# Meta-Decomposition of Efficacy, Incidence of Pressure Ulcer, and Prognosis of Stroke Sufferers after Applying Evidence-Based Ministration

Authors: Ting Su; Wenjun Hu; Meiling Song; Peiru Zhao
Journal: Contrast Media & Molecular Imaging
 (2022)

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## Abstract

In order to meta-analyze the effect of evidence-based ministration on the efficacy, incidence of pressure ulcers and prognosis of stroke are used. Literature retrieval is carried out in Wanfang Medicine, PubMed database, biomedical literature, and other medical databases through medical data and computers, focusing on the efficacy, pressure ulcer incidence, and prognosis of stroke sufferers after applying evidence-based ministration. For the relevant medical information literature on the effect, RevMan 5.2 software is used for meta-decomposition. For stroke sufferers, the application of evidence-based ministration intervention can notoriously enhance the clinical therapy effect of stroke sufferers, reduce the incidence of clinical pressure ulcers, and enhance the prognosis and quality of life of sufferers.


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## Body

## 1. Introduction

Stroke is an acute cerebrovascular ailment with high mortality, morbidity, and disability. The number of stroke sufferers in China is as high as 5–6 million, which is the leading cause of disability in adults and the second leading cause of death in addition to cancer [1, 2]. In addition, China is still growing at an annual rate of 1.3 million new cases, which brings a heavy burden to sufferers, families, and society. Studies have reported that 60% of sufferers with cerebrovascular ailment have notoriously enhanced their ability to live one year after regular rehabilitation. Evidence-based ministration is a new point of view, new thinking, and new concept of ministration developed under the influence of evidence-based medicine in the 1990s. At the time of the basis, its core is to emphasize the evidence [3, 4]. In order to obtain the best evidence to help ischemic stroke sufferers enhance their quality of life, some studies have pointed out that evidence-based ministration has a good intervention effect in the therapy of stroke sufferers, but its examination on pressure ulcers and prognosis of stroke sufferers are still in the exploratory stage [5]. In order to further explore the effect of evidence-based ministration intervention in stroke sufferers, this examination searched for and collected 8 randomized controlled studies, meta-analysis, combined with routine treatment and evidence-based treatment to intervene stroke patients.The rest of this paper is organized as follows. Section2 discusses related work, followed by literature search and literature selection criteria in Section 3. The evidence for meta-decomposition result is discussed in Section 4. Section 5 concludes the paper with summary.


## 2. Related Work

During the clinical therapy of stroke sufferers, due to the need for long-term bed rest, local tissue is compressed, and nutritional deficiencies and blood supply disorders are prone to occur, resulting in the loss of normal skin function of sufferers and increasing the risk of pressure ulcers. Routine care lacks pertinence and is less effective in preventing pressure ulcers in sufferers [6]. Evidence-based ministration is a ministration method formulated by clinical nurses to explore evidence-based theoretical basis and combine the ministration needs of sufferers, which ensures the planning and scientific nature of ministration programs. Spector et al. [7] found that most of the stroke sufferers are in a state of paralysis. In addition to the damage to the overall pressure capacity of the skin tissue, there may be inevitable pressure ulcers [8]. Reasonable application of triangle pillows not only enhances the effect of intervention but also effectively prevents and treats pressure ulcers [9].A ministration evidence-based management set is established to guide clinical nurses with different skills and backgrounds to engage in evidence-based ministration practice. Members of the ministration evidence-based management team can guide clinical nurses to obtain scientific evidence from ministration information and then combine the actual situation and needs of sufferers, analyze the applicability of the evidence, and formulate high-quality ministration programs. Implementation can enhance the evidence-based capacity of clinical nurses [10, 11]. At present, the effect of evidence-based ministration on stroke intervention is still at a stage of great controversy. Relevant studies on the mechanism of action and complication prevention have achieved great results.


## 3. Literature Search and Literature Selection Criteria

### 3.1. Literature Search

Stroke, evidence-based ministration, efficacy, pressure ulcers, prognosis, evidence-based care, efficacy, pressure ulcers, prognosis, etc. are used as search keywords. The relevant studies on the effect of evidence-based ministration on stroke sufferers are searched by computer. The general content of the literature is understood through abstracts, and the studies that meet the conditions of stroke, evidence-based ministration, efficacy, pressure ulcers, and prognosis are strictly screened. The examination must be approved by the relevant institutions, the kits are obtained from normal channels, and the operating steps during the examination are without mistakes. At the same time, the studies with duplication of content, inconsistent examination methods, and imprecise operations are excluded from the literature.


