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Jones AW, Makanjuola A, Bray N, Prior Y, Parker D, Nester C, Tang J, Jiang L. The efficacy of custom-made offloading devices for diabetic foot ulcer prevention: a systematic review. Diabetol Metab Syndr 2024; 16:172. [PMID: 39049069 PMCID: PMC11267867 DOI: 10.1186/s13098-024-01392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Therapeutic offloading devices, including insoles, shoes, and other orthoses, are some of the most commonly used interventions to treat or prevent diabetic foot ulceration. Custom-made offloading devices are increasingly used to offset the development of foot ulcers. However, whether these devices are more effective than prefabricated standard offloading devices is uncertain. Therefore, this systematic review collates and examines evidence on the efficacy of custom-made offloading devices in preventing foot ulcer incidence and recurrence in people diagnosed with diabetes. METHODS Five scientific databases were searched, covering 2011-2023. Initial searches and screening were carried out independently by two researchers. Studies meeting the inclusion criteria were further examined through additional screenings, and critical appraisal. Data relevant to the review aims were extracted and analysed within a narrative synthesis. RESULTS Of the 1,715 articles found in the initial searches, nine papers were found to meet inclusion criteria and were included in the review. The evidence shows that custom-made offloading devices are likely to be more effective for reducing or preventing diabetic foot ulcers than standard offloading devices. However, due to a lack of data it remains uncertain whether custom-made offloading devices are more cost-effective for preventing ulceration compared to standard insoles. Likewise, due to measurement heterogeneity between studies and lack of data, it is unclear whether adherence is higher in users of custom-made offloading devices, and whether such devices deliver significantly greater reductions in peak pressure as compared to standard offloading devices. CONCLUSION Custom-made offloading devices are more effective than standard devices for preventing diabetic foot ulceration, and we recommended their use when feasible; however, there remains uncertainty regarding their cost-effectiveness compared to standard insoles and offloading devices.
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Affiliation(s)
- Aled Wyn Jones
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK
| | - Abraham Makanjuola
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK
- Faculty of Life Sciences and Education, University of South Wales, Cardiff, UK
| | - Nathan Bray
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK.
| | - Yeliz Prior
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Daniel Parker
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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Crossland SR, Siddle HJ, Brockett CL, Culmer P. Evaluating the use of a novel low-cost measurement insole to characterise plantar foot strain during gait loading regimes. Front Bioeng Biotechnol 2023; 11:1187710. [PMID: 37662427 PMCID: PMC10469908 DOI: 10.3389/fbioe.2023.1187710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction: Under plantar loading regimes, it is accepted that both pressure and shear strain biomechanically contribute to formation and deterioration of diabetic foot ulceration (DFU). Plantar foot strain characteristics in the at-risk diabetic foot are little researched due to lack of measurement devices. Plantar pressure comparatively, is widely quantified and used in the characterisation of diabetic foot ulceration risk, with a range of clinically implemented pressure measurement devices on the market. With the development of novel strain quantification methods in its infancy, feasibility testing and validation of these measurement devices for use is required. Initial studies centre on normal walking speed, reflecting common activities of daily living, but evaluating response to differing gait loading regimes is needed to support the use of such technologies for potential clinical translation. This study evaluates the effects of speed and inclination on stance time, strain location and strain response using a low-cost novel strain measurement insole. Methods: The STrain Analysis and Mapping of the Plantar Aspect (STAMPS) insole has been developed, and feasibility tested under self-selected normal walking speeds to characterise plantar foot strain, with testing beyond this limited regime required. A treadmill was implemented to standardise speed and inclination for a range of daily plantar loading conditions. A small cohort, comprising of five non-diabetic participants, were examined at slow (0.75 m/s), normal (1.25 m/s) and brisk (2 m/s) walking speeds and normal speed at inclination (10% gradient). Results: Plantar strain active regions were seen to increase with increasing speed across all participants. With inclination, it was seen that strain active regions reduce in the hindfoot and show a tendency to forefoot with discretionary changes to strain seen. Stance time decreases with increasing speed, as expected, with reduced stance time with inclination. Discussion: Comparison of the strain response and stance time should be considered when evaluating foot biomechanics in diabetic populations to assess strain time interval effects. This study supports the evaluation of the STAMPS insole to successfully track strain changes under differing plantar loading conditions and warrants further investigation of healthy and diabetic cohorts to assess the implications for use as a risk assessment tool for DFU.
