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Huang J, Fan C, Ma Y, Huang G. Exploring Thermal Dynamics in Wound Healing: The Impact of Temperature and Microenvironment. Clin Cosmet Investig Dermatol 2024; 17:1251-1258. [PMID: 38827629 PMCID: PMC11144001 DOI: 10.2147/ccid.s468396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/18/2024] [Indexed: 06/04/2024]
Abstract
Exploring the critical role of thermal dynamics in wound healing, this manuscript navigates through the complex biological responses initiated upon wound infliction and how temperature variations influence the healing trajectory. Integrating biothermal physics, clinical medicine, and biomedical engineering, it highlights the significance of thermal management in wound care, emphasizing the wound microenvironment's division into internal and external domains and their collaborative impact on tissue repair. Innovations in real-time wound temperature monitoring, especially through intelligent wireless sensor dressings, are spotlighted as transformative, enabling precise wound condition management. The text underscores the necessity for further research to elucidate thermal regulation's molecular and cellular mechanisms on healing processes. It advocates for standardized protocols for localized heating treatments, integrating them into personalized wound care strategies to enhance therapeutic outcomes, improve patient well-being, and achieve cost-effective healthcare practices. This work presents a forward-looking perspective on refining wound management through sophisticated, evidence-based interventions, emphasizing the interplay between thermal dynamics and wound healing.
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Affiliation(s)
- Jun Huang
- Department of Clinical Medicine, Shandong Second Medical University (Weifang Medical University), Weifang, 261000, People’s Republic of China
- Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Chunjie Fan
- Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Yindong Ma
- Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Guobao Huang
- Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
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Ming A, Alhajjar A, Walter I, Piehler C, Hoetzsch J, Leuckert M, Clemens V, Petrow A, Siddiquee IM, Scurt FG, Isermann B, Mertens PR. Telemedical Monitoring of Plantar Temperature in Diabetic Patients at Risk of Foot Ulcers. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:9-16. [PMID: 38015655 PMCID: PMC10916763 DOI: 10.3238/arztebl.m2023.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The worldwide prevalence of diabetic foot ulcers (DFUs) among persons with diabetes is estimated at 6.3%, with an annual incidence of 9.1 to 26.1 million persons. The early detection of asymmetrical plantar temperature elevation, followed by reduction of weight-bearing on the affected foot, may be an effective mode of prevention. METHODS Patients with diabetes and peripheral neuropathy (DFU risk groups 2/3) were monitored for plantar abnormalities with a telemedical system consisting of sole inserts with temperature sensors and photographic documentation. An open, prospective, randomized controlled trial was performed to determine whether this system prevented DFUs. The intervention and control groups were also trained in ulcer prevention and observed in follow-up at 6-month intervals for 24 months. RESULTS 283 patients were recruited. In 85 137 observation days, DFUs arose in five patients in the control group (n = 143) and in no patient in the intervention group (n = 140). The primary outcome measure was the hazard ratio, which was calculated to be 0.015 (95% confidence interval [0; 19,717]; p = 0.25) after adjustment for age, sex, severity of neuropathy, and risk class. There were 239 alarms and 75 instructions to reduce weight-bearing on the foot. The subjects carried out the telemedical application on about 70% of the days of observation. Quality of life improved in both groups. CONCLUSION The tele-health system used in this trial is practical and enables the early detection of morbidity. Likely explanations for the unexpectedly low ulceration rate in this trial (and, in turn, for the lack of statistical significance) include the availability of a training program and regular follow-up examinations to patients in both arms of the trial, along with lower mobility levels due to the COVID pandemic.
