A systematic review of outcome reporting for interventions to treat people with diabetic foot ulceration

Dovell, George; Staniszewska, Aleksandra; Ramirez, Jozel; Murray, Inés; Ambler, Graeme K.; Twine, Christopher P.; Hinchliffe, Robert J.

doi:10.1111/dme.14664

Cited by 9 publications

(18 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 Next, these were independently rated on importance by the 11 external experts and 2 patient representatives, with a score of 1 (not important), 2 (of some importance), or 3 (very important). Subsequently, each member of the working group independently rated the outcomes according to GRADE as 'not important for decision-making' (score 1-3), 'important but not critical for decision-making' (score 4-6), 'critically important for decision-making' (score [7][8][9]. Group means and medians were calculated and discussed in a meeting with all authors until a consensus was reached for the selection of 12 outcomes that were considered the most important.…”

Section: Discussionmentioning

confidence: 99%

Classification of foot ulcers in people with diabetes: A systematic review

Monteiro‐Soares

Hamilton

Russell

et al. 2023

Diabetes Metabolism Res

View full text Add to dashboard Cite

BackgroundClassification and scoring systems can help both clinical management and audit the outcomes of routine care.AimThis study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.MethodsWe searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer.ResultsWe found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt‐Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer‐free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.ConclusionDespite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.

show abstract

Section: Discussionmentioning

confidence: 99%

Classification of foot ulcers in people with diabetes: A systematic review

Monteiro‐Soares

Hamilton

Russell

et al. 2023

Diabetes Metabolism Res

View full text Add to dashboard Cite

show abstract

“…In 2016, recommended reporting standards for research of intervention studies in DFU were published, which included specific data points when reporting on participants, interventions and outcomes 34 . The broad range of ulcer related outcomes reported in DFU research was highlighted as part of the COMET core outcome setting exercise 35 . In the review by Dovell et al there were 714 different outcomes reported in the DFU literature 35 .…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review

Hitchman

Totty

Smith

et al. 2022

International Wound Journal

View full text Add to dashboard Cite

Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses.Databases were searched for trials comparing ESWT plus standard care to standard care alone in participants with DFUs. Search results were reviewed by two independent reviewers. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. The primary outcome was time to healing. The search identified 345 papers after duplicates removed. Six trials consisting of 471 participants were included. There was unclear or high risk of bias across all domains. Time to ulcer healing was probably shorter in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). Patients treated with ESWT were more likely to heal at 20 weeks post-ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). There was significant heterogeneity. ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.diabetic foot, extracorporeal shockwave therapy, foot ulcer, shockwave therapy, wound healing Key Messages• there is a high level of uncertainty in the evidence on the clinical effectiveness of extracorporeal shockwave therapy in reducing diabetic foot ulcer healing time. All current randomised controlled trials are limited by an uncertain to high risk of bias • Future research should explore whether there is a dose dependant relationship between ESWT and time to DFU healing

show abstract

“…A core outcome set for DFU needs to be developed to allow the consistent measurement of outcomes in future studies to effectively compare the data regarding the effects of psychological interventions on DFU. 3 A systematic review was published subsequent to this Cochrane review and found low evidence on the effect of psychosocial interventions on DFU. 4 Similar recommendations for more high-quality research were made.…”

mentioning

confidence: 99%