Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not the addition of arginine protein supplementation is effective in wound healing of adult patients with stage II, III and IV pressure ulcers.

STUDY DESIGN: Systematic review of three English language primary studies. One observation controlled study and two randomized controlled studies all published between 2010- 2012.

DATA SOURCES: Two double blind randomized controlled trials and one observational controlled trial comparing the efficacy of arginine supplementation in wound healing of adult patients with stage II, III and IV pressure ulcers. All research articles were found using Cochrane Library EMB, Dynamed and Pubmed databases.

OUTCOMES MEASURED: Pressure ulcer healing size and time were documented and compared using The National Pressure Ulcer Advisory Panel (PUSH) tool. The PUSH tool measures length x width, exudate amount and tissue type. Patients’ nutritional status and intake are also monitored throughout the studying using Subjective Global Assessment (SGA) tool.

RESULTS: Two studies demonstrated significant decline in the ulcer size and healing time with the addition of arginine supplement. Brewer el al. showed patients receiving 9g of arginine daily has a mean healing time of 10.5 ±1.3 weeks compared to the historical group without arginine, which has mean healing time of 21.1±3.7 weeks. Van Anholt et al. demonstrated the intervention group receiving 9g of arginine has a significant decreased PUSH score, and faster healing time (p≤0.012). The p-value calculated for the intervention group is p=0.006 and for the control group is p=0.016. Leigh et al. showed similar wound healing size and time for the 4.5g arginine control group and the 9g arginine intervention group. The PUSH score for the 4.5g arginine group is 8.9±0.7, and for the 9g arginine group is 8.1±1.0. There is no significant difference in healing rate overall between the two groups, p=0.991. However, the time-to-heal rate decreased by half when compared both groups to historical data group receiving no supplement decreases the healing time.

CONCLUSIONS: All three studies showed that arginine oral supplementation is effective in decrease pressure ulcer healing time and size in adult patients with stage II, III and IV pressure ulcers. And one study showed no significant differences between the different dosing of the supplement.