Running head: EFFICACY OF PLATELET-RICH PLASMA

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Efficacy of Platelet-Rich Plasma in Chronic Wounds

Jessica L. Hoxie
Edson College of Nursing and Health Innovation, Arizona State University

Author Note
Jessica L. Hoxie is a graduate student in the Edson College of Nursing and Health
Innovation at Arizona State University. She has been a Registered Nurse for four years with
bedside experience on a trauma/telemetry unit. Holds a Master of Science in Nursing degree with
an emphasis in Leadership.
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Jessica L. Hoxie, Edson
College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd Street, Phoenix,
AZ 85004 email: jschwanb@asu.edu

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Abstract
Chronic wounds are responsible for exorbitant healthcare costs, poor quality of life, and
increased likelihood of associated systemic complications. Platelet-rich plasma is derived from
human blood and contains regenerative growth factors that have been proven to promote healing
in dermatology, aesthetics, and wounds, more often in traditional care settings. A quality
improvement project was implemented to determine if platelet-rich plasma is an effective
treatment option for chronic wounds in the mobile setting. All participants voluntarily signed
informed consent. Data was collected on three participants (n = 3). The project took place within
a mobile clinic that treats patients in their personal residences. All participants had a single
wound treated with platelet-rich plasma per the clinic’s protocol for five weeks. The BatesJensen Wound Assessment Tool is a valid and reliable tool that was completed at day one, week
three, and week six to determine if wound health had progressed with platelet-rich plasma
treatments. At the end of project, one wound completely healed, one wound scored significantly
lower on the Bates-Jensen Wound Assessment Tool, and one wound worsened with an increased
score. Descriptive statistics were used to analyze data. Overall, platelet-rich plasma proves to be
a promising treatment for chronic wounds in the mobile setting. Mobile clinics can benefit from
performing platelet-rich plasma treatments on chronic wounds as it decreases wound size and
improves healing time, which improves patients’ quality of life and decreases complications and
healthcare costs.
Keywords: platelet-rich plasma, chronic wounds, wound care, healing time, wound size,
mobile wound care

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Efficacy of Platelet-Rich Plasma in Chronic Wounds
Wound care is often overlooked and would benefit from more robust literature to guide
practice. Ineffective wound care drives up healthcare costs and negatively affects patients with
chronic wounds. There is an urgent need to determine which wound products are most useful for
wounds of different stages and types. Exploring the efficacy of wound products can turn patients'
lives around while aiding in relieving the burden on the healthcare system.
Problem Statement
The increasing cost of healthcare is an ongoing problem in the United States (US).
Chronic wounds and poor outcomes are partially responsible for the rising expenditure. Medicare
has determined that wound care and treatment costs will soon be responsible for between $28.1
billion and $96.8 billion (Sen, 2019). Positive wound outcomes will help reduce healthcare costs.
Not only do ineffective wound care and treatments adversely affect the cost, but they also
negatively impact patient outcomes and quality of life (QoL). Individuals with chronic wounds
have decreased QoL due to the toll wounds take on physical and emotional well-being
(Mahmoudi & Gould, 2020; Vogt et al., 2020). Chronic wounds do not close within one month,
do not undergo the proper healing process, and are frequently correlated with underlying
comorbidities that complicate healing (Sen, 2019; Sen, 2021). Wound-related complications are
always possible, keeping the cycle in perpetual motion. The Institute for Healthcare
Improvement (IHI) Triple Aim is a national initiative emphasizing three elements: improving
patient care satisfaction, improving population health, and reducing healthcare costs (IHI, n.d.b). Improving chronic wound outcomes directly aligns with the IHI Triple Aim initiative because
it improves patients' QoL and reduces healthcare costs in the US. Part of the problem is that
chronic and complex wounds need to heal completely. There is a shortcoming of powerful

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clinical research results that have meaning and applicability to practice (Mahmoudi & Gould,
2020). Platelet-rich plasma (PRP) is a reasonably new treatment used on chronic wounds, and the
lack of current research regarding efficacy complicates treatment plans for wound care providers.
Exploring the benefits of PRP on chronic wounds could be groundbreaking for the world of
wound care.
Purpose and Rationale
Determining the efficacy of PRP for chronic wounds in the mobile setting will provide
meaningful information for wound care providers and evidence to guide practice. In turn,
improved or successful wound closure will improve patient outcomes, decrease associated
complications, lower healthcare costs, and improve patients’ QoL. While the current focus is on
wound care, the same principles can be translated to other realms of healthcare to produce
similar outcomes that positively impact patients, healthcare, and the US economy. Not only will
discovering the efficacy of PRP improve patients' lives, but it will also help close the gap
between evidence and practice while treating the patient holistically. This paper explores how
PRP improves wound care, how its efficacy benefits patient outcomes, and how the doctoral
project will test efficacy in an unprecedented setting.
Background and Significance
Wound care for chronic wounds is expansive and fluid, and there is a lack of literature
surrounding clinical practice guidelines, standard protocols, and the efficacy of products and
therapies. Wound outcomes are determined by wound size and healing time, while patients'
reports on the QoL and overall satisfaction are also factors (Eriksson et al., 2022; Monaco et al.,
2021). Innovative products have the potential to improve wound outcomes. Dermatology,
aesthetics, and regenerative medicine use PRP because of its robust growth factors, proteins,

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cytokines, and peptides that promote skin and tissue regeneration (Samadi et al., 2018).
However, there is limited clinical research on using PRP on chronic wounds particularly in
mobile clinics.
Patients with Chronic Wounds
Certain patients are at higher risk for developing chronic wounds and impaired healing.
Diabetes, obesity, malnutrition, impaired mobility, and older age increase patients’ risks for
chronic wounds and complications (Evans & Kim, 2022; Sen, 2019; Wernick et al., 2022).
Managing and preventing risks can potentially improve wound progression and healing time. For
example, controlling glucose, weight loss, increasing protein intake, and frequent repositioning
can assist wounds in healing. Chronic wounds have little to no improvement within four to 12
weeks (Cho et al., 2020). There are many complications with chronic wounds, which include
infection, sepsis, osteomyelitis, and electrolyte imbalance (WoundSource, 2018). With chronic,
non-healing wounds and potential complications, patients will likely spend more on wound care
and treatments and risk QoL due to lifestyle changes necessary to accommodate the wounds. In
one study, authors found that chronic wound patients scored below the global average on two
different quality-of-life instruments due to unsightliness, malodor, and restriction of daily
activities (Vogt et al., 2020). Another study confirmed that QoL was lowest for patients with
chronic wounds and associated amputations, as the wounds affect physical functionality,
emotional health, and mental health (Olsson et al., 2019). Wound type, stage, patient history, and
risk factors are all considerations when determining appropriate management and treatment.
Patient-centered wound care is imperative in treating wounds, and in one study, results showed
that it leads to more satisfied and educated patients and improved QoL (Gethin et al., 2020).

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Efficacy of Platelet-Rich Plasma
Wound care uses various products depending on the wound's type, stage, and complexity,
some of which are more effective than others. It is common for providers to frequently change
wound products and dressing types depending on the progression or regression of the wounds. It
is crucial to assess the entirety of the patient as patients' bodies may react better to particular
products. For example, allergies and nutritional status may affect the choice of product type and
dressings. Some standard wound products include topical antibiotics, chemical debriding
products, and a variety of skin substitutes (Armstrong & Meyr, 2022; Bowers & Franco, 2020).
Wound products and treatments are ever-changing and require more scientific research to prove
efficacy. In a study comparing PRP gel with standard saline dressings for diabetic foot wounds
(DFU), results showed that the PRP group had a reduction in wound size and shorter wound
healing time (Elsaid et al., 2019). Another study exploring the use of PRP on tendon-exposed
wounds resulted in decreased scores on two scar scales, a lack of erythema and edema, and
improved size and staging of the wounds (Deng et al., 2022). Not only does PRP have a higher
likelihood of treating stubborn ulcers, but it is also easy to collect (Xia et al., 2019). Since wound
care is often trial-and-error, it is essential to retrospectively analyze the efficacy of the PRP data
to determine if PRP should become standard practice for chronic wounds. Not only does the data
prove efficacy, but it also provides evidence to guide clinical practice.
Current Practice
There is a need for more robust, current literature supporting clinical guidelines for
chronic wound care. Ausmed (2023) provides a comprehensive guide to wound care practice,
including wound assessment, dressings for different types of wounds, wound healing, and
cleansing and debridement recommendations with graphics. During an extensive literature

EFFICACY OF PLATELET-RICH PLASMA
review, this was the only current guideline found. Many other sources provide generic
recommendations for wound care that list products, procedures, and dressings as they could
apply to multiple wound types and stages, prolonging the healing process. Chronic wounds
depend on each individual requiring personalized treatments in order to maximize successful
healing (Laurano et al., 2022). Learning more about specific wound products and their efficacy
could aid in developing guideline updates.
Improving Wound Outcomes
The ultimate goal for chronic wound care is to have wounds close and heal promptly.
However, in some instances, wound closure is impossible, so managing symptoms and
preventing regression and complications is essential. With multiple therapies in wound care
providers' practice, it is difficult to determine which are most effective. Laurano et al. (2022)
reviewed the literature to explore several wound products, dressing types, and efficacy as
presented in randomized clinical trials. There is a clear gap between the literature and clinical
practice. The inability to incorporate evidence in clinical practice leads to substandard care and
sacrifices patient safety (Gardner, 2023). The gap is partly due to the need for clinical research
on specific wound products and therapies. Laurano et al. (2022) revealed the gap between
research and commercial wound products. Determining which products are most effective will
increase the amount of evidence-based literature to guide practice and, in turn, improve wound
outcomes. Improving wound outcomes will also reduce healthcare costs and enhance patients'
QoL. While the goal is to discover which products effectively improve wound outcomes, the
benefits are expansive across healthcare.