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Affiliation(s)
- Antao Ming
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Ahmad Alhajjar
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Isabell Walter
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Claudia Piehler
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Jacqueline Hoetzsch
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Martin Leuckert
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Vera Clemens
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Andreas Petrow
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Istiyak M. Siddiquee
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Florian G. Scurt
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
| | - Berend Isermann
- Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnosis, University Hospital Leipzig, University of Leipzig
| | - Peter R. Mertens
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, University Hospital, Otto-von-Guericke University, Magdeburg
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Lazarides MK, Rerkasem K, Papanas N. Chronic Wound Management: New Knowledge Still Required for This Constant Challenge. INT J LOW EXTR WOUND 2023; 22:633-634. [PMID: 37559384 DOI: 10.1177/15347346231194417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Miltos K Lazarides
- Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kittipan Rerkasem
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nikolaos Papanas
- Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Qin Q, Oe M, Nakagami G, Kashiwabara K, Sugama J, Sanada H, Jais S. The effectiveness of a thermography-driven preventive foot care protocol on the recurrence of diabetic foot ulcers in low-medical resource settings: An open-labeled randomized controlled trial. Int J Nurs Stud 2023; 146:104571. [PMID: 37586286 DOI: 10.1016/j.ijnurstu.2023.104571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Plantar temperature monitoring, along with a comprehensive preventive foot care approach, is utilized to prevent recurrence of diabetic foot ulcers. However, there is a lack of standardized protocols for individuals with diabetic foot ulcer history in low-medical resource countries. OBJECTIVE This study investigated the efficacy of nurse-led, thermographic-evaluation-guided foot care in preventing diabetic foot ulcer recurrence in a low-medical resource country. DESIGN Single-blind, 1:1 allocation randomized controlled trial. SETTINGS Two wound care facilities with wound care nurse specialists in Indonesia. PARTICIPANTS 120 patients with a diabetic foot ulcer history. INTERVENTION In the intervention group, baseline risk assessment including smartphone thermography evaluation was performed. Personalized foot care and education were conducted monthly for participants whose thermographs showed increased foot lesion temperature at baseline risk assessment. The control group received usual care and education using a booklet at baseline. The follow-up period was six months. MAIN OUTCOME Time to recurrence was evaluated using Kaplan-Meier survival analysis, and between-group comparisons were performed using the log-rank test. Potential risk factors were incorporated into the multivariate Cox regression model. Secondary outcomes included quality of life (European Quality of Life 5 Dimensions 3 Level Version) and foot care behavior, were analyzed using Mixed Models for Repeated Measures at baseline, third, and sixth follow-up (3 and 6 months from baseline). RESULTS 120 participants (intervention 60, control 60) were randomized. The intervention group had a significantly lower recurrence rate than the control group (15% vs. 35%, p = 0.011) and a significant difference in time to ulceration (log-rank test, p = 0.009) after a 6-month follow-up period. Intervention care reduced the risk of diabetic foot ulcer recurrence by 59% (Hazard ratio 0.41, 95% confidence interval 0.18, 0.96, p = 0.039) in multivariate Cox regression analysis. On the third follow-up, total diabetic foot care behavior score (p < 0.001) was significantly improved by the intervention. On the sixth follow-up, mobility (p = 0.020), self-care (p = 0.023), pain/discomfort (p < 0.001), anxiety/depression (p = 0.016), EuroQol Visual Analogue Scale score (p = 0.002), and total diabetic foot care behavior score (p < 0.001) showed significant improvements in the intervention group. CONCLUSIONS Foot care and personalized education delivered at a frequency based on the risk level assessed by thermography effectively reduced diabetic foot ulcer recurrence, and improved quality of life and foot care behaviors. REGISTRATION NUMBER UMIN000039012. TWEETABLE ABSTRACT Nurse-led diabetic foot care and education reduced diabetic foot ulcer recurrence in Indonesia.
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Affiliation(s)
- Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Oe
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kosuke Kashiwabara
- Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | - Hiromi Sanada
- Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Suriadi Jais
- The Nursing Institute of Muhammadiyah Pontianak, Pontianak, Indonesia.
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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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Holistic multi-class classification & grading of diabetic foot ulcerations from plantar thermal images using deep learning. Health Inf Sci Syst 2022; 10:21. [PMID: 36039095 PMCID: PMC9418397 DOI: 10.1007/s13755-022-00194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Diabetic foot is a common complication associated with diabetes mellitus (DM) leading to ulcerations in the feet. Due to diabetic neuropathy, most patients have reduced sensitivity to pain. As a result, minor injuries go unnoticed and progress into ulcers. The timely detection of potential ulceration points and intervention is crucial in preventing amputation. Changes in plantar temperature are one of the early signs of ulceration. Previous studies have focused on either binary classification or grading of DM severity, but neglect the holistic consideration of the problem. Moreover, multi-class studies exhibit severe performance variations between different classes. Methods We propose a new convolutional neural network for discrimination between non-DM and five DM severity grades from plantar thermal images and compare its performance against pre-trained networks such as AlexNet and related works. We address the lack of data and imbalanced class distribution, prevalent in prior work, achieving well-balanced classification performance. Results Our proposed model achieved the best performance with a mean accuracy of 0.9827, mean sensitivity of 0.9684 and mean specificity of 0.9892 in combined diabetic foot detection and grading. Conclusion To the best of our knowledge, this study sets a new state-of-the-art in plantar foot thermogram detection and grading, while being the first to implement a holistic multi-class classification and grading solution. Reliable automatic thermogram grading is a first step towards the development of smart health devices for DM patients.