### 3.2. Literature Selection Criteria

Inclusion criteria are as follows. (1) The sufferers in the study meet the diagnostic criteria for stroke. (2) The intervention measures are to receive evidence-based care and routine care during the therapy of stroke sufferers. (3) The rate of loss to follow-up during the follow-up process is less than 20% and the examination must be approved by relevant institutions. (4) The period of literature is within the range of nearly 20 years. (5) The original clinical data are complete. (6) There is no error in the operation steps during the study. (7) Except for the application of evidence-based sufferers in each set, the contents of other therapy are the same except for the disparity between ministration and usual care.Exclusion criteria are as follows. (1) Sufferers who do not conform to the diagnostic criteria of clinical CT and pathology and who are diagnosed with stroke after examination. (2) Sufferers who have received evidence-based ministration intervention before the study. (3) Animal experiments. (4) Contrary to the examination subject not relevant. (5) The article is a review, meta-analysis, case report, and conference abstract. (6) Sufferers with severe hematological ailments. (7) The dropout rate due to withdrawal or interruption of follow-up during the follow-up process is greater than 20%. (8) No evidence-based ministration intervention is applied during the study.Outcome indicators are curative effect, pressure ulcer, and prognosis.


### 3.3. Quality Evaluation

The quality of the literature is evaluated using the modified Jadad rating scale, which has a total score of 7, with 1–3 as low quality and 4–7 as high quality. For cohort studies, the Chinese version of the modified NOS scale is used to evaluate the quality of the literature. The scale has a total score of 10, with <5 as low quality and ≥5 as high quality.


### 3.4. Statistical Processing

The examination data are entered into RevMan5.2 statistical software for decomposition. Enumeration data are expressed by risk ratio (RR) and weighted mean disparity (WMD) or standard mean disparity (SMD). All effect sizes are expressed with 95% confidence interval (CI). Heterogeneity between the results of each study is tested by Chi2. When the heterogeneity among the studies satisfiesP<0.1 and I2≥50%, which is statistically extensive, the source of this property is analyzed by subset or sensitivity. When the heterogeneity among the studies satisfies P<0.1 and I2<50%, the heterogeneity is not statistically extensive, and the meta-decomposition is carried out with a fixed-effects model. When the source of heterogeneity is unclear, a random-effects model is used in the decomposition, and descriptive decomposition is used to analyze obvious clinical and methodological heterogeneity.


## 3.1. Literature Search

Stroke, evidence-based ministration, efficacy, pressure ulcers, prognosis, evidence-based care, efficacy, pressure ulcers, prognosis, etc. are used as search keywords. The relevant studies on the effect of evidence-based ministration on stroke sufferers are searched by computer. The general content of the literature is understood through abstracts, and the studies that meet the conditions of stroke, evidence-based ministration, efficacy, pressure ulcers, and prognosis are strictly screened. The examination must be approved by the relevant institutions, the kits are obtained from normal channels, and the operating steps during the examination are without mistakes. At the same time, the studies with duplication of content, inconsistent examination methods, and imprecise operations are excluded from the literature.


## 3.2. Literature Selection Criteria

Inclusion criteria are as follows. (1) The sufferers in the study meet the diagnostic criteria for stroke. (2) The intervention measures are to receive evidence-based care and routine care during the therapy of stroke sufferers. (3) The rate of loss to follow-up during the follow-up process is less than 20% and the examination must be approved by relevant institutions. (4) The period of literature is within the range of nearly 20 years. (5) The original clinical data are complete. (6) There is no error in the operation steps during the study. (7) Except for the application of evidence-based sufferers in each set, the contents of other therapy are the same except for the disparity between ministration and usual care.Exclusion criteria are as follows. (1) Sufferers who do not conform to the diagnostic criteria of clinical CT and pathology and who are diagnosed with stroke after examination. (2) Sufferers who have received evidence-based ministration intervention before the study. (3) Animal experiments. (4) Contrary to the examination subject not relevant. (5) The article is a review, meta-analysis, case report, and conference abstract. (6) Sufferers with severe hematological ailments. (7) The dropout rate due to withdrawal or interruption of follow-up during the follow-up process is greater than 20%. (8) No evidence-based ministration intervention is applied during the study.Outcome indicators are curative effect, pressure ulcer, and prognosis.