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Common Themes
A thorough literature review simultaneously exposed chronic wounds' burden on
individuals and the US (Bowers & Franco, 2020; Laurano et al., 2022; Sen, 2019; Sen, 2021;
Vogt, 2020). The lack of literature specifying effective treatments for chronic wounds in
conjunction with minimal clinical guidelines creates dilemmas for wound care providers.
Various comorbidities delay healing and put patients at risk for chronic wound complications
(Joszt, 2021; WoundSource, 2018). Providers must use judgment when creating care plans and
make adjustments as needed with little evidence to support decisions. More literature must study
specific wound products' efficacy to close the gap between literature and clinical practice.
Internal Data
In a mobile wound care organization in the southwestern US, clinic staff has recognized a
need for innovative and effective wound care treatments for chronic wounds. The organization
serves primarily geriatric patients with chronic wounds, and providers perform wound care in
patients' homes, group homes, and skilled nursing facilities (SNFs). Providers are passionate
about giving comprehensive care, teaming up with caregivers, and coordinating interdisciplinary
care. The organization has relationships with vendors who want providers to trial new products,
such as PRP, on chronic wounds to determine the products' efficacy in this unique setting.
Analyzing PRP-specific data will substantiate efficacy and guide practice based on evidence.
The data will influence the organization's decision-making and contribute to the literature other
wound care providers can reference.
PICOT Question
Current literature regarding PRP treatment proves there are many benefits and few risks.
With the organization eager to discover innovative treatments for chronic wounds, it is crucial to

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determine the efficacy of PRP among their patient population. Per current research and the
organization’s demands, the following PICOT question is presented: In patients with chronic
wounds (P), how does platelet-rich plasma therapy (I), compared to current wound therapy (C),
affect wound healing (O) within six weeks of implementation (T)?
Search Strategy
Three databases produced current literature regarding the PICOT question, which
included Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane
Review, and PubMed. The three databases are reputable because they provide credible, peerreviewed articles related to nursing and healthcare. The database searches included similar
keywords and phrases, and abstracts confirmed which studies were most applicable and relevant.
Database searches used various keyword combinations related to the PICOT question.
For the population, terms such as chronic wounds, non-healing wounds, pressure ulcers,
pressure wounds, and diabetic wounds produced substantial results. Keywords for the
intervention included platelet-rich plasma, PRP, protein-rich plasma, protein-rich plasma
wound care, and protein-rich plasma uses. Standard wound care and advanced wound care
generated comparisons to the intervention. The search for outcomes narrowed when keywords
included efficacy, benefits, wound outcomes, wound healing, and wound closure. Boolean
expressions made database searches more efficient. Each database used different keyword
combinations and produced numerous search results.
Initial and Final Search Yields
All three databases produced varying search yields. The initial CINAHL search yielded
255 articles using the following keywords: wounds, chronic wounds, pressure ulcers, pressure
wounds, PRP, plasma-rich protein, efficacy, benefits, and outcomes. The search presented 47

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articles after adding non-healing wounds and effectiveness. The Cochrane Review search used
combinations of the previous keywords. However, adding wound treatments, wound
management, chronic wound patients, complex wounds, wound healing, and wound closure
yielded 2,549 articles; this search did not include terms related to the intervention. The search
was narrowed to 283 articles when the keywords were broader, and the intervention terms were
applied. The PubMed search process was similar to the other two databases and initially yielded
615 articles, and the final search produced 145 articles.
Limitations, Inclusion, and Exclusion Criteria
After the final search yields produced hundreds of articles, inclusion and exclusion
criteria were applied. Search filters included academic and peer-reviewed journals printed in
English and published between 2018 and 2023. Abstracts determined applicability to the PICOT
question. A total of 20 articles underwent rapid critical appraisal, and ten studies underwent
thorough evaluation. Studies with small sample sizes were excluded. The ten studies include four
meta-analyses and systematic reviews, three randomized controlled trials (RCT), one quantitative
preliminary study, one quantitative cross-sectional study, and one case-control study (Appendix
A). Searching the gray literature provided generalized information about chronic wounds,
staging, standard wound care, and related cost disparities. An ancestral search was not
performed.
Critical Appraisal and Synthesis of Evidence
All research studies were evaluated using rapid critical appraisal to determine validity
and reliability and, eventually, their application to practice (Melnyk & Fineout-Overholt, 2019).
A total of 10 quantitative studies underwent a more thorough evaluation (see Appendix A, Table
A1). With the information collected in the evaluation table, a synthesis table summarizes all the

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studies' main data points (see Appendix A, Table A2). The studies used had high levels of
evidence, as the majority were meta-analyses, systematic reviews, and RCTs. The mean age of
participants in seven studies was 57 years, and three studies did not specify the mean age of
participants. The chronic wounds studied primarily included diabetic wounds, venous ulcers,
pressure ulcers, or burns.
The intervention for all but one study was PRP through gel, dressings, or injections. Vogt
et al. (2020) analyzed sociodemographics against the QoL in patients with chronic wounds rather
than investigating the efficacy of PRP on wounds like the other studies. The outcomes and
common themes among all the studies were compelling. In six studies, the wound sizes and
healing times significantly decreased with the use of PRP. Four studies found evidence that PRP
influenced the complete healing of chronic wounds. In addition to PRP efficacy, study results
found that PRP had minimal side effects, was safe, and cost-effective. Overall, PRP presents a
low risk to patients and promotes healing for complex and persistent wounds of various types.
Theory/Theoretical Framework Application
No two wounds are the same, often requiring a trial-and-error process to determine what
works best for each wound. The TIME framework is specific to wounds and provides a holistic
approach to assessing and managing chronic wounds (Leaper et al., 2012). The framework helps
to better understand the elements that influence wound healing. TIME is widely used in wound
care because it provides guidance for preparing the wound bed, improving the efficacy of
products and dressings, and enhancing outcomes. TIME stands for tissue assessment and
debridement, infection/inflammation, moisture imbalance, and the edge of the wound (Leaper et
al., 2012). While the four concepts of TIME focus on ideal wound bed preparation, it is just one
piece of the framework (see Appendix B, Figure B1). The TIME components each influence the

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wound as a whole; if one is missing, the wound can become compromised. The TIME
framework emphasizes the importance of patients’ environments and systemic issues like
comorbidities, which can also influence wound bed status. When preparing the wound bed, it is
imperative to consider product costs, influences on QoL, and the surrounding skin (Leaper et al.,
2012). The TIME framework provides a substantial foundation for using PRP on chronic wounds
since it proposes a thorough analysis of the entire patient while cultivating an optimal wound bed
prior to PRP application, further stimulating proper wound healing.
Implementation Framework
The Model for Improvement: Plan-Do-Study-Act (PDSA) is a quality improvement
model that provides a cycle to determine a need for change and a blueprint for implementing and
assessing interventions (see Appendix B, Figure B2) (IHI, n.d.-a). The model has a cyclical
approach that encourages constant evaluation and reassessment. Before developing a plan,
establishing goals, measures, and desired outcomes is paramount (IHI, n.d.-a). The plan consists
of clearly stating the goals and determining details related to change execution, who will be
involved, and specific data points for outcome measurement. Next, implementation of the plan
occurs, and data is collected. After implementation, the data is studied and analyzed. In order to
act on the change in a more permanent fashion, it is imperative to make necessary modifications
to improve processes with hopes of eventually advancing standard practice. Finally, plans for
modifications reinitiate the PDSA cycle. The PDSA model is consistent with the execution of the
doctoral project as the project regarding PRP application on chronic wounds is planned,
performed, studied, and acted on in a scaffolding fashion throughout the program’s remaining
semesters.

