The Evidence for and against the Effectiveness of Pressure Garment Therapy for Scar Management
Notice bibliographique
Résumé
Sir: With regard to the recently published article entitled “Review of Over-the-Counter Topical Scar Treatment Products,”1 the authors should be commended. This is an extremely important topic, as virtually every plastic surgery patient receives advice regarding scar management. The myriad of products available and the lack of high-quality scientific evidence make it difficult to provide exact advice. The aim of Shih et al.’s article was “to evaluate the evidence from published controlled clinical trials in humans on some of the most commonly used over-the-counter products for treatment of symptomatic scars.” The article states, “retrospective clinical and ultrasonic studies since the 1960s are supportive” of pressure therapy. However, of the references provided, none is a clinical study providing evidence of improved outcomes with the use of pressure garment therapy. All are case studies of patients treated with pressure therapy, and none has a comparison group or control treatment. The article goes on to state that “the only prospective, randomized study on the efficacy of pressure garments demonstrated no significant difference in wound healing” compared with control subjects.2 In addition, the article recognizes that published studies have shown that pressure therapy may in fact lead to patient morbidity. Garments can be uncomfortable and lead to skin breakdown, ulceration, and even bony deformation. Given the available evidence, one must conclude that the use of pressure therapy is not supported by the available evidence. The article states that further evidence is not available because of a lack of interest by researchers. Several centers have conducted studies to assess the effects of pressure therapy.3,4 Other studies have been conducted, but they are rarely published. This is most likely a reflection of publication bias.5 Publication bias occurs when research with statistically significant results is more likely to be submitted and published than is work with null or nonsignificant results. Given the lack of currently available evidence and the universal application of pressure therapy, I believe there is a need for adequately powered studies of high methodological quality to determine the effectiveness of pressure garment therapy. The article states, more than once, that “conducting a study on the efficacy of pressure therapy would likely be either difficult or unethical, because it would involve withholding an accepted treatment from control subjects.” The continued use of an expensive, unproven, and potentially harmful therapy without any further evidence may also be unethical. The National Institutes of Health is currently funding a large randomized control trial to assess the use of pressure therapy. It is my hope that this study will be adequately powered to shed light on this important issue. Alexander Anzarut, M.D., M.Sc. Division of Plastic and Reconstructive Surgery University of Alberta Edmonton, Alberta, Canada
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,032 | 0,131 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,006 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,004 |
| Communication savante | 0,005 | 0,005 |
| Science ouverte | 0,004 | 0,002 |
| Intégrité de la recherche | 0,007 | 0,009 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».