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Qin Q, Nakagami G, Ohashi Y, Dai M, Sanada H, Oe M. Development of a self-monitoring tool for diabetic foot prevention using smartphone-based thermography: Plantar thermal pattern changes and usability in the home environment. Drug Discov Ther 2022; 16:169-176. [PMID: 36002308 DOI: 10.5582/ddt.2022.01050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thermography is a well-known risk-assessment tool for diabetic foot ulcers but is not widely used in the home setting due to the influence of the complicated home environment on thermographic images. This study investigated changes in thermographic images in complicated home environments to determine the feasibility of smartphone-based thermography in home settings. Healthy volunteers (age > 20 years) were recruited and required to take plantar thermal images using smartphone-based thermography attached to a selfie stick at different times of the day for 4 days. The thermal images and associated activities and environmental factors were then analyzed using content analysis. Areas with the highest temperature on the plantar thermal images were described and categorized. Device usability was evaluated using 10-point Likert scales, with 10 representing the highest satisfaction. A total of 140 plantar thermal images from 10 participants were analyzed. In 12 classifications, the three commonest patterns based on the highest temperature location were medial arch (42.1%), whole plantar (10.7%), and forefoot and medial arch (7.9%). The medial arch pattern is most frequently seen after awakening (67.5%) compared to other time points. Device usability was rated 7.5 out of 10 on average. This study was the first to investigate the plantar thermal patterns in the home settings, and the medial arch pattern was the most common hot area, which matches previous findings in well-controlled clinical settings. Therefore, smartphone-based thermography may be feasible as a self-assessment tool in the home setting.
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Affiliation(s)
- Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Misako Dai
- Research Center for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Oe
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Araújo ALD, Negreiros FDDS, Florêncio RS, Oliveira SKPD, Silva ARVD, Moreira TMM. Effect of thermometry on the prevention of diabetic foot ulcers: a systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3567. [PMID: 35584410 DOI: 10.1590/1518-8345.5663.3567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. METHOD a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. CONCLUSION thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.
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Affiliation(s)
- Açucena Leal de Araújo
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | | | - Thereza Maria Magalhães Moreira
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil.,Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
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Araújo ALD, Negreiros FDDS, Florêncio RS, Oliveira SKPD, Silva ARVD, Moreira TMM. Efecto de la termometría en la prevención de las úlceras del pie diabético: revisión sistemática con metaanálisis. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5663.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumen Objetivo: analizar el efecto de la termometría cutánea del pie en personas con diabetes mellitus, en comparación con la prevención estándar de las úlceras del pie adoptada en estos pacientes. Método: revisión sistemática con metaanálisis. Protocolo registrado en PROSPERO (CRD42020202686). Se siguieron las recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se realizó en las fuentes de datos: SCOPUS, Web of Science, MEDLINE a través de PubMed, MEDLINE a través de EBSCO, MEDLINE a través de la Biblioteca Virtual en Salud, Embase, CINAHL, Cochrane Library, LILACS a través de la Biblioteca Virtual en Salud, Google Scholar, Biblioteca Digital Brasileña de Tesis y Disertaciones, Catálogo de Tesis y Disertaciones-Capes, Open Grey y ProQuest Dissertations and Theses. El riesgo de sesgo se evaluó mediante la Cochrane Collaboration Risk of Bias Tool (RoB 2), el metaanálisis se realizó con el software Review Manager 5.4 y la certeza de la evidencia se evaluó mediante el sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: de los 670 registros, cinco artículos fueron elegibles. El metaanálisis se calculó para el resultado prevención de la incidencia de úlceras del pie diabético, con sumarización del efecto (RR 0,53; IC95% 0,29, 0,96; p=0,02), con certeza de evidencia moderada. Conclusión: la termometría mostró un efecto protector sobre la incidencia de úlceras del pie diabético en comparación con el cuidado estándar del pie.
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Affiliation(s)
- Açucena Leal de Araújo
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
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Araújo ALD, Negreiros FDDS, Florêncio RS, Oliveira SKPD, Silva ARVD, Moreira TMM. Effect of thermometry on the prevention of diabetic foot ulcers: a systematic review with meta-analysis*. Rev Lat Am Enfermagem 2022. [PMID: 35584410 PMCID: PMC9109465 DOI: 10.1590/1518-8345.5663.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. Method: a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. Results: of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. Conclusion: thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.