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Implications for Practice Change
Evidence has proven that using PRP on chronic wounds has countless benefits with little
to no adverse effects. However, the PRP efficacy data still requires more development, hindering
its widespread use. Collecting extensive data points on PRP use and efficacy can influence
eventual evidence-based practice changes. A local mobile wound-care organization desires to be
innovative and lead the path for change in wound care by implementing and studying the effects
of PRP on chronic wounds of various etiologies. After a thorough literature review, PRP use on
chronic wounds is primarily used in inpatient and outpatient clinic environments; it has yet to be
studied in the mobile setting. Collecting various data points in the mobile setting can present
groundbreaking data and results.
The compelling evidence discovered, and the organization's aspirations for innovation
have created an opportunity to fill a gap in the literature while improving outcomes for patients
with chronic wounds. The stakeholders primarily consist of the nurse practitioners (NPs)
applying the PRP when performing wound care. As the NPs chart the wounds, specific data
points must be collected for analysis. Data points should include past medical history, wound
etiology, time wounds have been open, meticulous measuring, adverse events, and healing time.
After data is collected, an analysis will determine PRP efficacy on chronic wounds in the mobile
setting. The ultimate goal is to improve wound size and healing time while minimizing adverse
events and wound care costs.
Methods
Ethical Considerations
Protecting human subjects throughout the duration of the project was top priority. Prior to
beginning the project, the Institutional Review Board at Arizona State University approved the

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protocol under an expedited review. Both a written informed consent and HIPAA Authorization
Form were signed by all participants.
Population and Setting
Participants were required to be over the age of 18, speak English, have stage III or IV
wounds, and receive PRP treatment for their chronic wounds. Participants were excluded from
the project if they did not read or speak English, were unable to make medical decisions
independently, were unable or unwilling to properly cover dressings while showering or bathing,
have an acute osteomyelitis diagnosis, or were currently undergoing wound treatment with skin
substitutes. The site champion and NP used clinical judgement to determine which patients were
eligible to receive treatment with PRP, while the doctor of nursing practice (DNP) student
managed recruitment and screening for potential participants. Since the project site was a mobile
clinic, all project visits were performed in patients’ residences.
Intervention and Timeline
The project intervention took place during participants regularly scheduled wound care
visits. All participants received PRP treatments for a minimum of six weeks unless the NP made
the clinical decision to end treatment. At day one of the PRP treatment, the Bates-Jensen Wound
Assessment Tool (BWAT) was completed by the DNP student after the wound was cleansed by
the NP per the clinic’s protocol (See Appendix C). The NP continued to treat the wounds with
PRP for the following six weeks. The DNP student attended visits at day one, week three, and
week six to collect the BWAT. Not all participants began simultaneously; however, all
participants were enrolled for six weeks of treatment on individual timelines.

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Data Collection
A substantial amount of data was collected throughout the project’s implementation.
After participants signed consent, a brief chart review was completed by the DNP student with
assistance from the NP. The NP reviewed electronic medical records (EMRs) and shared
demographic information with the DNP student, along with additional information about past
medical history and wound history (See Appendix D). During the visits at day one, week three,
and week six, the BWAT was be completed by the DNP student. The BWAT consists of 13
items related to wound characteristics. The total score was placed on the Wound Status
Continuum included in the BWAT, which indicates tissue health, wound regeneration, and
wound degeneration. Trending the Wound Status Continuum scores between day one, week
three, and week six provided vast information about the effects of PRP on chronic wounds.
Data Analysis
Demographic data collected on the Chart Audit Form was analyzed with descriptive
statistics using Intellectus Statistics (2023). Descriptive statistics were used to describe the
sample and to examine clinical significance of PRP on wound status from BWAT scores at day
one, week three, and week six between three wound types (traumatic wound, diabetic wound,
and pressure ulcer). One participant did not complete the week six visit, therefore only day one
and week three data were used. Two participants completed all three visits.
Budget
All PRP kits and equipment were gifted to the project site by the PRP vendor free of
charge. Standard wound supplies that were applied on top of the PRP dressing were the project
site’s responsibility. The budget plan lists costs for preparation, implementation, and evaluation

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of the project and its data (See Appendix E). No grants or scholarships were awarded for the
project implementation.
Results
Population
Intellectus Statistics (2023) was used to store, analyze, and manage data. Demographic
data of the population was collected (see Appendix F, Table F1). The population consisted of
three patients (n = 3) that were established with the mobile clinic. Most participants were female
(n = 2, 67%) and the remaining participant was male (n = 1, 33%). All subjects were White, nonHispanic. Two subjects were former smokers (n = 2, 67%) and one subject was a lifetime nonsmoker (n = 1, 33%). One subject was currently undergoing UltraMIST (a cleansing
procedure) once per week (n = 1, 33%), while the other two participants did not receive
UltraMIST (n = 2, 67%). All participants had a history of cardiac disease and received oral or
topical antibiotics prior to initiation of PRP treatment. The average age of the sample was 69 (SD
= 9.54) with a range from 63 to 80 (see Appendix F, Table F2).
Laboratory values of all participants were analyzed using descriptive statistics (see
Appendix F, Table F3). Intent to treat analysis was required for C-reactive protein and
hemoglobin A1c laboratory values for one participant. The average wound stage was 4 (SD =
0.58) with a range from 3 to 4. The average hemoglobin A1c was 6 (SD = 1.30) with a range
from 4.70 to 7.30. The average of prealbumin was 23.37 (SD = 12.09) with the minimum of 9.80
and a maximum of 33. White blood count averaged 8.3 (SD = 1.81) and ranged from 6.4 to 10.
Lastly, C-reactive protein averaged 5.56 (SD = 5.01) and ranged from 0.55 to 10.56.

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BWAT Scores and Wound Types
The Wound Status Continuum was completed using the BWAT scores and were graphed
for each wound type (see Appendix F, Figure 1). The traumatic wound decreased from a score of
24 to 9, indicating complete closure. The diabetic wound scores decreased to 21 from 28, moving
closer on the Wound Status Continuum towards wound regeneration. The pressure ulcer
degenerated as scores increased from 28 to 29.
BWAT Scores and Smoking Status
Two-thirds (67%) of the participants’ wounds improved with PRP treatment. All three
participants completed visits at day one and week three. The non-smoker had the most
significant improvement in BWAT scores between the two visits with a decrease in 3 points.
While the former smokers’ BWAT scores decreased from day one to week three, the
improvement was less significant and only decreased by 1 point.
BWAT Scores and UltraMIST Therapy
UltraMIST System uses low-frequency ultrasound and saline to cleanse wounds and
control inflammation to promote wound healing (Sanuwave, n.d.). One subject was receiving
UltraMIST while being concurrently treated with PRP. BWAT scores increased from 28 at day
one to 29 at week three, indicating wound degeneration. The other two subjects did not receive
UltraMIST and wounds improved, averaging scores of 26 at day one and 23 at week 3.
Sustainability
Continuing treatment with PRP on chronic wounds within the mobile clinic is highly
dependent on equipment availability and NP participation. There were several instances when
PRP kits were difficult to obtain from the vendor. Further, while the literature and data prove
promising results, only two NPs agreed to trial PRP. If the project site is interested in pursuing

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PRP as a treatment option within the mobile clinic, then shipment of PRP kits should be
scheduled regularly. In addition, to obtain more data on effectiveness of PRP, more NPs should
consider using PRP to treat appropriate wounds. Since PRP kits were gifted to the project site,
cost-effectiveness could not be determined. In the future the clinic will be required to purchase
kits, which will determine if the treatment is cost-effective.
Discussion
Traumatic Wound
The traumatic wound was the only wound that completely healed. The subject’s
significant past medical history included hyperlipidemia, hypertension, hyperthyroidism, and
former smoker. Hemoglobin A1c and C-reactive protein were not collected for this participant.
Prealbumin and white blood count levels were within normal limits. This participant did not
receive UltraMIST while undergoing PRP treatments. The BWAT scores decreased by 15
points between day one and week six, indicating the most significant improvement in wound
status compared to the diabetic wound and pressure ulcer.
Diabetic Wound
The participant with the diabetic wound had a past medical history of type 2 diabetes,
hypertension, breast cancer, peripheral neuropathy, and heart palpitations. The participant never
smoked. Hemoglobin A1c, prealbumin, and C-reactive protein levels were all elevated. The
participant did not receive UltraMIST while being treated with PRP. BWAT scores decreased
by 7 points between day one and week six indicating improvement in wound health.
Pressure Ulcer
The subject with the pressure ulcer had a significant history of cardiac disease including
congestive heart failure, hypercholesterolemia, myocardial infarct, previous cardiac arrest,

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peripheral vascular disease, coronary artery bypass surgery, and was a former smoker.
Hemoglobin A1c, white blood count, and prealbumin levels were all within normal limits. Creactive protein level was elevated. The participant was receiving UltraMIST once per week
while being treated with PRP. The participant expired prior to the week six visit. BWAT scores
increased by 1 point between the day 1 visit and the week three visit indicating wound
degeneration.
Overall PRP Efficacy
It is imperative to consider patients holistically when assessing effectiveness of PRP
treatments on chronic wounds. Past medical history and patients’ current health as indicated by
laboratory values have a major impact on treatments, wound status, and potential for wound
improvement. While two of the three participants experienced improvement with PRP
treatments, it is imperative to consider the current health of the participant that experienced
wound degeneration. As evidenced by the data collected in this project, PRP had the most
significant impact on the traumatic wound. The diabetic wound also responded to PRP
treatments; however, it did not completely close like the traumatic wound. The data collected
reflects worsening of pressure ulcer wound status with PRP treatments.
Limitations
Limitations were recognized throughout the implementation phase of the project. First,
implementation was delayed due to the clinic not having a PRP treatment protocol in place. The
NP was required to create a protocol based on the vendor’s instructions, which took
approximately two months. The NP also had difficulty recruiting participants that qualified for
PRP treatments. Only one other NP was willing to administer PRP treatments, which contributed
to a small sample size. Shortly after implementation was initiated, the PRP kits expired and there