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Affiliation(s)
- Sarah R. Crossland
- School of Mechanical Engineering, Institute of Functional Surfaces, University of Leeds, Leeds, United Kingdom
| | - Heidi J. Siddle
- School of Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Claire L. Brockett
- Deparment of Mechanical Engineering, INSIGNEO Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Peter Culmer
- School of Mechanical Engineering, Institute of Design, Robotics and Optimisation, University of Leeds, Leeds, United Kingdom
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Sousa LB, Almeida I, Bernardes RA, Leite TR, Negrão R, Apóstolo J, Salgueiro-Oliveira A, Parreira P. A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration. Front Public Health 2023; 11:1061383. [PMID: 36794077 PMCID: PMC9922787 DOI: 10.3389/fpubh.2023.1061383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/06/2023] [Indexed: 01/31/2023] Open
Abstract
Background The incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters. Method This study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC). Results The involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies. Discussion The three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.
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Affiliation(s)
- Liliana B. Sousa
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal,*Correspondence: Liliana B. Sousa ✉
| | - Inês Almeida
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Teófilo R. Leite
- Indústrias e Comércio de Calçado S. A. (ICC), Sol-Pinheiro, Guimarães, Portugal
| | - Rui Negrão
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - João Apóstolo
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Pedro Parreira
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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Does in-shoe pressure analysis to assess and modify medical grade footwear improve patient adherence and understanding? A mixed methods study. J Foot Ankle Res 2022; 15:94. [PMID: 36564819 PMCID: PMC9789308 DOI: 10.1186/s13047-022-00600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Medical grade footwear (MGF) with demonstrated plantar-pressure reducing effect is recommended to reduce the risk of diabetes-related foot ulceration (DFU). Efficacy of MGF relies on high adherence (≥ 80%). In-shoe pressure analysis (IPA) is used to assess and modify MGF, however, there is limited evidence for the impact on patient adherence and understanding of MGF. The primary aim of this study was to determine if self-reported adherence to MGF usage in patients with previous DFU improved following IPA compared to adherence measured prior. The secondary aim was to determine if patient understanding of MGF improved following in-shoe pressure analysis. METHODS Patients with previous DFU fitted with MGF in the last 12 months were recruited. The first three participants were included in a pilot study to test procedures and questionnaires. MGF was assessed and modified at Week 0 based on findings from IPA using the Pedar system (Novel). Patients completed two questionnaires, one assessing patient adherence to MGF at Week 0 and Week 4, the other assessing patient understanding of MGF before and after IPA at week 0. Patient understanding was measured using a 5-point Likert scale (strongly disagree 1 to strongly agree 5). Patient experience was assessed via a telephone questionnaire administered between Weeks 0-1. RESULTS Fifteen participants were recruited, and all completed the study. Adherence of ≥ 80% to MGF usage inside the home was 13.3% (n = 2) pre-IPA and 20.0% (n = 3) at Week 4. Outside the home, ≥ 80% adherence to MGF was 53.3% (n = 8) pre-IPA, and 80.0% (n = 12) at Week 4. Change in scores for understanding of MGF were small, however, all participants reported that undergoing the intervention was worthwhile and beneficial. CONCLUSIONS Self-reported adherence inside the home demonstrated minimal improvement after 4 weeks, however, adherence of ≥ 80% outside the home increased by 27%, with 80% of all participants reporting high adherence at Week 4. Participants rated their learnings from the experience of IPA as beneficial.
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Crawford F, Nicolson DJ, Amanna AE, Smith M. Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews. BMC Med Res Methodol 2022; 22:274. [PMID: 36266628 PMCID: PMC9583498 DOI: 10.1186/s12874-022-01738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Reliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)]. Methods Medline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews. Findings The overview identified 30 systematic reviews of patient education, footwear and off-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60%), weak search or selection strategies (70%) and quality appraisal methods (53%) and inexpert conduct and interpretation of quantitative and narrative evidence syntheses (57%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap. Interpretation The majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01738-y.
