Effect of Ozone Therapy on Diabetes-related Foot Ulcer Outcomes: A Systematic Review and Meta-analysis-Reference-Cited by-同舟云学术

Effect of Ozone Therapy on Diabetes-related Foot Ulcer Outcomes: A Systematic Review and Meta-analysis

Published:2024-08 Issue:27 Volume:30 Page:2152-2166
ISSN:1381-6128
Container-title:Current Pharmaceutical Design
language:en
Short-container-title:CPD

Author:

Izadi Morteza¹,Jafari-Oori Mehdi²,Eftekhari Zohre³,Jafari Nematollah Jonaidi¹,Maybodi Mohamad Kazem-Emami⁴,Heydari Soleyman⁵,Vahedian-Azimi Amir⁶,Atkin Stephen L.⁷,Jamialahmadi Tannaz⁸,Sahebkar Amirhossein⁹

Affiliation:

1. Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

2. Faculty of Nursing, Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

3. Biotechnology Department, Pasteur Institute of Iran, Tehran, Iran

4. Orthopedic Department, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

5. Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

6. Nursing Faculty, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

7. Royal College of Surgeons in Ireland-Bahrain, Adliya, Manama, Kingdom of Bahrain

8. International UNESCO Center for Health-related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran

9. Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Purpose: This study aimed to assess the effectiveness of ozone therapy in treating Diabetes-related Foot Ulcer (DFU) and its outcomes. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and ProQuest databases for published studies evaluating the use of ozone as an adjunct treatment for DFU, from inception to December 21, 2022. The primary outcome measure was the change in wound size after the intervention compared to pretreatment. Secondary outcomes included time to complete ulcer healing, number of healed patients, adverse events, amputation rates, and hospital length of stay. Quantitative data synthesis for the meta-analysis was performed using a random-effects model and generic inverse variance method, while overall heterogeneity analysis was conducted using a fixed-effects model. Interstudy heterogeneity was assessed using the I2 index (>50%) and the Cochrane Q statistic test. Sensitivity analysis was performed using the leave-one-out method. Results: The meta-analysis included 11 studies The meta-analysis included 11 studies comprising 960 patients with DFU. The results demonstrated a significant positive effect of ozone therapy on reducing foot ulcer size (Standardized Mean Difference (SMD): -25.84, 95% CI: -51.65 to -0.04, p = 0.05), shortening mean healing time (SMD: -38.59, 95% CI: -51.81 to -25.37, p < 0.001), decreasing hospital length of stay (SMD: -8.75, 95% CI: -14.81 to -2.69, p < 0.001), and reducing amputation rates (Relative Risk (RR): 0.46, 95% CI: 0.30-0.71, p < 0.001), compared to standard treatment. Conclusion: This meta-analysis indicates that ozone therapy has additional benefits in expediting complete DFU healing, reducing the amputation rates, and decreasing hospital length of stay, though its effects do not differ from standard treatments for complete ulcer resolution. Further research is needed to address the heterogeneity among studies and to better understand the potential beneficial effects of ozone therapy. Registration Number:: CRD42023386828.

Publisher

Bentham Science Publishers Ltd.