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was a delay in shipment of new PRP kits from the vendor. In addition, multiple subjects missed
appointments, which delayed BWAT collections. In some instances, BWATs were not collected
exactly at weeks three and six.
Recommendations
PRP is currently used in in- and out-patient settings for aesthetics, orthopedics, and
wound care; however, it has not been established in the mobile wound care setting. In order for
Centers for Medicare and Medicaid Services (CMS) to create a current procedural technology
(CPT) code for reimbursement purposes, more data needs to be collected. Most importantly, PRP
has potential to improve wound status leading to decreased healthcare costs, and improved
patient outcomes and quality of life. It is recommended that the mobile clinic continue to
perform PRP treatments on various wound types and collect data. In order to continue PRP
services, the clinic can host a training event for all NPs to increase comfortability with the
innovative treatment option. This will allow for more NPs to participate and increase the amount
of data collected. With a vast amount of data, the clinic can prove efficacy of PRP on chronic
wounds in the mobile setting.
Conclusion
Chronic wounds are complex and challenging to treat. PRP offers a new method to
manage and treat wounds, which can change the world of wound care. The literature provides
promising evidence for its efficacy in inpatient and outpatient settings; however, its use in the
mobile setting has not yet been explored. By setting the foundation with the TIME framework
and the Plan-Do-Study-Act model, the project’s data provided promising results. The mobile
clinic can potentially pioneer a new standard treatment for chronic wounds in the mobile setting.
Not only can PRP positively impact patients, but it also can reduce the burden of healthcare costs

EFFICACY OF PLATELET-RICH PLASMA

21

in the US diving deeper into the use and efficacy of PRP on chronic wounds in the mobile setting
has the power to be revolutionary.

EFFICACY OF PLATELET-RICH PLASMA

22

References
Armstrong, D. G., Meyr, A. J. (2022). Basic principles of wound management. UpToDate.
Retrieved February 2, 2023, from https://www.uptodate.com/contents/basic-principlesof-wound-management#H152341897
Ausmed. (2023). Wound care: A guide to practice for healthcare professionals.
https://www.ausmed.com/cpd/guides/wound-care#chapter3
Bowers, S., & Franco, E. (2020). Chronic wounds: Evaluation and management. American
Family Physician, 101(3), 159-166.
https://www.aafp.org/pubs/afp/issues/2020/0201/p159.html
Cho, S. K., Mattke, S., Gordon, H., Sheridan, M., & Ennis, W. (2020). Development of a model
to predict healing of chronic wounds within 12 weeks. Advances in Wound Care, 9(9),
516-524. http://doi.org/10.1089/wound.2019.1091
del Pino-Sedeño, T., Trujillo-Martín, M. M., Andia, I., Aragón-Sánchez, J., Herrera-Ramos, E.,
Iruzubieta Barragán, F. J., & Serrano-Aguilar, P. (2019). Platelet-rich plasma for the
treatment of diabetic foot ulcers: A meta-analysis. Wound Repair and
Regeneration, 27(2), 170–182. https://doi.org/10.1111/wrr.12690
Deng, Z., Long, Z.-S., Gong, F.-P., & Chen, G. (2022). The efficacy and safety of platelet-rich
plasma in the tendon-exposed wounds: A preliminary study. Journal of Orthopaedic
Surgery & Research, 17(1), 1–8. https://doi.org/10.1186/s13018-022-03401-0
Elbarbary, A. H., Hassan, H. A., Elbendak, E. A. (2020). Autologous platelet-rich plasma
injection enhances healing of chronic venous leg ulcer: A prospective randomised
study. International Wound Journal, 17(4), 992–1001. https://doi.org/10.1111/iwj.13361

EFFICACY OF PLATELET-RICH PLASMA

23

Elsaid, A., El-Said, M., Emile, S., Youssef, M., Khafagy, W., & Elshobaky, A. (2020).
Randomized controlled trial on autologous platelet-rich plasma versus saline dressing in
treatment of non-healing diabetic foot ulcers. World Journal of Surgery, 44(4), 1294–
1301. https://doi.org/10.1007/s00268-019-05316-0
Eriksson, E., Liu, P. Y., Schultz, G. S., Martins-Green, M. M., Tanaka, R., Weir, D., Gould, L.
J., Armstrong, D. G., Gibbons, G. W., Wolcott, R., Olutoye, O. O., Kirsner, R. S., &
Gurtner, G. C. (2022). Chronic wounds: Treatment consensus. Wound Repair and
Regeneration, 30(2), 156-171. https://doi.org/10.1111/wrr.12994
Evans, K., Kim, P. J. (2022). Overview of treatment of chronic wounds. UpToDate. Retrieved
February 2, 2023, from https://www.uptodate.com/contents/overview-of-treatment-ofchronic-wounds?topicRef=15912&source=see_link#H45052022
Gardner, S. (2023). The theory-practice gap in wound care: Effective ways of embedding your
learning into clinical practice. Wound Care Today. https://www.woundcaretoday.com/journals/issue/wound-care-today/article/theory-practice-gap-wound-care
Gethin, G., Probst, S., Stryja, J., Christiansen, N., & Price, P. (2020). Evidence for personcentred care in chronic wound care: A systematic review and recommendations for
practice. Journal of Wound Care, 29(Sup9b), S1–S22.
https://doi.org/10.12968/jowc.2020.29.Sup9b.S1
Institute for Healthcare Improvement. (n.d.-a) How to improve.
https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChan
ges.aspx
Institute for Healthcare Improvement. (n.d.-b) The IHI triple aim initiative.
https://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

EFFICACY OF PLATELET-RICH PLASMA

24

Intellectus Statistics [Online computer software]. (2023). Intellectus Statistics.
https://statistics.intellectus360.com
Joszt, L. (2021). Comparing costs of wound therapy in the post-acute setting. American Journal
of Managed Care. https://www.ajmc.com/view/comparing-costs-of-wound-therapy-inthe-post-acute-setting
Kao, Y. C., Lin, D. Z., Lee, S. L., Chen, C., Wang, H. J., & Chiu, W. K. (2021). Assisted therapy
with platelet-rich plasma for burn patients: A meta-analysis and systematic
review. Burns, 47(5), 1012–1023. https://doi.org/10.1016/j.burns.2020.11.005
Laurano, R., Boffito, M., Ciardelli, G., & Chiono, V. (2022). Wound dressing products: A
translational investigation from the bench to the market. Engineered Regeneration, 3(2),
182-200. https://doi.org/10.1016/j.engreg.2022.04.002
Leaper, D. J., Schultz, G., Carville, K., Fletcher, J., Swanson, T., & Drake, R. (2012). Extending
the TIME concept: What have we learned in the past 10 years? International Wound
Journal, 9(2), 1–19. https://doi.org/10.1111/j.1742-481X.2012.01097.x
Mahmoudi M., & Gould, L. J. (2020). Opportunities and challenges of the management of
chronic wounds: A multidisciplinary viewpoint. Chronic Wound Care Management and
Research, 2020(7), 27-36.
https://doi.org/10.2147/CWCMR.S260136
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and
healthcare: A guide to best practice (4th ed.). Lippincott, Williams & Wilkins.
Monaco, D., Iovino, P., Lommi, M., Marano, G., Zaghini, F., Vellone, E., Alvaro, R., & Sili, A.
(2021). Outcomes of wound care nurses' practice in patients with pressure ulcers: An

EFFICACY OF PLATELET-RICH PLASMA

25

integrative review. Journal of Clinical Nursing, 30(3-4), 372–384.
https://doi.org/10.1111/jocn.15583
Olsson, M., Järbrink, K., Divakar, U., Bajpai, R., Upton, Z., Schmidtchen, A., & Car, J. (2019).
The humanistic and economic burden of chronic wounds: A systematic review. Wound
Repair and Regeneration, 27(1), 114–125. https://doi.org/10.1111/wrr.12683
Qu, W., Wang, Z., Hunt, C., Morrow, A. S., Urtecho, M., Amin, M., Shah, S., Hasan, B., AbdRabu, R., Ashmore, Z., Kubrova, E., Prokop, L. J., & Murad, M. H. (2021). The
effectiveness and safety of platelet-rich plasma for chronic wounds: A systematic review
and meta-analysis. Mayo Clinic Proceedings, 96(9), 2407–2417.
https://doi.org/10.1016/j.mayocp.2021.01.030
Samadi, P., Sheykhhasan, M., & Khoshinani, H. M. (2019). The use of platelet-rich plasma in
aesthetic and regenerative medicine: A comprehensive review. Aesthetic Plastic
Surgery, 43(3), 803–814. https://doi.org/10.1007/s00266-018-1293-9
Sanuwave. (n.d.). UltraMIST System. https://sanuwave.com/products/ultramist/
Sen, C. K. (2019). Human wounds and its burden: An updated compendium of
estimates. Advances in Wound Care, 8(2), 39–48.
https://doi.org/10.1089/wound.2019.0946
Sen, C. K. (2021). Human wound and its burden: Updated 2020 compendium of
estimates. Advances in Wound Care, 10(5), 281–292.
https://doi.org/10.1089/wound.2021.0026
Tian, J., Cheng, L.-H.-H., Cui, X., Lei, X.-X., Tang, J.-B., & Cheng, B. (2019). Application of
standardized platelet-rich plasma in elderly patients with complex wounds. Wound
Repair and Regeneration, 27(3), 268-276. https://doi.org/10.1111/wrr.12702

