Ask an answerable question (PICO)：
Peripheral arterial occlusive disease (PAOD) commonly had poor wound healing problems. People who have severe PAOD may suffer from severe disability or death due to limb amputation and infection which may result in huge medical expenses, and increase the economic burden on patients, families ,and society. Today, the main effective treatment for PAOD is percutaneous transluminal angioplasty (PTA) which is an invasive treatment. Recently, studies have shown that the use of far-infrared radiation (FIR) can alleviate PAOD in hemodialysis patients. Compared with the invasive treatment, PTA , FIR is a non-invasive treatment that is characterized as easy to use and had relatively lower adverse effects on patients such as cardiovascular complications (for example acute myocardial infarction), bleeding, thrombosis, and even death. Therefore, this article aims to explore whether FIR can improve the circulation in the feet for PAOD of hemodialysis patients by using evidence-based methods. It is hoped that the result can provide references for improving the patient’s foot circulation and increased the quality of patient care.
The Method and Analysis of Literature Review：
This article searched for the published articles which focused on the effectiveness of FIR on the PAOD in hemodialysis patients. The search database includes Cinahl, Medline, ProQuest Nursing, Cochrane, and PubMed, by using the keywords of “hemodialysis patients”, “far-infrared radiation”, “peripheral arterial disease, “ankle-brachial index”, “pain” and “foot circulation” in article titles, abstracts ,and keywords. Initially, 7 articles were searched. The foot circulation included foot temperature, blood follow, and pulse intensity. After carefully reviewed the abstracts and texts based on the inclusion and exclusion criteria of this article, 1 experimental study and 2 quasi-experimental studies were finally included.
Critical Appraisal：
Critical appraisal of the RCT study was conducted by using Joanna Briggs Institute (JBI) Critical Appraisal Checklist Tools for Randomized Controlled Trials. The results complied with 8 items out of 13 for the experimental study. Critical appraisal for the 2 quasi-experimental studies was using JBI Critical Appraisal Tools for quasi-experimental studies and indicated 7-8 items out of 9 standard criteria were meet. Then, according to the evidence grade standard of Joanna Briggs Institute, the included literature were rated as evidence level 1.c for experimental study and level 2.c for the 2 quasi-experimental studies.
Results, Conclusions and Recommendations：
The beneficial effects of FIR in hemodialysis patients with PAOD are decreasing patients’ pain, improving intermittent claudication, foot temperature, arterial blood flow, and pulsation intensity. There is no consensus on the effect of FIR on the ankle brachial pressure index (ABI). However, the research results suggested that FIR has more advantages than disadvantages. Hemodialysis patients may improve foot temperature, arterial blood flow, pulsation intensity, and decrease pain due to PAOD by using 6 months of the FIR during hemodialysis. The top radiator was set at a height of 25 cm above the surface of the PAOD with the treatment time set at 40 min during hemodialysis three times per week.
