The use of wound healing assessment methods in psychological studies: a review and recommendations
ABSTRACT To provide a critical review of methods used to assess human wound healing in psychological research and related disciplines, in order to guide future research into psychological influences on wound healing.
Acute wound models (skin blister, tape stripping, skin biopsy, oral palate biopsy, expanded polytetrafluoroethylene tubing), surgical wound healing assessment methods (wound drains, wound scoring), and chronic wound assessment techniques (surface area, volumetric measurements, wound composition, and assessment tools/scoring systems) are summarized, including merits, limitations, and recommendations.
Several dermal and mucosal tissue acute wound models have been established to assess the effects of psychological stress on the inflammatory, proliferative, and repair phases of wound healing in humans, including material-based models developed to evaluate factors influencing post-surgical recovery. There is a paucity of research published on psychological factors influencing chronic wound healing. There are many assessment techniques available to study the progression of chronic wound healing but many difficulties inherent to long-term clinical studies.
Researchers need to consider several design-related issues when conducting studies into the effects of psychological stress on wound healing, including the study aims, type of wound, tissue type, setting, sample characteristics and accessibility, costs, timeframe, and facilities available. Researchers should consider combining multiple wound assessment methods to increase the reliability and validity of results and to further understand mechanisms that link stress and wound healing.
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- "A classic hallmark of AD is a chronic itch/scratch cycle that leads to persistent barrier disruption. To mimic this mechanically induced barrier disruption (Taljebini et al., 1996; Koschwanez and Broadbent, 2011), we performed tape stripping in human discarded skins. TJ barrier recovery was monitored by measuring TEER and the paracellular fluorescein flux using the modified micro-Snapwell system with and without Pam3CSK4 treatment (see Materials and Methods and Figure 4a). "
ABSTRACT: Atopic dermatitis (AD) is characterized by epidermal tight junction (TJ) defects and a propensity for Staphylococcus aureus skin infections. S. aureus is sensed by many pattern recognition receptors, including Toll-like receptor 2 (TLR2). We hypothesized that an effective innate immune response will include skin barrier repair, and that this response is impaired in AD subjects. S. aureus-derived peptidoglycan (PGN) and synthetic TLR2 agonists enhanced TJ barrier and increased expression of TJ proteins, claudin-1 (CLDN1), claudin-23 (CLDN23), occludin, and Zonulae occludens 1 (ZO-1) in primary human keratinocytes. A TLR2 agonist enhanced skin barrier recovery in human epidermis wounded by tape stripping. Tlr2(-/-) mice had a delayed and incomplete barrier recovery following tape stripping. AD subjects had reduced epidermal TLR2 expression as compared with nonatopic subjects, which inversely correlated (r=-0.654, P=0.0004) with transepidermal water loss (TEWL). These observations indicate that TLR2 activation enhances skin barrier in murine and human skin and is an important part of a wound repair response. Reduced epidermal TLR2 expression observed in AD patients may have a role in their incompetent skin barrier.Journal of Investigative Dermatology advance online publication, 6 December 2012; doi:10.1038/jid.2012.437.Journal of Investigative Dermatology 12/2012; 133(4). DOI:10.1038/jid.2012.437 · 6.37 Impact Factor
Article: The psychology of wound healing[Show abstract] [Hide abstract]
ABSTRACT: Research into the effects of psychological factors on wound healing represents an ideal research model for psychoneuroimmunology, as both the impact on clinically relevant health outcomes and the underlying biological mechanisms can be examined. Mounting interest in this topic from biological scientists, psychologists, and medical specialists has resulted in new findings that are discussed in this review. Known psychological influences on wound healing include stress as well as coping styles, positive affect, environmental enrichment, and social support. Research has highlighted the roles of oxytocin, vasopressin, epinephrine, cortisol, and leukocyte redistribution in wound healing. Clinical significance has been demonstrated by a growing number of studies in patient populations. Furthermore, pragmatic interventions with clinical samples have demonstrated clear benefits of psychological interventions on wound healing. Recent studies add to growing evidence that psychology impacts wound repair, and highlight in particular the positive role of social support on modulating the negative effects of stress. The first few studies to demonstrate that psychological interventions can improve healing in clinical populations are exciting developments. New knowledge of psychobiological mechanisms provides opportunities to develop further interventions to improve health outcomes.Current opinion in psychiatry 12/2011; 25(2):135-40. DOI:10.1097/YCO.0b013e32834e1424 · 3.55 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: This article comprises a review of the literature published during the period January 2011 to June 2012 on the topic of the psychosocial impact of wounds and strategies to manage them. RECENT FINDINGS: There is a growing discussion of the reciprocal link between psychological influences and wound healing. Although the mechanisms underlying these influences are not well understood, evidence from the reviewed literature adds to the existing body of evidence demonstrating that negative psychological states can impair immune function and wound healing. Despite this recognition, there are still few studies that provide strategies to address the identified psychosocial issues associated with wounds, particularly those of chronic duration. SUMMARY: A wide range of psychosocial factors likely to be associated with a wound have been identified. The importance of understanding the nature and extent of their impact is illustrated by the patients' experiences of living with a chronic wound which they rate as serious as cancer or myocardial infarction. Although there is currently limited evidence on which to base management strategies, it is recommended that interventions should commence with a comprehensive individualized assessment which can then inform the development of an appropriate management plan that includes the identified psychosocial issues.Current opinion in supportive and palliative care 11/2012; 7(1). DOI:10.1097/SPC.0b013e32835bf2a3