## 3.3. Quality Evaluation

The quality of the literature is evaluated using the modified Jadad rating scale, which has a total score of 7, with 1–3 as low quality and 4–7 as high quality. For cohort studies, the Chinese version of the modified NOS scale is used to evaluate the quality of the literature. The scale has a total score of 10, with <5 as low quality and ≥5 as high quality.


## 3.4. Statistical Processing

The examination data are entered into RevMan5.2 statistical software for decomposition. Enumeration data are expressed by risk ratio (RR) and weighted mean disparity (WMD) or standard mean disparity (SMD). All effect sizes are expressed with 95% confidence interval (CI). Heterogeneity between the results of each study is tested by Chi2. When the heterogeneity among the studies satisfiesP<0.1 and I2≥50%, which is statistically extensive, the source of this property is analyzed by subset or sensitivity. When the heterogeneity among the studies satisfies P<0.1 and I2<50%, the heterogeneity is not statistically extensive, and the meta-decomposition is carried out with a fixed-effects model. When the source of heterogeneity is unclear, a random-effects model is used in the decomposition, and descriptive decomposition is used to analyze obvious clinical and methodological heterogeneity.


## 4. Meta-Decomposition and Sensitivity Decomposition

### 4.1. Literature Search Results

After the Chinese and English databases are searched according to the search strategy, a total of 565 documents are collected, and the documents are screened according to the established inclusion and exclusion criteria. Finally, 8 documents are included, including 3 English documents and 5 Chinese documents. Figure1 shows the flowchart of literature selection. It is clearly evident from Figure 1 that the proposed selection method is effective. Table 1 shows the flowchart of literature selection. It is clearly evident from Table 1 that there are 1 low-quality study and 7 high-quality studies.Figure 1
Flowchart of literature selection.Table 1
Basic characteristics of literature.
AuthorYear of publicationOutcomesQuality scoreLi [12]2017(2)3Tian [13]2017(1) (2)6Huang [14]2019(2) (3)5Zhao [15]2020(1) (2) (3)5Wang [16]2020(1) (3)5Deng [17]2018(1) (2) (3)6Zhu [18]2019(1) (3)6Dang [19]2021(2)5


### 4.2. Literature Bias Decomposition Results

The 8 final included studies are randomized contrasted studies with multi-center characteristics, and all of them give detailed descriptions of the randomization method, and the method is correct [20–23]. Figure 2 shows the bias decomposition of literature. It is clearly evident from Figure 2 that there is no significant publication bias.Figure 2
Bias decomposition of literature.Figure3 shows the publication bias of single literature. It is clearly evident from Figure 3 that the risk of bias of the included studies was low.Figure 3
Bias decomposition of literature.


