Phototherapy for Treating Pressure Injuries: A Meta-Analysis of Randomized Controlled Trials

Background: A pressure ulcer is defined as ＂an area of localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear＂. The term ＂pressure injury＂ replaces ＂pressure ulcer＂ in the National Pressure Injury Advisory Panel Pressure Injury Staging System according to NPUAP since 2016. The use of phototherapy that is, light (or laser) used as an adjuvant, nonsurgical intervention, with the aim of having a therapeutic effect on healing has increased recently. The objective of the study is to determine the effects of phototherapy on the healing of pressure injuries. Materials and Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE were searched up to 31 December 2016 with no restrictions on language or publication date. Randomized controlled trials (RCTs) comparing the effects of phototherapy (in addition to standard treatment) with sham phototherapy (in addition to standard treatment), another type of phototherapy (in addition to standard treatment) or standard or conventional treatment alone. Two review authors assessed studies for relevance according to pre-specified selection criteria, extracted data and evaluated study methodological quality. Attempts to obtain missing data were made by contacting study authors. Disagreement was resolved by consensus and discussion with a third review author. Results: A total of eight RCTs involving 477 participants were included. All the trials were assessed to be at unclear risk of bias. Trials compared the use of phototherapy with standard care only (seven trials) or sham phototherapy (one trial). Overall, there was insufficient evidence to determine the relative effects of phototherapy for healing pressure injuries. Time to complete healing was reported in three studies. Two studies showed the ultraviolet (UV) treated group had a shorter mean time to complete healing than the control group (mean difference -2.13 weeks (95% CI -3.53 to -0.72, P value 0.003)). One study reported that the laser group had a longer mean time to complete healing than the control group (mean difference 5.77 weeks; 95% CI -0.25 to 11.79). Adverse effects were reported in only two studies that compared phototherapy with control. Pooling was not undertaken because of differences in outcome measures reported. Conclusions: The effects of phototherapy in treating pressure injuries remain uncertain. The quality of evidence is low due to the unclear risk of bias and small number of trials available for analysis. The possibility of benefit or harm of this treatment cannot be ruled out. Further research is recommended.