EFFICACY OF PLATELET-RICH PLASMA

26

Uçar, Ö., & Çelik, S. (2020). Comparison of platelet-rich plasma gel in the care of the pressure
ulcers with the dressing with serum physiology in terms of healing process and dressing
costs. International Wound Journal, 17(3), 831–841. https://doi.org/10.1111/iwj.13344
Vogt, T. N., Koller, F. J., Santos, P. N. D., Lenhani, B. E., Guimarães, P. R. B., & Kalinke, L. P.
(2020). Quality of life assessment in chronic wound patients using the Wound-QoL and
FLQA-Wk instruments. Investigacion Y Educacion En Enfermeria, 38(3).
https://doi.org/10.17533/udea.iee.v38n3e11
Wernick, B., Nahirniak, P., & Stawicki, S. P. (2022). Impaired wound healing.
In StatPearls. StatPearls Publishing. Retrieved February 2, 2022
from https://www.ncbi.nlm.nih.gov/books/NBK482254/?report=printable
WoundSource. (2018). Complications in chronic wound healing and associated interventions.
https://www.woundsource.com/blog/complications-in-chronic-wound-healing-andassociated-interventions
Xia, Y., Zhao, J., Xie, J., Lv, Y., & Cao, D. S. (2019). The efficacy of platelet-rich plasma
dressing for chronic non-healing ulcers: A meta-analysis of 15 randomized controlled
trials. Plastic and Reconstructive Surgery, 144(6), 1463–1474.
https://doi.org/10.1097/PRS.0000000000006281

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Appendix A
Evaluation and Synthesis Tables

Table A1
Evaluation Table for Quantitative Studies
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

Author/Year:
Elsaid, et al.,
2019
Randomized
controlled trial
on autologous
platelet-rich
plasma versus
saline dressing
in treatment of
non-healing
diabetic foot
ulcers
Country:
Egypt

Inferred
Physiologic
Model

Design:
Prospective RCT
open-label

N= 24

IV1: PRP gel

Demographics:
CG: n = 12, 6 M, 6 F
IG: n = 12, 8 M, 6 F
Mean age: 55.2
Mean HbA1c%: 7.9
Mean duration of
ulcer: 5.4 months

DV1: Percent size
reduction of DFU

Tools:
No tools were
stated for wound
measuring

Statistical Tests
Used:
Independent
sample t test,
paired sample t
test, χ2

Setting:
Outpatient clinic of
the General Surgery
Department of
Mansoura University
Hospital

Definitions:
Chronicity- non-healing
ulcer for 12 or more
weeks

DV1: PRP
group/control
group
longitudinal:
43.2%/4.1%,
P = 0.001
PRP
group/control
group
horizontal:
42.3%/8.2%,
P = 0.009

Funding:
None
Bias:

Purpose:
To assess the role
of PRP in gel
form as a
treatment of clean
non-healing DFU
in comparison
with regular
dressing with
saline as a control

Exclusion:
Chronic limb
ischemia;
osteomyelitis;
exposed tendons,

DV2: Healing of DFU
DV3: Time to maximal
wound healing

Validity/
Reliability: Not
applicable

DV2: PRP
group: 25%
complete
healing
Control
group: 0%
complete
healing

Level of
Evidence;
Application to
practice;
Generalization
Level of
Evidence: II
Strengths: RCT,
no
complications,
no attrition,
adequate sample
size, low cost
Weakness:
Open-label, not
compared to
other standard
wound therapies,
no specified
tools for
measuring
wounds, wound
measuring
methods are
unknown

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Open-label
study;
investigators
were aware of
the treatment

28
Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

DV3: PRP
group: 6.3
weeks
Control
group: 10.4
weeks

ligaments, or bones;
radio- or
chemotherapy within
3 months of study
start-up; low
platelets, serum
albumin, or
hemoglobin

Application:
Applicable for
chronic nonhealing DFU

Attrition:
0 lost to follow-up
Author/Year:
Deng, et al.,
2022
The efficacy
and safety of
platelet-rich
plasma in the
tendon-exposed
wounds: A
preliminary
study
Country:
China
Funding:
None
Bias:

Inferred
Physiologic
Model

Design:
Quantitative
preliminary study

Purpose:
To preliminarily
evaluate the
therapeutic
potentials of PRP
in such refractory
wounds with
exposed tendons,
as well as
corresponding
efficacy and
safety, so as to

N= 12

IV1: PRP application

Demographics:
5 males, 7 females
Mean age: 42.7
Wound Types:
Traffic accidents (3),
contusion (2), burns
(2), diabetes
complications (4),
melanoma
complications (1)

DV1: VAS scores

Setting:
Admissions to
Jiangxi Provincial
People’s Hospital,
The First Affiliated

Level of
Evidence;
Application to
practice;
Generalization
Feasibility:
Recommended
for use in
practice for DFU
as PRP gel is
effective and has
low cost

DV2: VSS scores
DV3: MSS scores

Definitions: PRPtherapeutic biological
product extracted from
the venous blood of the
body, which contains
high concentrations of
platelets
Refractory woundsrefer to conditions that

Tools:
VAS, VSS, MSS
Validity/
Reliability:
VAS: highly
reliable for
assessing pain
VSS: poor
interobserver
reliability, fair
intraobserver
reliability
MSS: good
reliability even
among different
observers
No numbers
reported

Statistical Tests
Used: Normality
tests, mean &
standard deviation
analyzed with
paired t test

DV1: Mean
VAS pre- was
6.9 & postwas 3.5
DV2: Mean
VSS pre- was
7.4 & postwas 3.6
DV3: Mean
MSS pre- was
12.3 & postwas 5.4

Level of
Evidence: III
Strengths: PRP
is easy to obtain,
curative effects
of vascular
regeneration are
reliable, PRP is
less technically
demanding,
provides more
treatment
options, less
invasive than
skin flap, no
adverse effects

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

None identified

Theoretical/
Conceptual
Framework

29

Design/ Method/
Purpose

Sample/Setting

Variables

provide a
reference for
broader clinical
applications in the
future

Hospital of
Nanchang Medical
Center

ulcers that are still
difficult to improve,
secretion is not
reduced, and
granulation tissue is not
formed after dressing
changes and
applications of different
therapies

Exclusion:
Severe lesions of
large blood vessels
with obvious
ischemia on Doppler
ultrasound, wound
too large with
exposed bone and/or
blood vessels and
other wounds
requiring skin flaps,
severe organ
dysfunction,
malignant tumors;
glucocorticoids,
immunosuppressive
agents,
chemotherapy
Attrition:
0 lost to follow-up

Measurement/
Instrumentation

Data Analysis

Results/
Findings

Level of
Evidence;
Application to
practice;
Generalization
Weakness:
Optimal
concentration of
PRP is unknown,
composition of
PRP differs
between patients,
mechanisms of
action are
unknown, small
sample size,
minimal report
of reliability and
validity of tools
used
Feasibility:
Recommended
for use due to
low cost, no
complications,
less invasive
Application:
Applicable for a
variety of
wounds with
exposed tendon

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN

30

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

Author/Year:
Xia et al., 2019
The efficacy of
platelet-rich
plasma dressing
for chronic nonhealing ulcers:
A meta-analysis
of 15
randomized
controlled trials

Inferred
Physiologic
Model

Design: Metaanalysis

N= 15 randomized
trials including 630
adult patients

IV: PRP on nonhealing ulcers

Tools:
Cochrane
Collaboration’s 6Item Tool for
assessing risk of
bias
Review Manager
Software
Validity/
Reliability: High
reliability,
recommended
tool for Cochrane
Reviews

Statistical Tests
Used: Chi-squared
and I2, subgroup
analyses

DV1: More
healed
diabetic ulcers
in PRP group
compared to
control group,
p = 0.0003, no
significant
differences in
venous ulcers

Country: Not
specified
Funding: No
funding
Bias: No bias
stated,
publication bias
was not
significant after
evaluation

Purpose: To
summarize the
current evidence
to evaluate
whether superior
outcomes can be
obtained by using
platelet-rich
plasma in nonhealing ulcers
compared with
traditional wound
care

Demographics: 252
women, 378 men,
average age 61.25, 6
articles with diabetic
ulcers, 5 articles with
venous ulcers, 4
articles for various
refractory ulcers
Setting: No setting
specified
Exclusion: No
original or
incomplete data,
duplicate
publications,
postoperative
wounds, review
articles, letters to
editors, editorials,
conference abstracts,
preclinical studies,
acute wounds

CG: Traditional wound
care
DV1: Chronic ulcers
completely healed
DV2: Number of ulcers
healed in weeks 4, 8, &
12
DV3: Percentage of
wound area healed
DV4: Healing rate per
day
Definitions:
Chronic/non-healing
ulcers- traumatic or
spontaneous lesions
that cannot heal within
reasonable amount of
time, mostly on
extremities
PRP- blood products
obtained after autologous
whole blood concentration
and separation, contains
platelet concentrations 4-

