Clinical Efficacy: Knowing What Works

Rationale:  Clinicians use evidence of product efficacy to supplement clinical judgment as they strive to deliver consistent quality patient and wound outcomes. The scientific method that proves efficacy is clear, but frequent misleading use of the word “efficacy” in conclusions and interpretations can confuse clinical decision makers. More accurate efficacy communication can improve professional capacity to support and implement accurate care decisions. Objective: Review wound care efficacy literature to define efficacy and clarify its use in informing sound patient-oriented practice decisions. Methods: MEDLINE, Joanna Briggs, AHRQ and Google websites were reviewed respectively for scientific studies, best practice guidelines, evidence-based practice and lay literature definitions and interpretations of wound care efficacy. The best available evidence of efficacy was summarized for an example wound to illustrate a simple path for using evidence of efficacy to inform decisions about what may work best for a given patient. Results:  Evidence of wound care modality efficacy was summarized in the context of recognized AHRQ “strength of evidence” definitions. Conclusions supportable by each type of study design were illustrated with examples of best available evidence from published literature for common modalities. Some wound care modalities had clear evidence of efficacy. Several incorrectly used case studies or series to support “efficacy” claims. Few modalities had clear evidence of efficacy compared to current best practice. Conclusion:  Improved uniformity and accuracy of efficacy interpretations could reduce confusion and improve consistency of wound care practice and outcomes, elevating the credibility of wound care as a specialty.