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


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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.

About the authors

Morteza Izadi

Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences

Email: info@benthamscience.net

Mehdi Jafari-Oori

Faculty of Nursing, Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences

Email: info@benthamscience.net

Zohre Eftekhari

Biotechnology Department, Pasteur Institute of Iran

Email: info@benthamscience.net

Nematollah Jafari

Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences

Email: info@benthamscience.net

Mohamad Maybodi

Orthopedic Department, Trauma Research Center, Baqiyatallah University of Medical Sciences

Email: info@benthamscience.net

Soleyman Heydari

Trauma Research Center, Baqiyatallah University of Medical Sciences

Email: info@benthamscience.net

Amir Vahedian-Azimi

Nursing Faculty, Trauma Research Center, Baqiyatallah University of Medical Sciences

Author for correspondence.
Email: info@benthamscience.net

Stephen Atkin

, Royal College of Surgeons in Ireland-Bahrain

Email: info@benthamscience.net

Tannaz Jamialahmadi

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

Email: info@benthamscience.net

Amirhossein Sahebkar

Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences

Author for correspondence.
Email: info@benthamscience.net

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