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Affiliation(s)
- Fay Crawford
- The School of Medicine, The University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.
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Observation of Wound Healing Effect and Aesthetic Satisfaction of Patient with Second Degree Burn Wounds Treated by Kangfuxin Solution. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1664225. [PMID: 35845586 PMCID: PMC9283044 DOI: 10.1155/2022/1664225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
Objective To study the effect of wound healing and aesthetic satisfaction of patient with second degree burn wounds treated by Kangfuxin solution. Methods 84 cases of burn plastic surgery in our hospital from October 2020 to October 2021 were included. All patients were randomly divided into observation group and control group with 42 cases in each group. Patients in both groups received basic treatment after admission, and patients in the control group received conventional treatment. Patients in the observation group were treated with Kangfuxin solution after admission. The clinical efficacy, wound healing time, secretion disappearance time, infection rate, and scar formation rate after treatment were compared between the two groups. The scores of patients and observer scar assessment scale (POSAS) before and after treatment were compared between the two groups, and the occurrence of adverse reactions during treatment was also compared between the two groups. Results The total effective rate of the observation group was 92.86%, which was significantly higher than that of the control group (61.90%) (P < 0.05).The time of wound healing and secretion disappearance in the observation group was significantly shorter than that in the control group (P < 0.05); the infection rate and scar formation rate in the observation group were significantly lower than those in the control group (P < 0.05).The scores of PSAs and OSAS in the observation group were significantly lower than those before treatment and after treatment in the control group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the observation group (7.14%) and the control group (9.52%) (P > 0.05). Conclusion The Kangfuxin solution has the advantages of fast wound healing, high patient satisfaction, better therapeutic effect, and high safety, which is worth clinical application.
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Rao SS, Prabhu A, Kudkuli J, Surya S, Rekha P. Hyaluronic acid sustains platelet stability with prolonged growth factor release and accelerates wound healing by enhancing proliferation and collagen deposition in diabetic mice. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2021.102898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ghazali MJ, Ren X, Rajabi A, Zamri WFHW, Mohd Mustafah N, Ni J. Finite Element Analysis of Cushioned Diabetic Footwear Using Ethylene Vinyl Acetate Polymer. Polymers (Basel) 2021; 13:polym13142261. [PMID: 34301018 PMCID: PMC8309306 DOI: 10.3390/polym13142261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/01/2023] Open
Abstract
With the development of societies, diabetic foot ulcers have become one of the most common diseases requiring lower extremity amputation. The early treatment and prevention of diabetic foot ulcers can considerably reduce the possibility of amputation. Using footwear to redistribute and relieve plantar pressure is one of the important measures for the treatment and prevention of diabetic foot ulcers. Thus, the evaluation and prediction of the distribution of plantar pressure play an important role in designing footwears. Herein, the finite element method was used to study plantar pressure under two kinds of foot models, namely, the skeletal structure foot model and the whole foot model, to explore the influence of human bones on the pressure of the soles of the feet and obtain accurate foot pressure. Simulation results showed that under the two models, the plantar pressure and the pressure from the footwear with ethylene vinyl acetate were all reduced. The total deformation demonstrated a slight increase. These stresses are very useful as they enable the design of suitable orthotic footwear that reduces the amount of stress in individuals with diabetic foot ulcers.
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Affiliation(s)
- Mariyam J. Ghazali
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
- Correspondence: (M.J.G.); (A.R.)
| | - Xu Ren
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou 310018, China; (X.R.); (J.N.)
| | - Armin Rajabi
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
- Correspondence: (M.J.G.); (A.R.)
| | - Wan Fathul Hakim W. Zamri
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
| | - Nadia Mohd Mustafah
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh 47000, Selangor, Malaysia;
| | - Jing Ni
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou 310018, China; (X.R.); (J.N.)
