Prognostic factors for delayed healing of complex wounds in adults: A scoping review

Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.

Stroke and physiological relationships during the incremental front crawl test: outcomes for planning and pacing aerobic training

Purpose: This study aimed to evaluate the physiological responses associated with the stroke length (SL) and stroke rate (SR) changes as swimming velocity increases during an incremental step-test. Moreover, this study also aimed to verify if SL and SR relationships toward maximal oxygen uptake (V̇O2max), gas respiratory compensation point (RCP), exchange threshold (GET), and swimming cost can be applied to the management of endurance training and control aerobic pace. Methods: A total of 19 swimmers performed the incremental test until volitional exhaustion, with each stage being designed by percentages of the 400 m (%v400) maximal front crawl velocity. V̇O2max, GET, RCP, and the respective swimming velocities (v) were examined. Also, the stroke parameters, SL, SR, the corresponding slopes (SLslope and SRslope), and the crossing point (Cp) between them were determined. Results: GET and RCP corresponded to 70.6% and 82.4% of V̇O2max (4185.3 ± 686.1 mL min-1), and V̇O2 at Cp, SLslope, and SRslope were observed at 129.7%, 75.3%, and 61.7% of V̇O2max, respectively. The swimming cost from the expected V̇O2 at vSLslope (0.85 ± 0.18 kJ m-1), vSRslope (0.77 ± 0.17 kJ m-1), and vCp (1.09 ± 0.19 kJ m-1) showed correlations with GET (r = 0.73, 0.57, and 0.59, respectively), but only the cost at vSLslope and vCp correlated to RCP (0.62 and 0.69) and V̇O2max (0.70 and 0.79). Conclusion: SL and SR exhibited a distinctive pattern for the V̇O2 response as swimming velocity increased. Furthermore, the influence of SL on GET, RCP, and V̇O2max suggests that SLslope serves as the metabolic reference of heavy exercise intensity, beyond which the stroke profile defines an exercise zone with high cost, which is recommended for an anaerobic threshold and aerobic power training. In turn, the observed difference between V̇O2 at SRslope and GET suggests that the range of velocities between SL and SR slopes ensures an economical pace, which might be recommended to develop long-term endurance. The results also highlighted that the swimming intensity paced at Cp would impose a high anaerobic demand, as it is located above the maximal aerobic velocity. Therefore, SLslope and SRslope are suitable indexes of submaximal to maximal aerobic paces, while Cp's meaning still requires further evidence.