95% confidence
rate for Review
Manager Software

DV2: Week 4
the # of
healed ulcers
in PRP group
was greater
than control
group, p =
0.0002,
difference
between the 2
groups was
37.74%;
Week 8 # of
ulcers in PRP
group was
greater than
control, p =
0.02, 23.8%
difference; no

Level of
Evidence;
Application to
practice;
Generalization
Level of
Evidence: I

Strengths:
Large population
size, wide
variety of ulcer
types, PRP is
safe and
effective in
utilizing growth
factors, all
studies were
RCT, robust data
points

Weakness:
Unknown
whether patients
and assessors
were blinded;
differing
variations like
follow-up
duration,
controls, ulcer
duration time,

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

31
Sample/Setting

Variables

Attrition: Not
applicable

5x higher than whole
blood

Measurement/
Instrumentation

Data Analysis

Results/
Findings

significant
difference at
12 weeks
DV3: PRP
had higher
percentage of
healed ulcers,
p = 0.02
DV4: Square
of healing
area per day
in PRP group
was higher p
< 0.00001
PRP favored
diabetic ulcers

Author/Year:
Vogt et al.,
2020
Quality of life
assessment in
chronic wound
patients using
the WoundQoL and
FLQA-Wk
instruments

Inferred
HealthRelated
Quality of Life
Model

Design:
Quantitative
study with crosssectional design

Purpose: To
assess changes in
the QoL of

N= 100
Demographics:
Mean age 60.98, 51
male, 53 married, 75
retired, 65 had one
wound, 92 patients
with lower extremity
wounds, 83 were
treated for more than
24 months

IV1: Sociodemographic
(age, sex, education)
DV1: QoL
DV2: FLQA-Wk
Definitions: QoL- an
individual’s perception
of their position in life
in the context of the
culture and value

Tools:
Researcherdeveloped
collection for
sociodemographic
and clinical
characteristics;
QoL instrument;
FLQA-Wk
instrument

Statistical Tests
Used: Descriptive
statistics for
sociodemographic,
descriptive
measures for QoL
& FLQA-Wk, ttest, Mann
Whitney,

DV1: QoL
value of 37.50
(low QoL)
DV2: FLQAWk value of
44.20 (below
average)
Spearman’s
correlation

Level of
Evidence;
Application to
practice;
Generalization
ulcer location,
and ulcer
measurements;
variation in PRP
preparation; no
standard interval
between
applications
Feasibility: PRP
is safe, easy to
prepare, and has
beneficial effects
Application:
More effective
for diabetic
ulcers compared
to venous ulcers
Level of
Evidence: III
Strengths: Valid
and reliable
tools,
questionnaires
easy to
administer,
simple statistics,
has implications

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Country:
Brazil
Funding: None
stated
Bias: None
identified,
possible bias if
assisting
participant with
answering
questionnaire

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

patients with
chronic wounds
and compare the
average values of
the domains of
the Wound-QoL
and FLQA-Wk
with
sociodemographic
variables

32
Sample/Setting

Setting: 2 outpatient
clinics
Exclusion: altered
cognitive and mental
state, no means of
communication to
answer questions,
neoplastic chronic
wounds
Attrition: None
noted

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

systems in which they
live and in relation to
their goals,
expectations, standards,
and concerns

Validity/
Reliability:
Validity/reliability
of researcherdeveloped tool is
unknown, no
evidence
mentioned
QoL and FLQAWk had
Cronbach’s Alpha
of 0.84 & 0.85
confirming
reliable internal
consistency

ANOVA,
Spearman test

coefficient
0.308
indicates
higher the
age, the lower
the score

Level of
Evidence;
Application to
practice;
Generalization
for providers
with wound care
patients
Weakness:
Difficult to
determine if
lower QoL and
higher age is
related to general
health and
treatment;
unknown
qualifications of
professionals
assisting with
questionnaires
for those who
need help
Feasibility:
Indicates
holistic, patientcentered care for
wound patients
Application:
Multidisciplinary
teams help the
patient as a
whole to

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN

33

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

Level of
Evidence;
Application to
practice;
Generalization
streamline care,
improve wounds,
and improve
QoL

Author/Year:
Qu et al., 2021
The
effectiveness
and safety of
platelet-rich
plasma for
chronic
wounds: A
systematic
review and
meta-analysis

Inferred
Physiological
Model

Design:
Systematic
review and metaanalysis

N= 25 studies, 1592
patients

IV: PRP

Tools: Cochrane
Collaboration’s
Risk of Bias 2,
Newcastle Ottawa
Scale

Statistical Tests
Used: Calculated
relative risk,
weighted mean
difference,
DerSimonianLaird random
effect model with
Hartung-KnappSidik-Jonkman
variance
correction, fixed
effect,
heterogeneity,
funnel plots and
Egger’s
regression, twotailed P values

DV1:
Moderate
strength of
evidence of
diabetic
ulcers;
insufficient
evidence for
venous

Level of
Evidence: I

Country:
United States
Funding:
Agency for
Healthcare
Research and
Quality, US
Department of
Health and
Human
Services

Purpose: To
evaluate
effectiveness and
adverse events of
autologous PRP
in individuals
with lower
extremity diabetic
ulcers, lower
extremity venous
ulcers, and
pressure ulcers

Demographics:
5 studies from
Africa, 9 from Asian,
9 from Europe, 2
from US; Diabetic
ulcers- 13 RCT, 1
observational
Venous ulcers- 6
RCT, 3 observational
Pressure ulcers- 1
RCT, 1 observational
Setting: Not
specified
Exclusion:
Traumatic wounds,
peripheral artery
disease, acute
wounds, PRP after
skin grafting, in vitro
studies, single-arm

CG: Other wound care
excluding PRP
DV1: Complete wound
closure
DV2: Time to wound
closure
DV3: Wound area
DV4: Wound depth
reduction

Definitions:
Autologous PRP is the
fraction of blood
plasma from peripheral
blood that contains
higher than baseline
concentrations of
platelets with cytokines
and growth factors

Validity/
Reliability:
High reliability,
recommended
tool for Cochrane
Reviews for RCTs

DV2: Shorter
time with low
strength of
evidence for
diabetic
DV3: More
wound area
with low
strength of
evidence for
diabetic;
insufficient
evidence for
venous

Strengths:
Statistically
complex
yielding valuable
data, large
population size,
high level of
evidence, many
checks and
balances, variety
of wound types
Weakness:
Statistically
complex,
insufficient
evidence for
many outcomes,
sample size
possibly too
large

Feasibility:
Evidence does
Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Bias: Included
studies have
moderate to
high risk of bias

34
Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

observational
studies, case studies,
non-English studies

DV4: Wound
depth
reduction with
low strength
of evidence
for diabetic

Attrition: None

Author/Year:
Elbarbary et al.,
2020
Autologous
PRP plasma
injection
enhances
healing of
chronic venous
leg ulcer: A
prospective
randomized
study
Country:
Egypt
Funding: Not
stated

Inferred
Physiological
Model

Design:
Prospective
randomized study
Purpose: To
evaluate efficacy
of PRP
application versus
PRP injection for
treatment of
chronic venous
leg ulcers

N= 90

IV1: PRP application

Demographics:
CG: n = 30, 24
males,
IG1: n = 30, 26
males,
IG2: n = 30, 22
males
Mean age:
CG: 41.8 years
IG1: 45.4 years
IG2: 43.4 years

IV2: PRP injection

Setting: outpatient
clinic & vascular
surgery department

Results/
Findings

DV1: Ulcer reduction
DV2: Ulcer complete
healing rate
DV3: Ulcer recurrence
DV4: Safety

Definitions: None
specified

Tools: Ulcer
tracking technique
Validity/
Reliability: High
reliability since
ulcer
measurement was
standardized for
each ulcer by
delineating wound
edge and
measuring with 1
cm2 squares for
accuracy and
consistency

Statistical Tests
Used: Data
analyzed using
version 26 of IBM
SPSS, parametric
for mean and
standard
deviation,
nonparametric for
median and range,
ANOVA for
differences among
groups, ShapiroWilks test to
verify distribution
normality, P <.05

DV1:
CG: 52% at 3
months, 69%
at 6 months,
78.6% at 12
months
IG1: 65% at 3
months, 92%
at 6 months,
92.7% at 12
months
P = .015 (3
months), .001
(6 months),
<.001 (12
months)

Level of
Evidence;
Application to
practice;
Generalization
not prove
efficacy of PRP
on chronic
wounds
Application: No
significant
adverse events,
however, little
benefit for use of
PRP on most
chronic wounds
Level of
Evidence: II
Strengths: All
groups with
same population
size, consistency
in wound
measurement,
same types of
ulcers for entire
study,
consistency is
PRP collection
methods and
dressing types,
the person
measuring

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Bias: No biases
identified

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

35
Sample/Setting

Exclusion:
renal/hepatic/cardiac
failure, uncontrolled
diabetes,
malignancy,
connective tissue
disorder, pregnancy,
lactation, active
infection, bone or
tendon exposure,
antiplatelets/steroids
or
immunosuppressives,
inability to give
consent
Attrition: None

