Evidence-based practice in wound care: toward addressing our knowledge gaps.

BACKGROUND Chronic nonhealing wounds are a major complication for many veterans. Particularly at risk are veterans with reduced mobility, such as those who have suffered a spinal cord injury (SCI). Chronic wounds cause significant suffering, including profound negative effects on general physical health, socialization, financial status, body image, level of independence, and control. For individuals with SCI, the development of a pressure ulcer is one of the leading causes of readmission to the hospital after acute rehabilitation and a major source of morbidity and even mortality. The management of chronic wounds is also extremely costly for clinical facilities, from the acute care setting to long-term care. Many clinical practice guidelines (CPGs) for wound care are currently being issued with the overall goal of reducing the incidence and prevalence of this significant healthcare complication. CPGs have the potential to improve the standard of care for chronic wounds and decrease associated costs. A wealth of basic science and early clinical trials are being carried out in the field of chronic wound care research. However, there remains a disconnect between early stage research efforts and implementation as routine clinical practice in the care of veterans with chronic wounds. The 2nd International Conference on Evidence Based Practice in Wound Care: The Effective Implementation of Pressure Ulcer Clinical Practice Guidelines was held in Cleveland, Ohio, in June 2009 [1]. This program was designed for the many specialties involved in the interdisciplinary field of wound care research. The focus of the conference was on topics related to the effective selection and implementation of evidence-based CPGs. Over 150 attendees were provided with educational tools to enable them to effectively implement evidence-based practice approaches to pressure ulcer care. While many felt that they were familiar with CPGs for their specialty, there were concerns that implementation could be hindered by lack of support and continuing education in best evidence-based practices for wound care. In conjunction with the 2nd International Conference on Evidence Based Practice in Wound Care, an expert panel was convened in June 2009 to develop a research agenda based on critical knowledge gaps regarding pressure ulcers in individuals with SCI and on the implementation of advanced clinical practices. A literature-based discussion of the consensus panel conclusions is presented as a second Guest Editorial in this issue of JRRD [2]. The research articles presented illustrate both preclinical and clinical research that will lead to improved rehabilitative and lifetime outcomes for at-risk veterans, particularly those with SCI. Kath M. Bogie, DPhil ARTICLES IN THIS ISSUE "Effect of sensory and motor electrical stimulation in vascular endothelial growth factor expression of muscle and skin in full thickness wound. " Asadi et al. Electrotherapy for the treatment of chronic wounds has long been known, and there have been many clinical reports conducted on the technique. However, widespread implementation has been limited by lack of definitive proof demonstrating the positive effects of electrical stimulation (ES) on wound healing. The current limitations imposed on electrotherapy usage by the Centers for Medicare and Medicaid Services and the lack of Food and Drug Administration approval reflect the underlying deficit in understanding of the physiological mechanism that is an essential precursor to optimization of clinical therapy. In their article, "Effect of sensory and motor electrical stimulation in vascular endothelial growth factor expression of muscle and skin in full thickness wound," Asadi et al. report on a preclinical study employing an acute animal wound model [3]. Varying ES paradigms were employed to study the effect on angiogenesis, as indicated by expression of vascular endothelial growth factor (VEGF). …