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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.
MedLine Citation:
PMID:  23303652     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Effective off-loading is considered to be an important part of the successful clinical management of people with diabetes, as between 15% and 25% of them will suffer from a foot ulcer during their lifetime. 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. METHODS: Medical bibliographic databases, the internet and reference lists were 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 according to their risk of bias and data were extracted. Results were pooled using random effects meta-analysis and tested for heterogeneity. RESULTS: When compared to removable devices, non-removable off-loading devices (NRDs) were found, on average, to be more effective at promoting the healing of diabetic foot ulcers (RR(p)  = 1.43; 95% CI 1.11, 1.84; I(2)  = 66.9%; p = 0.001; k = 10). Analysis, stratified by type of removable device, lacked power to find a statistically significant difference between NRDs and RCWs; however, on average NRDs performed better than therapeutic shoes at promoting the healing of diabetic foot ulcers (RR(p)  = 1.68; 95% CI 1.09, 2.58; I(2)  = 71.5%; p = 0.004; k = 6). The two types of NRDs (ie. total contacts casts (TCC) and instant TCCs) were found to be equally effective (RR(p)  = 1.06; 95% CI 0.88, 1.27; I(2)  = 3.3%; p = 0.31; k = 2). CONCLUSION: NRDs, 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 © 2012 John Wiley & Sons, Ltd.
Authors:
Judy K Morona; Elizabeth S Buckley; Sara Jones; Edith A Reddin; Tracy L Merlin
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-10
Journal Detail:
Title:  Diabetes/metabolism research and reviews     Volume:  -     ISSN:  1520-7560     ISO Abbreviation:  Diabetes Metab. Res. Rev.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883450     Medline TA:  Diabetes Metab Res Rev     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 John Wiley & Sons, Ltd.
Affiliation:
Adelaide Health Technology Assessment, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, South Australia, Australia. tracy.merlin@adelaide.edu.au.
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