### 4.3. Meta-Decomposition Results

A total of 5 studies are included for the clinical efficacy of stroke sufferers [24–26]. The results of the heterogeneity test show that there is no heterogeneity among the included studies. Therefore, a fixed-effects model is used to analyze the evidence-based ministration set. The total effective rate of therapy is notoriously higher than that of the routine ministration set, and the disparity is statistically extensive after the combined studies (RR: 0.29, 95% CI: (0.23, 0.36), P<0.00001). Figure 4 shows the forest plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers. It is clearly evident from Figure 4 that evidence-based application of stroke sufferers’ ministration intervention can effectively enhance the clinical therapy effect of sufferers.Figure 4
Forest plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers.Figure5 shows the funnel plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers. It is clearly evident from Figure 5 that evidence-based application of stroke sufferers’ ministration intervention can effectively enhance the clinical therapy effect of sufferers.Figure 5
Funnel plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers.A total of 6 studies are included for the incidence of clinical pressure ulcers in sufferers with stroke. The results of the heterogeneity test show that I2 = 0%,P=0.81, indicating that there is no heterogeneity among the included studies. The incidence of pressure ulcers in the ministration set is notoriously lower than that in the routine ministration set, and the disparity is statistically extensive after the combined studies (RR: 0.23, 95% CI: (0.13, 0.42), P<0.00001), which can be considered as an effective therapy for stroke sufferers. Figure 6 shows the forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers. It is clearly evident from Figure 6 that the application of evidence-based ministration intervention can effectively reduce the incidence of pressure ulcers in sufferers.Figure 6
Forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers.Figure7 shows the funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers. It is clearly evident from Figure 7 that evidence-based ministration intervention can effectively reduce the incidence of pressure ulcers in sufferers.Figure 7
Funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers.A total of 5 studies are included for the clinical prognosis of stroke sufferers. The results of the heterogeneity test show that I2 = 99% andP=<0.00001, indicating that there is no heterogeneity among the included literature. Therefore, a fixed-effects model is used to analyze the evidence-based ministration set. The total effective rate of the sufferer’s therapy is notoriously higher than that of the routine care set, and the disparity is statistically extensive after the combined studies (RR: 15.44, 95% CI: (7.61, 23.27), P=0.0001). It can be considered that the application of the therapy system for stroke sufferers is effective. Figure 8 shows the forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers. It is clearly evident from Figure 8 that syndrome ministration intervention can effectively enhance the quality of life of sufferers with clinical prognosis.Figure 8
Forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers.Figure9 shows the funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers. It is clearly evident from Figure 9 that syndrome ministration intervention can effectively enhance the quality of life of sufferers with clinical prognosis.Figure 9
Funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers.


### 4.4. Sensitivity Decomposition

Sensitivity decomposition is performed on the 8 included studies. Table2 shows the result of sensitivity decomposition. It is clearly evident from Table 2 that there is no extensive change in the meta results of the three indicators, indicating that the heterogeneity among the 8 included literature in this study is relatively high, so it has a high reference value.Table 2
Sensitivity decomposition.
EndingRR/WMD 95% CIPI2Curative effect———Overall(6)RR: 0.29, 95% CI: (0.23,0.36)<0.000010.0Sensitivity decomposition pressure ulcerRR: 0.29, 95% CI: (0.23,0.36)——Overall(3)RR: 0.23, 95% CI: (0.13,0.42)＜0.000010.0Sensitivity decomposition prognostic quality of lifeRR: 0.23, 95% CI: (0.13,0.42)——Overall(3)RR: 15.4495% CI: (7.61, 23.27)＜0.0000199.00Sensitivity decompositionRR: 15.4495% CI: (7.61, 23.27)——


## 4.1. Literature Search Results

After the Chinese and English databases are searched according to the search strategy, a total of 565 documents are collected, and the documents are screened according to the established inclusion and exclusion criteria. Finally, 8 documents are included, including 3 English documents and 5 Chinese documents. Figure1 shows the flowchart of literature selection. It is clearly evident from Figure 1 that the proposed selection method is effective. Table 1 shows the flowchart of literature selection. It is clearly evident from Table 1 that there are 1 low-quality study and 7 high-quality studies.Figure 1
Flowchart of literature selection.Table 1
Basic characteristics of literature.
AuthorYear of publicationOutcomesQuality scoreLi [12]2017(2)3Tian [13]2017(1) (2)6Huang [14]2019(2) (3)5Zhao [15]2020(1) (2) (3)5Wang [16]2020(1) (3)5Deng [17]2018(1) (2) (3)6Zhu [18]2019(1) (3)6Dang [19]2021(2)5


## 4.2. Literature Bias Decomposition Results

The 8 final included studies are randomized contrasted studies with multi-center characteristics, and all of them give detailed descriptions of the randomization method, and the method is correct [20–23]. Figure 2 shows the bias decomposition of literature. It is clearly evident from Figure 2 that there is no significant publication bias.Figure 2
Bias decomposition of literature.Figure3 shows the publication bias of single literature. It is clearly evident from Figure 3 that the risk of bias of the included studies was low.Figure 3
Bias decomposition of literature.


