for further research on the treatment methods, which is why they were chosen as the theoretical framework of the proposed research.Diabetic Ulcer Healing and Closure Interventions Essay

Thus, this study will seek to compare the two methods to determine their comparative effectiveness. The main concept to be explored is the reduction of ulcer size, as it is widely used to measure the efficiency of treatment (Zhang et al., 2014). For any patients that show no significant positive dynamic, the research will also try to describe the personal factors that impaired the efficiency of the applied treatment method.Diabetic Ulcer Healing and Closure Interventions Essay

Review of the Literature

As diabetic foot ulcers are a pressing nursing problem, they are extensively studied in modern research. For instance, Zhang et al. (2017) provide a useful overview of the prevalence of diabetic foot ulcers. The researchers found the global prevalence of diabetic foot ulcers to be 6.3%, with the highest prevalence rate in the United States (13%) and the lowest (1.5%) in Australia (Zhang et al., 2017).Diabetic Ulcer Healing and Closure Interventions Essay

The researchers studied diabetic foot ulcers in the context of the Rajavithi Hospital in Thailand. The study found the prevalence of diabetic foot ulcers to be 3.4%, with 2.2% of patients having a history of amputation (Sarinnapakorn et al., 2016). Overall, both studies show that diabetic foot ulcers are a prevalent problem among the patients with type II diabetes that can lead to severe complications.Diabetic Ulcer Healing and Closure Interventions Essay

There are also many studies on the treatment of diabetic foot ulcers. For example, a study by Zhang et al. (2014) describes the effectiveness of negative-pressure wound therapy in the treatment of diabetic foot ulcers, compared to other treatment methods, such as standard wound care. The researchers found that the use of negative-pressure wound therapy was associated with shorter recovery periods, higher reduction in the ulcer area, and a higher proportion of fully healed ulcers (Zhang et al., 2014).

Thus, negative-pressure wound therapy is considered to be the preferred method of treating diabetic foot ulcers. Another study by Mafi et al. (2014) supports these findings, discussing other positive aspects of negative-pressure wound therapy, such as its cost-effectiveness and its role in preventing infection. The number of recent studies examining the effectiveness of the alternative intervention, hyperbaric oxygen therapy, is relatively low. Stoekenbroek et al. (2014) provide a comprehensive systematic review of existing research on the treatment of diabetic foot ulcers with hyperbaric oxygen therapy. The researchers analyzed seven studies with an overall participant count of 376 patients.Diabetic Ulcer Healing and Closure Interventions Essay

The findings indicate a low level of evidence of the effectiveness of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers, as well as a need for further comprehensive research. Overall, the existing body of research shows more evidence of the effectiveness of negative-pressure wound therapy in the treatment of diabetic foot ulcers, compared to hyperbaric oxygen therapy. However, given the lack of high-quality primary research on hyperbaric oxygen therapy, considering this method as an alternative intervention could provide useful information regarding the comparative effectiveness of the two interventions.Diabetic Ulcer Healing and Closure Interventions Essay

Methodology

The research will use quantitative methodology. Randomized control trial is the preferred study design, as it is widely used to determine the effectiveness of clinical interventions. For instance, all studies mentioned in Stoekenbroek et al. (2014) used the RCT methodology to evaluate the effectiveness of hyperbaric oxygen therapy. Moreover, RCT will help to reduce the possible bias, as the allocation of subjects to one of the intervention groups occurs at random. In order to apply this methodology to the chosen research topic, three groups of patients are needed.