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Collings R, Freeman J, Latour JM, Paton J. Footwear and insole design features for offloading the diabetic at risk foot-A systematic review and meta-analyses. Endocrinol Diabetes Metab 2021; 4:e00132. [PMID: 33532602 PMCID: PMC7831212 DOI: 10.1002/edm2.132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/25/2022] Open
Abstract
The aim of this systematic review was to identify the best footwear and insole design features for offloading the plantar surface of the foot to prevent foot ulceration in people with diabetic peripheral neuropathy. We searched multiple databases for published and unpublished studies reporting offloading footwear and insoles for people with diabetic neuropathy and nonulcerated feet. Primary outcome was foot ulcer incidence; other outcome measures considered were any standardized kinetic or kinematic measure indicating loading or offloading the plantar foot. Fifty-four studies, including randomized controlled studies, cohort studies, case-series, and a case-controlled and cross-sectional study were included. Three meta-analyses were conducted and random-effects modelling found peak plantar pressure reduction of arch profile (37 kPa (MD, -37.5; 95% CI, -72.29 to -3.61; P < .03), metatarsal addition (35.96 kPa (MD, -35.96; 95% CI, -57.33 to -14.60; P < .001) and pressure informed design 75.4 kPa (MD, -75.4 kPa; 95% CI, -127.4 to -23.44 kPa; P < .004).The remaining data were presented in a narrative form due to heterogeneity. This review highlights the difficulty in differentiating the effect of different insole and footwear features in offloading the neuropathic diabetic foot. However, arch profiles, metatarsal additions and apertures are effective in reducing plantar pressure. The use of pressure analysis to enhance the effectiveness of the design of footwear and insoles, particularly through modification, is recommended.
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Affiliation(s)
- Richard Collings
- School of Health ProfessionsFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
- Department of Podiatry, Torbay and South DevonNHS Foundation TrustPlymouthUK
| | - Jennifer Freeman
- School of Health ProfessionsFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Jos M. Latour
- School of Nursing and MidwiferyFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Joanne Paton
- School of Health ProfessionsFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
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Crawford F, Chappell FM, Lewsey J, Riley R, Hawkins N, Nicolson D, Heggie R, Smith M, Horne M, Amanna A, Martin A, Gupta S, Gray K, Weller D, Brittenden J, Leese G. Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model. Health Technol Assess 2020; 24:1-198. [PMID: 33236718 PMCID: PMC7768791 DOI: 10.3310/hta24620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation. OBJECTIVES Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis. DESIGN We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis. INTERVENTIONS The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated. MAIN OUTCOME MEASURE The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a 'treat-all' strategy. DATA SOURCES Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule. REVIEW METHODS We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019. RESULTS The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk. LIMITATIONS The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates. CONCLUSIONS There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable. FUTURE WORK RECOMMENDATIONS Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus. STUDY REGISTRATION This study is registered as PROSPERO CRD42016052324. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fay Crawford
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
- The Sir James Mackenzie Institute for Early Diagnosis, The School of Medicine, University of St Andrews, St Andrews, UK
| | - Francesca M Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Lewsey
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Neil Hawkins
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald Nicolson
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Smith
- Library & Knowledge Service, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | | | - Aparna Amanna
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Angela Martin
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Saket Gupta
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Karen Gray
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julie Brittenden
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Graham Leese
- Diabetes and Endocrinology, Ninewells Hospital, NHS Tayside, Dundee, UK
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Korada H, Maiya A, Rao SK, Hande M. Effectiveness of customized insoles on maximum plantar pressure in diabetic foot syndrome: A systematic review. Diabetes Metab Syndr 2020; 14:1093-1099. [PMID: 32652497 DOI: 10.1016/j.dsx.2020.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Diabetic foot syndrome is a severe complication of type 2 diabetes mellitus with diabetic peripheral neuropathy. Increased maximum plantar pressure is a strong predictor that may be detrimental and cause a plantar ulcer. This present systematic review aims to evaluate the effectiveness of customized insoles on reducing maximum plantar pressure in diabetic foot syndrome. METHODS We conducted a systematic review (PubMed, Cochrane Database of Systematic Reviews, CINAHL, Pedro, Scopus) to summarize the evidence on the customized insole on maximum plantar pressure in diabetic foot syndrome. Randomized and non-randomized studies were included in the review. The quality of the included studies was assessed independently by the two review authors with the Modified Downs and Black checklist for the assessment of the methodological quality of both randomized and non-randomized studies. RESULTS A total of 1512 studies screened. After the exclusion criteria, 5 studies were included in the study. The outcome measure that was considered is maximum plantar pressure and pressure-time integral. CONCLUSIONS We concluded that the practice of customized insoles could significantly reduce maximum plantar pressure. While developing an insole, parameters like contoured insoles with shape and pressure based, weight-bearing position, and duration with good adherence to footwear application can significantly reduce maximum plantar pressure.
