Comparison of the clinical effectiveness of different off‐loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta‐analysis

Diabetes/Metabolism Research and Reviews - Tập 29 Số 3 - Trang 183-193 - 2013
Judy K. Morona1, Elizabeth Buckley1, Sara Jones2, Edith A. Reddin1, Tracy Merlin1
1Adelaide Health Technology Assessment, Discipline of Public Health, School of Population Health University of Adelaide Adelaide South Australia Australia
2School of Health Sciences, Division of Health Sciences University of South Australia Adelaide South Australia Australia

Tóm tắt

SummaryEffective off‐loading is considered to be an important part of the successful clinical management of diabetic foot ulcers. The aim of this systematic review is to investigate the safety and effectiveness of different off‐loading devices for the treatment of diabetic foot ulcers. The medical literature was extensively searched from January 1966 to May 2012. Systematic reviews and controlled studies that compared the use of different off‐loading devices formed the evidence base. Studies were critically appraised to determine their risk of methodological bias, and data were extracted. Results were pooled using random effects meta‐analysis and tested for heterogeneity. When compared with removable devices, non‐removable off‐loading devices were found, on average, to be more effective at promoting the healing of diabetic foot ulcers (RRp = 1.43; 95% CI 1.11, 1.84;I2 = 66.9%;p = 0.001;k = 10). Analysis, stratified by type of removable device, did not detect a statistically significant difference between non‐removable off‐loading devices and removable cast walkers; however, on average non‐removable off‐loading devices performed better than therapeutic shoes at promoting the healing of diabetic foot ulcers (RRp = 1.68; 95% CI 1.09, 2.58;I2 = 71.5%;p = 0.004;k = 6). The two types of non‐removable off‐loading devices i.e. total contact casts and instant total contact casts (removable cast walker rendered irremovable by securing with bandage or lace), were found to be equally effective (RRp = 1.06; 95% CI 0.88, 1.27;I2 = 3.3%;p = 0.31;k = 2). In conclusion, non‐removable off‐loading devices regardless of type, are more likely to result in ulcer healing than removable off‐loading devices, presumably because patient compliance with off‐loading is facilitated. Copyright © 2013 John Wiley & Sons, Ltd.

Từ khóa


Tài liệu tham khảo

10.1177/193229681100500636

10.2337/diacare.13.5.513

10.1111/j.1365-2796.1993.tb01003.x

Armstrong DG, 1998, Evidence‐based options for off‐loading diabetic wounds, Clin Podiatr Med Surg, 15, 95, 10.1016/S0891-8422(23)01030-3

10.1056/NEJM199409293311307

10.2337/diacare.18.10.1383

10.2337/diacare.23.12.1746

10.2337/dc08-0771

10.2337/diacare.28.3.551

10.2337/diacare.19.8.818

Cavanagh PR, 1996, Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention, Diabet Med, 13, S17

10.1093/ptj/76.3.296

American Diabetes Association.Consensus Development Conference on Diabetic Foot Wound Care: 7‐8 April 1999 Boston Massachusetts: Diabetes Care 22:1354‐1360 1999.

10.2337/diacare.24.6.1019

10.1016/j.clinbiomech.2011.03.010

10.1016/j.jvs.2010.06.007

10.1177/107110079001100303

10.1046/j.1464-5491.1999.00137.x

Spencer SA, 2000, Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews

10.1002/dmrr.850

Hunt D, 2011, Diabetes: foot ulcers and amputations, Clin Evid (Online)., 2011

Ndip A, 2012, Neuropathic diabetic foot ulcers – evidence‐to‐practice, Int J Gen Med., 5, 129

SIGN.SIGN 50 – A guideline developer's handbook. January 2008 edn: Scottish Intercollegiate Guidelines Network 2008.

10.2337/diacare.28.3.555

Stata Corporation, 2011, Intercooled Stata 12.0 for Windows

10.1016/0197-2456(86)90046-2

10.12968/jowc.2006.15.2.26888

10.2337/diacare.26.10.2848

10.2337/diacare.12.6.384

10.1080/03093640701318672

10.2337/dc06-1750

10.1046/j.1464-5491.2003.01011.x

10.2337/dc07-0990

10.2337/dc09-1708

10.1016/S1067-2516(96)80125-6

10.1177/107110078100200202

10.1016/j.gaitpost.2009.01.003

10.1177/0022034509359125

10.1001/archderm.136.12.1531

10.1046/j.1464-5491.2001.00422.x

10.2337/diacare.28.2.243

10.2337/diacare.24.12.2153

10.2337/diacare.26.9.2595

Thông tin
Thông tin xuất bản

Diabetes/Metabolism Research and Reviews

Tập 29 Số 3

183-193

Thông tin tác giả