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

indicated
significance

DV2: CG:
46.7%
IG1: 66.7%
IG2: 80%
P = .007
DV3: 7.8% of
total ulcers
completely
closed, no
significant
difference
between
groups, P =
.326
DV4:
CG: cellulitis
7.6%
IG1: 1/30
superficial
minute ulcer
IG2: cellulitis
7.6%,
superficial
minute ulcer
1/30

Level of
Evidence;
Application to
practice;
Generalization
wounds was
blinded to
groups
Weakness: Most
recurrences due
to noncompliance with
compression
therapy
Feasibility: PRP
injection is most
effective in
healing chronic
venous ulcers,
PRP application
is more effective
than
compression
therapy alone
Application:
PRP injection
and application
to be used on
chronic venous
ulcers

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN

36

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

Author/Year:
Kao et al., 2021
Assisten
therapy with
platelet-rich
plasma for burn
patients: A
meta-analysis
and systematic
review

Inferred
Physiological
Model

Design: Metaanalysis and
systematic review

N= 8 studies, 449
patients

IV1: PRP application

Tools:
Cochrane Risk of
Bias tool

Statistical Tests
Used: Review
Manager for
statistical analysis,
odds ratios & 95%
confidence
intervals for
categorical
variables, I2 for
heterogeneity, p
<0.05 for
statistical
significance

DV1: PRP
had
significantly
shorter time
[95% CI: 4.87, -2.04],
I2: 0%, p
<0.00001

Country:
Taiwan
Funding: Not
specified
Bias: Included
studies have
varying degrees
of bias

Purpose:
Evaluate the
safety and
efficacy of PRP
treatment on burn
wounds

Demographics:
6 RCTs, 2
retrospective studies
Mean follow-up: 34 months
Wound degree: 2nd
degree wound (3),
deep 2nd and 3rd
degree wound (2),
chemical ocular (2),
unspecified degree
(1)
Setting: Not
specified
Exclusion: Not
English or Chinese
language, nonhuman
participants, no focus
on wound healing,
case reports & case
series
Attrition: None

DV1: Time to complete
epithelialization
DV2: Wound closure
rates at 2 & 3 weeks

Newcastle-Ottawa
Scale

DV3: Post-operative
infection rates

Validity/
Reliability:
Reliable, used to
assess bias in
RCTs, uses 6
domains to assess
bias

DV4: Graft take rate
Definitions: None
specified

Reliable for
determining
methodological
quality using a
rating system,
appropriate for
RCTs

DV2: PRP
had
significant
difference
compared to
control groups
at 2 weeks
[95% CI:
7.08, 18.49],
I2: 0%, p
<0.0001 and 3
weeks [95%
CI: 5.97,
19.34], I2:
55%, p =
0.0002
DV3: No
significant
difference, p
= 0.09

Level of
Evidence;
Application to
practice;
Generalization
Level of
Evidence: I
Strengths: Only
high quality
studies were
included after
analysis by 2
independent
reviewers,
reliable tools
used for
inclusion
Weakness:
Varying biases
depending on the
included studies,
small sample
size, varying
wound types,
variation in PRP
collection,
variation in
wound
measurement
Feasibility: PRP
application
provides benefits
to burn wounds

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

37
Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

DV4: No
significant
difference, p
= 0.27

Level of
Evidence;
Application to
practice;
Generalization
of different
stages with low
risk
Application:
PRP application
on burn wounds

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Author/Year:
del PinoSedeño et al.,
2019
Platelet-rich
plasma for the
treatment of
diabetic foot
ulcers: A metaanalysis
Country: Spain
Funding: Not
specified
Bias: Included
studies have
varying degrees
of bias

Inferred
Physiological
Model

Design:
Systematic
review and metaanalysis
Purpose:
Evaluate the
safety and
efficacy of PRP
for treatment of
DFUs compared
to standard or
alternative
therapies

38
N= 10 studies, 525
participants
Demographics:
CG: Standard or
alternative therapy
IG: PRP
Study types: 8
RCTs, 2 prospective
longitudinalobservational
Mean age: 57.98
years
Gender: 43%
women
Setting: Not
specified
Exclusion: Other
wound types, no
restrictions on
publication date or
languages
Attrition: 48 lost to
follow-up

IV1: PRP
DV1: Wound
healing/epithelialization
DV2: Volume of ulcer
DV3: Complete wound
healing
DV4: Safety
DV5: Recurrences
DV6: Rate of adverse
events

Definitions: None
specified

Tools:
Cochrane
Collaboration’s
tools
Grading of
Recommendations
Assessment,
Development, and
Evaluation
(GRADE)
Validity/
Reliability:
Reliable, used to
assess bias in
RCTs, uses 6
domains to assess
bias
Good reliability,
uses 5 domains to
assess
quality/certainty
of evidence

Statistical Tests
Used: Review
Manager version
5.3, MantelHaenszel method,
mean difference,
heterogeneity,
DerSimonian and
Laird method,
meta regression
methods

DV1: No
increase in
epithelialized
area, p = 0.41
DV2:
Significantly
decreased
volume of
ulcer, p < 0.01
DV3: PRP
significantly
decreased
time to heal, p
= 0.02
DV4: No
differences in
rates of
wound
complications,
p > 0.01
DV5: No
differences in
rates of
recurrences, p
= 0.43
DV6: PRP
decreased rate
of adverse
events, p =
0.02

Level of
Evidence: I
Strengths: Same
wound type in
all studies
Weakness: No
clear exclusion
criteria, different
PRP collection
protocols,
different PRP
substances used,
different
frequency of
PRP application,
7/10 studies had
high risk of bias
in at least one
domain, wound
measuring
techniques
varied, different
dressing types,
homogeneity
decreased
significantly
with removal of
one study

Feasibility:
Indicates
benefits to PRP
on diabetic
wounds with
minimal risks
Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Author/Year:
Tian et al.,
2019
Application of
standardized
PRP in elderly
patients with
complex
wounds
Country:
China
Funding:
National
Natural Science
Foundation of
China, National
Key Research
and
Development
Plan of China,
National Basic
Science and
Development
Program,
Health &
Medical

Theoretical/
Conceptual
Framework

Inferred
Physiological
Model

Design/ Method/
Purpose

Design: Case
control study
Purpose: To
develop a
standardized
method for PRP
preparation

39
Sample/Setting

N= 21
Demographics:
Gender: 12 females
Mean age: 68.3
years
Setting: Not
specified
Exclusion: Cancer,
connective-tissue
disease,
immunodeficiency
disorders, mental
disorders, serious
cardiac diseases,
infections,
coagulation defects,
platelets <100 x
106/L, hemoglobin
concentration <110
g/L
Attrition: None

Variables

IV1: Standardized PRP
prep with centrifugation
twice
DV1: Platelet
count/platelet indices
DV2: Wound healing
time
Definitions:
PRP: The plasma
fraction from whole
blood with a supraphysiologic
concentration of
platelets

Measurement/
Instrumentation

Tools:
No tools
specified,
measuring
tools/techniques
was not identified
Validity/
Reliability: N/A

Data Analysis

Statistical Tests
Used: mean and
standard deviation
for platelet
indices, paired
sample t-tests, p <
0.05 indicated
significance, SPSS
v21

Results/
Findings

DV1: Platelet
count
increased
from 219 in
whole blood
to 1,218 after
2nd
centrifugation,
p <0.05
DV2:
Accelerated
healing after
PRP prep (no
statistical
values
proving this)

Level of
Evidence;
Application to
practice;
Generalization
Application:
For DFU
Level of
Evidence: III
Strengths: Clear
outline of how
PRP prep was
done including
measurements,
centrifuge
settings, and
required platelet
counts for
samples;
formulas for
platelet
concentration
included
Weakness:
Statistical results
for efficacy were
not presented ,
large controlled
pilot study
needed to
confirm results

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

40
Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

Treatment
Collaborative
Innovation
Major Special
Projects of
Guangzhon,
Science &
Technology
Planning
Project of
Guangdong
Province of
China, Science
and Technology
Key Project of
Guangdong
Province

Level of
Evidence;
Application to
practice;
Generalization
Feasibility:
Cost-effective
and timeefficient
Application:
Standardized
PRP prep
increases
consistency in
PRP therapy for
complex
wounds,
increases
outcomes, and
does not present
side effects

Bias: None
identified
Author/Year:
Uçar et al.,
2020
Comparison of
PRP gel in the
care of the
pressure ulcers
with the
dressing with
serum

Inferred
Physiological
Model

Design:
Prospective RCT
Purpose:
Compare effects
of PRP gel and
gas dressing with
serum
physiologic
applied to stage II

N= 60

IV1: PRP gel

Demographics:
CG: 52.4% female
IG: 47.6% femlae
Mean age:
CG: 67.8 years
IG: 68.3 years

CG: Serum
physiological gas
dressing

Tools: Barthel
Daily Living
Activities Scale,
Glaskow Coma
Scale, PUSH

Statistical Tests
Used: SPSS 15
package,
KolmogorovSmirnov test, ttest,
Nonparametric
Mann Whitney U
test,

