FIRST things first when evaluating wound healing research

wound healing research

You hear more and more about evidence-based wound care. But what does that mean and how can you tell when a study is a good one?

wound care

By Bill Richlen, PT, WCC, DWC

To evaluate the reliability of wound healing research, you can use the acronym FIRST to help. Here’s what each step means.

F — Funding

Who funded the study? Was the data published for the financial gain of a company?

You should compare these studies to other existing data to determine whether the results are true or manipulated. Studies funded by a manufacturer, or those in which the researchers and authors have a financial relationship with the manufacturer, tend to be biased.

I — Investigation

Was the experiment looking at cause and effect, or was it looking at correlation? Causation is when X causes Y. Correlation means X and Y are only related in some way.

For example, taller people tend to be heavier. This is a correlation rather than causation. On the other hand, sustained pressure on a bony prominence will cause a pressure injury.

What was tested in the wound healing research specifically? Was it the actual product or just the agent that is in the product?

For example, independent studies of hypochlorous acid show effective antimicrobial effects, but does that mean a product with that agent performs the same?

R — Results

Do the results seem objective and reliable? Can the results be reproduced?

This becomes very important when wound care treatments are tested “in vitro.” Testing in vitro refers to experiments being done in a lab, not in a wound. Will the same product render the same results in a real wound environment?

It is important to discern if the results are factual. Were they published in a peer-reviewed journal? It also is important to remember a good wound healing research study will suggest findings but may not prove a hypothesis with 100% certainty.

You get gold-standard treatments and best practices from reproducible and reliable results.

For example, diabetic wounds should be offloaded, venous ulcers need compression, wounds with necrotic tissue should be debrided provided there is adequate tissue perfusion, and patients need adequate nutrition to heal wounds.

S — Subjects

How big was the study? Were the experiments completed on animals or people?

Were the experiments done in a petri dish? Was there a control group?

You can expect the results of a trial to be more reliable when large numbers of subjects were tested. You also should be asking if clinical trials were done in actual wound environments.

T — Time

How old is the wound healing research? If it is more than 10 years old, are there more recent studies and do they have the same results?

Wound care technology and products change and improve rapidly. So, you should always look for the most recent and cutting-edge treatments provided they also are effective and reliable.

Evidence-based practice should include asking questions and thinking critically. It involves finding information and evidence to support your treatments.

You should evaluate treatments for best practices, cost effectiveness and from a patient perspective.

The Cleveland Clinic suggests five steps to evidence-based practice:

  1. Ask: What problem is my patient facing? What is the etiology and contributing factors to this wound?
  2. Acquire: Search for evidence for the best treatment options. Our WCEI manual is a great tool for this. Remember the six basics of wound care and apply those.
  3. Appraise your treatment: Am I treating this wound according to its etiology? If a patient has a venous ulcer, am I applying appropriate compression? The patient has a pressure injury, so are you removing the source of pressure?
  4. Apply the evidence: Start by removing the cause of the wound. Then, ensure good nutrition, manage bioburden, practice good wound bed prep and apply gold-standard treatments.
  5. Assess: Are my treatments working? You should assess every week and evaluate if you do not see improvement within two weeks. If wound healing stalls, you should review to ensure you have met the six basics and consider adjunctive therapies to help heal the wound.

Clinicians can get caught up in the latest, greatest topical product rather than critically assessing the patient and the wound.

Have you done your due diligence in researching the effectiveness of products/treatments before you started using them?

As clinicians, we often miss the boat by putting too much emphasis on the treatment of choice rather than relying on evidence-based practices.

You should always refer to your wound care education and expertise.

Earn wound care certification with our institute today.

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Bill Richlen, PT, WCC, DWC, is a clinical instructor for the Wound Care Education Institute. As a licensed physical therapist, Richlen has experience in advanced wound care consultations in long-term care, outpatient, skilled rehabilitation and home health. He has served as a clinical instructor for physical therapy students, been the director of several large rehabilitation departments, and has been providing multi-disciplinary wound care education to nurses and therapists for more than 17 years. His expertise in diverse settings enhance his role as a clinical instructor. His dynamic and captivating teaching style keeps attendee’s attention throughout each course.

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