title: A 'test and treat' strategy for elevated wound protease activity for healing in venous leg ulcers.
abstract: BACKGROUND
  Venous leg ulcers are a common and recurring type of complex wound. They can be painful, malodorous, prone to infection and slow to heal. Standard treatment includes compression therapy and a dressing. The use of protease-modulating treatments for venous leg ulcers is increasing. These treatments are based on some evidence that a proportion of slow to heal ulcers have elevated protease activity in the wound. Point-of-care tests which aim to detect elevated protease activity are now available. A 'test and treat' strategy involves testing for elevated proteases and then using protease-modulating treatments in ulcers which show elevated protease levels.
  
  
  OBJECTIVE
  To determine the effects on venous leg ulcer healing of a 'test and treat' strategy involving detection of high levels of wound protease activity and treatment with protease-modulating therapies, compared with alternative treatment strategies such as using the same treatment for all participants or using a different method of treatment selection.
  
  
  METHODS
  We searched the following electronic databases to identify reports of relevant randomised clinical trials: The Cochrane Wounds Group Specialised Register (January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) Issue 12, 2015); Ovid MEDLINE (1946 to January 2016); Ovid MEDLINE (In-Process & Other Non-Indexed Citations January 2016); Ovid EMBASE (1974 to January 2016); EBSCO CINAHL (1937 to January 2016). We also searched three clinical trials registers, reference lists and the websites of regulatory agencies. There were no restrictions with respect to language, date of publication or study setting.
  
  
  METHODS
  Published or unpublished RCTs which assessed a test and treat strategy for elevated protease activity in venous leg ulcers in adults compared with an alternative treatment strategy. The test and treat strategy needed to be the only systematic difference between the groups.
  
  
  METHODS
  Two review authors independently performed study selection; we planned that two authors would also assess risk of bias and extract data.
  
  
  RESULTS
  We did not identify any studies which met the inclusion criteria for this review. We identified one ongoing study; it was unclear whether this would be eligible for inclusion.
  
  
  CONCLUSIONS
  Currently there is no randomised evidence on the impact of a test and treat policy for protease levels on outcomes in people with venous leg ulcers.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK, M13 9PL.
authors.forename: Gill
authors.initials: G
authors.lastname: Norman
authors.forename: Maggie J
authors.initials: MJ
authors.lastname: Westby
authors.forename: Nikki
authors.initials: N
authors.lastname: Stubbs
authors.forename: Jo C
authors.initials: JC
authors.lastname: Dumville
authors.forename: Nicky
authors.initials: N
authors.lastname: Cullum
mesh_terms: D004796:Clinical Enzyme Tests; D006801:Humans; D010447:Peptide Hydrolases / Q000032:analysis*; D014647:Varicose Ulcer / Q000201:enzymology* / Q000628:therapy*; D014945:Wound Healing
chemical_list: D010447:Peptide Hydrolases