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Affiliation(s)
- Açucena Leal de Araújo
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
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Bus SA, Aan de Stegge WB, van Baal JG, Busch-Westbroek TE, Nollet F, van Netten JJ. Effectiveness of at-home skin temperature monitoring in reducing the incidence of foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial (DIATEMP). BMJ Open Diabetes Res Care 2021; 9:9/1/e002392. [PMID: 34493496 PMCID: PMC8424833 DOI: 10.1136/bmjdrc-2021-002392] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The skin of people with diabetic foot disease is thought to heat up from ambulatory activity before it breaks down into ulceration. This allows for early recognition of imminent ulcers. We assessed whether at-home monitoring of plantar foot skin temperature can help prevent ulcer recurrence in diabetes. RESEARCH DESIGN AND METHODS In this parallel-group outcome-assessor-blinded multicenter randomized controlled trial (7 hospitals, 4 podiatry practices), we randomly assigned people with diabetes, neuropathy, foot ulcer history (<4 years, n=295), or Charcot's neuro-arthropathy (n=9) to usual care (ie, podiatric treatment, education, and therapeutic footwear) or usual care plus measuring skin temperatures at 6-8 plantar sites per foot each day (enhanced therapy). If ∆T>2.2°C between corresponding sites on the left and right foot for two consecutive days, participants were instructed to reduce ambulatory activity until this hotspot disappeared and contact their podiatrist. Primary outcome was ulcer recurrence in 18 months on the plantar foot, interdigital, or medial/lateral/anterior forefoot surfaces; secondary outcome was ulcer recurrence at any foot site. RESULTS On the basis of intention-to-treat, 44 of 151 (29.1%) participants in enhanced therapy and 57 of 153 (37.3%) in usual care had ulcer recurrence at a primary outcome site (RR: 0.782 (95%CI 0.566 to 1.080), p=0.133). Of the 83 participants in enhanced therapy who measured a hotspot, the 24 subsequently reducing their ambulatory activity had significantly fewer ulcer recurrences (n=3) than those in usual care (RR: 0.336 (95% CI 0.114 to 0.986), p=0.017). Enhanced therapy was effective over usual care for ulcer recurrence at any foot site (RR: 0.760 (95% CI 0.579 to 0.997), p=0.046). CONCLUSIONS At-home foot temperature monitoring does not significantly reduce incidence of diabetic foot ulcer recurrence at or adjacent to measurement sites over usual care, unless participants reduce ambulatory activity when hotspots are found, or when aiming to prevent ulcers at any foot site. TRIAL REGISTRATION NUMBER NTR5403.
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Affiliation(s)
- Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Wouter B Aan de Stegge
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The Netherlands
| | - Jeff G van Baal
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frans Nollet
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Alahakoon C, Fernando M, Galappaththy C, Matthews EO, Lazzarini P, Moxon JV, Golledge J. Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 2020; 37:1266-1279. [PMID: 32426872 DOI: 10.1111/dme.14323] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim of this study was to perform an up-to-date systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of home foot temperature monitoring, patient education and offloading footwear in reducing the incidence of diabetes-related foot ulcers. METHODS A literature search was performed using MEDLINE, PubMed, CINAHL, Scopus and Cochrane databases to identify relevant original studies. Meta-analyses were performed using intention-to-treat principals for worst (main analysis) and best (sub-analysis) case scenarios. Leave-one-out sensitivity analyses were used to assess the consistency of findings. RESULTS Of 7575 unique records, 17 RCTs involving 2729 participants were included. Four tested home foot temperature monitoring (n = 468), six examined patient education (n = 823) and seven assessed offloading footwear (n = 1438). Participants' who performed home foot temperature monitoring [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.31 to 0.84; n = 468] and those provided offloading footwear (OR 0.48, 95% CI 0.29 to 0.80; n = 1438) were less likely to develop a diabetes-related foot ulcer. Patient education programmes did not significantly reduce diabetes-related foot ulcer incidence (OR 0.59, 95% CI 0.29 to 1.20; n = 823). Sensitivity analyses suggested that offloading footwear findings were consistent, but home foot temperature findings were dependent on the individual inclusion of one trial. All RCTs had either high or unclear risk of bias. CONCLUSION This meta-analysis suggests that offloading footwear is effective in reducing the incidence of diabetes-related foot ulcers. Home foot temperature monitoring also appears beneficial but larger trials are needed (PROSPERO registration no.: CRD42019135226).
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Affiliation(s)
- C Alahakoon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M Fernando
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - C Galappaththy
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
| | - E O Matthews
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
| | - P Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - J V Moxon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - J Golledge
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
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