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Affiliation(s)
- Hrishikesh Korada
- Centre for Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Centre for Diabetic Foot Care and Research, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Sharath Kumar Rao
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manjunath Hande
- Comprehensive Geriatric Clinic, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Crawford F, Nicolson DJ, Amanna AE, Martin A, Gupta S, Leese GP, Heggie R, Chappell FM, McIntosh HH. Preventing foot ulceration in diabetes: systematic review and meta-analyses of RCT data. Diabetologia 2020; 63:49-64. [PMID: 31773194 PMCID: PMC6890632 DOI: 10.1007/s00125-019-05020-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
AIMS/HYPOTHESIS Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data. METHODS We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses. RESULTS Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions. CONCLUSIONS/INTERPRETATION Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.
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Affiliation(s)
- Fay Crawford
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK.
- School of Medicine, University of St Andrews, Fife, UK.
| | | | - Aparna E Amanna
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | - Angela Martin
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | - Saket Gupta
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | | | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA) Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Francesca M Chappell
- The Centre for Clinical Brain Sciences (CCBS) Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
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Collings R, Freeman J, Latour JM, Glasser S, Paton J. Footwear and insole design features to prevent foot ulceration in people with diabetes: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:1824-1834. [PMID: 28708747 DOI: 10.11124/jbisrir-2016-003291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The aim of this systematic review is to identify the key design features of footwear and insoles that are used to offload the plantar surface of the foot to prevent foot ulceration in adults with diabetes.More specifically, the objectives are to identify the key design features of footwear and insoles to offload the plantar surface of the foot with regard to.
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Affiliation(s)
- Richard Collings
- 1School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, United Kingdom 2Department of Podiatry, Torbay and Southern Devon NHS Foundation Trust, Torquay, United Kingdom 3School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, United Kingdom 4The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence
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Reduction of relative centrifugal forces increases growth factor release within solid platelet-rich-fibrin (PRF)-based matrices: a proof of concept of LSCC (low speed centrifugation concept). Eur J Trauma Emerg Surg 2017; 45:467-479. [PMID: 28324162 PMCID: PMC6579868 DOI: 10.1007/s00068-017-0785-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/10/2017] [Indexed: 02/05/2023]
Abstract
Purpose The present study evaluated the platelet distribution pattern and growth factor release (VEGF, TGF-β1 and EGF) within three PRF (platelet-rich-fibrin) matrices (PRF, A-PRF and A-PRF+) that were prepared using different relative centrifugation forces (RCF) and centrifugation times. Materials and methods immunohistochemistry was conducted to assess the platelet distribution pattern within three PRF matrices. The growth factor release was measured over 10 days using ELISA. Results The VEGF protein content showed the highest release on day 7; A-PRF+ showed a significantly higher rate than A-PRF and PRF. The accumulated release on day 10 was significantly higher in A-PRF+ compared with A-PRF and PRF. TGF-β1 release in A-PRF and A-PRF+ showed significantly higher values on days 7 and 10 compared with PRF. EGF release revealed a maximum at 24 h in all groups. Toward the end of the study, A-PRF+ demonstrated significantly higher EGF release than PRF. The accumulated growth factor releases of TGF-β1 and EGF on day 10 were significantly higher in A-PRF+ and A-PRF than in PRF. Moreover, platelets were located homogenously throughout the matrix in the A-PRF and A-PRF+ groups, whereas platelets in PRF were primarily observed within the lower portion. Discussion the present results show an increase growthfactor release by decreased RCF. However, further studies must be conducted to examine the extent to which enhancing the amount and the rate of released growth factors influence wound healing and biomaterial-based tissue regeneration. Conclusion These outcomes accentuate the fact that with a reduction of RCF according to the previously LSCC (described low speed centrifugation concept), growth factor release can be increased in leukocytes and platelets within the solid PRF matrices.
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