Comparative efficacy and safety of non-pharmacological nursing interventions for diabetic foot ulcers: a systematic review and network meta-analysis

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BACKGROUND: Non-pharmacological nursing interventions are increasingly employed to enhance diabetic foot ulcer (DFU) healing and patient outcomes. However, the comparative effectiveness and safety profiles of various adjunctive nursing strategies remain unclear. This network meta-analysis systematically evaluated and ranked non-pharmacological nursing interventions for DFU management. METHODS: A comprehensive systematic search was conducted in PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and Web of Science from inception to March 31, 2025. Randomized controlled trials (RCTs) comparing non-pharmacological adjunctive nursing interventions (e.g., hyperbaric oxygen therapy [HBOT], light therapy [LT], ultrasound therapy [US], extracorporeal shock-wave therapy [ESWT], exercise therapy [EXER], continuous diffusion of oxygen [CDO], negative pressure wound therapy [NPWT]) with standard care or alternative interventions for DFU were included. Primary outcomes assessed were healing rate, healing time, wound area reduction, recurrence rate, amputation rate, and adverse events. Bayesian network meta-analysis was conducted using random-effects models, with results expressed as odds ratios (OR), standardized mean differences (SMD), and surface under cumulative ranking curves (SUCRA). RESULTS: Sixty-seven RCTs involving 5957 patients were included. LT significantly increased healing rates compared with standard care (OR = 7.62; 95% CI, 2.92-19.90; SUCRA = 88.8%). US produced the largest wound area reduction (SMD = -3.17; 95% CI, -4.81 to -1.53; SUCRA = 98.4%). ESWT was superior in shortening healing time (SMD = -2.02; 95% CI, -3.33 to -0.71; SUCRA = 94.4%) and reducing amputation risk (OR = 0.40; 95% CI, 0.23-0.70). EXER significantly reduced recurrence rates (OR = 0.07; 95% CI, 0.02-0.33; SUCRA = 97.4%). CDO demonstrated the fewest adverse events (OR = 0.27; 95% CI, 0.08-0.85; SUCRA = 89.2%). CONCLUSION: This analysis provides targeted evidence for selecting adjunctive nursing interventions based on specific clinical goals. LT and US are optimal for enhancing wound closure and reducing wound area, ESWT is most effective for rapid healing and limb preservation, EXER excels at recurrence prevention, and CDO offers superior safety. These findings facilitate tailored nurse-led care plans and inform clinical guidelines.

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