DV1:
IG:
Decreased 4.7
ro 2.83, p
=.001
CG:
Increased 4.83
to 5.0, p =.166

Level of
Evidence: II

Strengths: All
dressings
performed by the
DV1: Wound size
researcher for
consistency, all
DV2: Exudate amount
Validity/
wounds
Reliability:
measured using
Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Citation

physiology in
terms of healing
process and
dressing costs
Country:
Turkey
Funding:
Zonguldak
Bulent Ecevit
University
Scientific
Research
Projects Unit,
Grant: 201819093093-01
Bias: None
identified

Theoretical/
Conceptual
Framework

41

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data Analysis

Results/
Findings

pressure ulcer in
coccyx for 2
months on
healing process
and dressing costs

Setting: inpatient
palliative care unit
post-surgery

DV3: Tissue type

Turkish validity
and reliability of
Barthel’s
published in 2000;
reliability and
validity
coefficient for this
study was 0.95

Nonparametric
Wilcoxon test,
Chi-square and
Fisher’s exact test,
p <0.05 indicates
significance

DV2:
IG:
Decreased
1.93 to 0.93, p
=.001
CG:
Decreased
2.17 to 1.93, p
=.115

Exclusion: Impaired
renal function,
albumin, platelets,
blood glucose,
limited mobility;
non-Turkish literacy,
wounds other than
coccyx stage II,
immunodeficiency
Attrition: None

Definitions:
Serum physiological
gas dressing is a
method that prevents
the entry of external
microorganisms into
the wound that protects
the moisture of the
wound, but cannot
provide antiseptic
properties

Glaskow Coma
Scale is reliable
and valid as it is
used widely to
determine level of
consciousness
PUSH is used
frequently in
Turkey, but
validity and
reliability has not
yet been
determined

DV3:
IG:
Decreased
1.87 to 1.2, p
=.001
CG:
Increased 1.87
to 1.97, p
=.366

Level of
Evidence;
Application to
practice;
Generalization
the same camera
and disposable
rulers
Weakness:
Unknown
reliability of
PUSH
Feasibility:
Easily accessible
and low cost
Application:
PRP gel is
effective in
treating stage II
coccyx pressure
ulcers

Key: CG Control Group, CI Confidence Interval, DFU Diabetic Foot Ulcers, DV Dependent Variable, FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version, IG
Intervention Group, IV Independent Variable, MSS Manchester Scar Scale, PRP Platelet-Rich Plasma, PUSH Pressure Ulcer Scale for Healing, QoL Quality of Life, RCT
Randomized Controlled Trial, VAS Visual Analog Scale, VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN

42

Table A2
Synthesis Table
Study
(Author, year)

del PinoSedeño et al.,

Deng et al.,
2022

Elbarbary et
al., 2020

Elsaid, et al.,
2019

Kao et al.,
2021

Qu et al., 2021

Tian et al.,
2019

Uçar et al.,
2020

Vogt et al.,
2020

Xia et al., 2019

SR/MA
I

Quantitative
preliminary
III

RCT
II

RCT
II

SR/MA
I

SR/MA
I

Case control
III

RCT
II

Quantitative
with crosssectional
III

Meta-analysis
I

10 studies
58
X

12
43
X

90
44

24
55
X

449
Not stated

1592
Not stated

21
68

60
68

100
61

630
Not stated
X
X

X

X

2019
Design
LOE

Sample
n subjects
M-Age
Diabetic wound
Venous ulcer
Pressure ulcer
Burn
Other
Setting
Inpatient
Outpatient
Unknown
Interventions
PRP gel/dressing
PRP injection
Sociodemographics
PRP centrifuge x2
Outcomes/ Themes
Wound size
Healing time
Complete healing
Number healed
Exudate amount
QoL & FLQA-Wk

X
X
X
X

X
X

X

X

X
X

X

X
X

X

X
X

X

X
X

X

X

X

X

X
X

X
X

X
↓
↓
↑

↓
↓
↑

↓
↓
↑

↓
↑
↑

↓
↓
↑

↓
↓
↓

↓

↓
↑
↑
↑

Key: FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version LOE Level of Evidence M-Age Mean Age MA Meta-Analysis MSS Manchester Scar Scale PRP Platelet-Rich Plasma QoL
Quality of Life SR Systematic Review VAS Visual Analog Scale VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Study
(Author, year)

del PinoSedeño et al.,

Deng et al.,
2022

↑
↑

↑
↑
↑
↓
↓
↓

43
Elbarbary et
al., 2020

Elsaid, et al.,
2019

Kao et al.,
2021

Qu et al., 2021

Tian et al.,
2019

Uçar et al.,
2020

Vogt et al.,
2020

Xia et al., 2019

2019
Safety
Cost-effective
Platelet count
VAS
VSS
MSS

↑

↑

↑

↑
↑

↑
↑
↑

↑
↑
↑

↑
↑

Key: FLQA-Wk Freiburg Life Quality Assessment Wound – Wound Version LOE Level of Evidence M-Age Mean Age MA Meta-Analysis MSS Manchester Scar Scale PRP Platelet-Rich Plasma QoL
Quality of Life SR Systematic Review VAS Visual Analog Scale VSS Vancouver Scar Scale

EFFICACY OF PLASMA-RICH PROTEIN
Appendix B
Models and Frameworks
Figure B1
The TIME Framework

(Leaper et al., 2012)

44

EFFICACY OF PLASMA-RICH PROTEIN
Figure B2
Model for Improvement: Plan-Do-Study-Act (PDSA)

(IHI, n.d.-a)

45

Running head: EFFICACY OF PLATELET-RICH PLASMA
Appendix C

1

EFFICACY OF PLASMA-RICH PROTEIN

47

EFFICACY OF PLASMA-RICH PROTEIN

48

Appendix D
Chart Audit Form

Subject
ID

100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
200
201

AGE
(YEARS)

GENDER
1 Male
2 Female
3 Other
(write in)

RACE
1 American
Indian/Alaskan
Native
2 Asian
3 Black/African
American
4 Native Hawaiian or
Other Pacific
Islander
5 White
6 Other

ETHNICITY
1 Hispanic or
Latino
2 Not
Hispanic or
Latino

SMOKING
1 Current
2 Former
3 Nonsmoker
4 Vape

ALLERGIES

PMH
1 T2D
2 HTN
3 Obesity
4 CKD
5 Liver disease
6 PVD
7 DVT hx
8 Other cardiac
disease

ABX
(TYPE &
DATE)

WOUND
TYPE
1 Diabetic
ulcer
2 Pressure
ulcer
3 Traumatic
4 Venous
ulcer
5 Other

WOUND
STAGE
1 III
2 IV

ONSET
(write
in)

EFFICACY OF PLASMA-RICH PROTEIN

49

Appendix E
Budget
Phase
Preparation

Activities
Print Bates-Jensen
Wound Assessment
Tool ($0.05/page x
30 pages)
Print written
informed consents
and HIPAA form
($0.05/page x 30
pages)
Print recruitment
flyers ($0.05/page x
30 pages)
Locking storage file
box
Microsoft Office
Delivery
Gas ($3.95/gallon)
Masks
Evaluation
Intellectus
Statistician
Cost Versus
Reduction in
Revenue/Savings unnecessary wound
care dressings and
procedures
Reduction in woundrelated complications
and hospitalizations

Cost
$1.50

subtotal

Total

$1.50

$39.99
$34.99
$63.20
$9.99
$80
$300

$77.98
$73.19
$380

$531.17

EFFICACY OF PLASMA-RICH PROTEIN

50

Appendix F
Table F1
Frequency Table for Demographics
Variable
Gender
Male
Female
Smoking Status
Former
Non-smoker
UltraMIST
Yes
No
Past Medical History
Cardiac disease + peripheral vascular disease
Cardiac disease + hypertension
Cardiac disease + type 2 diabetes
Prior Antibiotics
Custom lipogel & oral antibiotics
Custom lipogel
Custom lipogel, oral & topical antibiotics

n

%

1 33.33
2 66.67
2 66.67
1 33.33
1 33.33
2 66.67
1 33.33
1 33.33
1 33.33
1 33.33
1 33.33
1 33.33

Table F2
Summary Statistics Table for Age
Variable
M
SD
n
Min
Max
Age (years)
69.00
9.54
3
63.00
80.00
Note. 'M’ signifies the mean. ‘SD’ is the standard deviation. ‘n’ is the sample size. ‘Min’ and
‘Max’ represent the range.

EFFICACY OF PLASMA-RICH PROTEIN

51

Table F3
Frequency Table for Laboratory Values
Variable
M
SD
n
Min
Max
Wound stage
3.67
0.58
3
3.00
4.00
Hemoglobin A1c (%)
6.00
1.30
3
4.70
7.30
Prealbumin (mg/dL)
23.37
12.09
3
9.80
33.00
White blood count (microliters)
8.30
1.81
3
6.40
10.00
C-reactive protein (mg/L)
5.56
5.01
3
0.55
10.56
Note. 'M’ signifies the mean. ‘SD’ is the standard deviation. ‘n’ is the sample size. ‘Min’ and
‘Max’ represent the range.
Figure 1
Bates-Jensen Wound Assessment Tool Scores for Wound Types