OFFLOADING FOR THE TREATMENT OF DIABETIC FOOT ULCERS - A SYSTEMATIC REVIEW
A systematic review of the literature was undertaken, using the guidance of the Cochrane Collaboration.
3. DEFINITION OF TERMS
Diabetic Foot Ulcers wounds that occur on the feet of people with type 1 and type 2 diabetes. Diabetic foot ulcers usually occur on the bottom of the foot.6
Offloading is a treatment and prevention intervention with the objective of relieving, reducing or redistributing plantar pressure evenly, to avoid the concentration of high pressure in the feet and to protect pressure points.3,6
4. REVIEW QUESTION
What is the impact of offloading in the treatment of diabetic foot ulcers?
6. INCLUSION & EXCLUSION CRITERIA
All studies, in English or Portuguese, where different types of casts, therapeutic shoes and other orthotic devices were compared and analysed in adult patients with only diabetic foot ulcers were included. Studies where participants were reported to have foot deformities and artropathies were excluded.
7. DATA EXTRACTION & QUALITY APPRAISAL
The information extracted included: author, date of study, title, source, study geographical location, research question/aim/objectives, care setting, type of wound, inclusion/exclusion criteria, sample size, patient characteristics, design details, study type, allocation, intervention details, outcome measures, analysis, results, conclusions and recommendations
Quality appraisal was undertaken using the risk of bias assessment from RevMan 5.2 tool for all randomized controlled trials retrieved. The EBL Critical Appraisal Checklist7 was used for the other quantitative studies retrieved.
8. DATA SYNTHESIS AND ANALYSIS
In all randomized controlled trials dichotomous data were analysed in terms of risk ratio, and continuous data were analysed in terms of mean differences and were presented in a forest plot.
9. SEARCH STRATEGY
14 studies met the inclusion criteria
This systematic review has confirmed that casting is the first line of choice for the treatment of diabetic foot ulcers. studies need to address other factors such as cost, compliance and quality of life. These factors are of importance not only for clinical practice and management, but also for patients.
Offloading is a key treatment strategy for the management of diabetic foot ulceration and total contact casts were found to be the most effective devices to achieve ulcer healing. However, they are not without complications and further, their impact on cost, compliance and quality of life is not well understood.