## 4.3. Meta-Decomposition Results

A total of 5 studies are included for the clinical efficacy of stroke sufferers [24–26]. The results of the heterogeneity test show that there is no heterogeneity among the included studies. Therefore, a fixed-effects model is used to analyze the evidence-based ministration set. The total effective rate of therapy is notoriously higher than that of the routine ministration set, and the disparity is statistically extensive after the combined studies (RR: 0.29, 95% CI: (0.23, 0.36), P<0.00001). Figure 4 shows the forest plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers. It is clearly evident from Figure 4 that evidence-based application of stroke sufferers’ ministration intervention can effectively enhance the clinical therapy effect of sufferers.Figure 4
Forest plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers.Figure5 shows the funnel plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers. It is clearly evident from Figure 5 that evidence-based application of stroke sufferers’ ministration intervention can effectively enhance the clinical therapy effect of sufferers.Figure 5
Funnel plot comparing the effect of evidence-based ministration intervention and routine ministration intervention on the curative effect of stroke sufferers.A total of 6 studies are included for the incidence of clinical pressure ulcers in sufferers with stroke. The results of the heterogeneity test show that I2 = 0%,P=0.81, indicating that there is no heterogeneity among the included studies. The incidence of pressure ulcers in the ministration set is notoriously lower than that in the routine ministration set, and the disparity is statistically extensive after the combined studies (RR: 0.23, 95% CI: (0.13, 0.42), P<0.00001), which can be considered as an effective therapy for stroke sufferers. Figure 6 shows the forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers. It is clearly evident from Figure 6 that the application of evidence-based ministration intervention can effectively reduce the incidence of pressure ulcers in sufferers.Figure 6
Forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers.Figure7 shows the funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers. It is clearly evident from Figure 7 that evidence-based ministration intervention can effectively reduce the incidence of pressure ulcers in sufferers.Figure 7
Funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the incidence of pressure ulcers in stroke sufferers.A total of 5 studies are included for the clinical prognosis of stroke sufferers. The results of the heterogeneity test show that I2 = 99% andP=<0.00001, indicating that there is no heterogeneity among the included literature. Therefore, a fixed-effects model is used to analyze the evidence-based ministration set. The total effective rate of the sufferer’s therapy is notoriously higher than that of the routine care set, and the disparity is statistically extensive after the combined studies (RR: 15.44, 95% CI: (7.61, 23.27), P=0.0001). It can be considered that the application of the therapy system for stroke sufferers is effective. Figure 8 shows the forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers. It is clearly evident from Figure 8 that syndrome ministration intervention can effectively enhance the quality of life of sufferers with clinical prognosis.Figure 8
Forest plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers.Figure9 shows the funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers. It is clearly evident from Figure 9 that syndrome ministration intervention can effectively enhance the quality of life of sufferers with clinical prognosis.Figure 9
Funnel plot comparing the effects of evidence-based ministration intervention and routine ministration intervention on the prognosis of stroke sufferers.


## 4.4. Sensitivity Decomposition

Sensitivity decomposition is performed on the 8 included studies. Table2 shows the result of sensitivity decomposition. It is clearly evident from Table 2 that there is no extensive change in the meta results of the three indicators, indicating that the heterogeneity among the 8 included literature in this study is relatively high, so it has a high reference value.Table 2
Sensitivity decomposition.
EndingRR/WMD 95% CIPI2Curative effect———Overall(6)RR: 0.29, 95% CI: (0.23,0.36)<0.000010.0Sensitivity decomposition pressure ulcerRR: 0.29, 95% CI: (0.23,0.36)——Overall(3)RR: 0.23, 95% CI: (0.13,0.42)＜0.000010.0Sensitivity decomposition prognostic quality of lifeRR: 0.23, 95% CI: (0.13,0.42)——Overall(3)RR: 15.4495% CI: (7.61, 23.27)＜0.0000199.00Sensitivity decompositionRR: 15.4495% CI: (7.61, 23.27)——


## 5. Conclusion

For stroke sufferers, evidence-based ministration intervention can notoriously enhance the clinical therapy effect of stroke sufferers, reduce the risk of pressure ulcers, and enhance the clinical quality of sufferers’ prognosis, which is worthy of clinical application. At present, the effect of evidence-based ministration on stroke intervention is still at a stage of great controversy. Relevant studies on the mechanism of action and complication prevention have achieved great results, laying an examination sample basis for meta-decomposition. The quantitative decomposition of the effect of evidence-based ministration on stroke intervention can make the results more scientific and reliable.



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