Efeitos da espuma de feltro no tratamento do pé diabético: revisão sistemática com metanálise

Abstract

RESUMO Objetivo: Avaliar os efeitos da espuma de feltro no tratamento da úlcera plantar do pé diabético. Método: Revisão sistemática, com metanálise. As buscas foram realizadas na Cochrane Library, PubMed, CINAHL, Science Direct, Web of Science, SCOPUS, IBECS e LILACS. A Cochrane Collaboration Risk of Bias Tool foi utilizada para a avaliação do risco de viés. As metanálises foram calculadas pelo programa Review Manager, enquanto o Grades of Recommendation, Assessment, Development and Evaluation foi utilizado para a avaliação da qualidade da evidência. Resultados: Foram incluídos quatro ensaios clínicos e duas coortes. Houve a redução de 10,77 quilos pascais (IC 95% −14,92, −6,62; p<0,001) na média de pressão plantar dos indivíduos expostos ao feltro. Conclusão: Evidenciou-se maior redução da pressão plantar com o uso do feltro. Recomenda-se o desenvolvimento de novos modelos de órteses de alívio de pressão plantar a partir da espuma de feltro, acompanhado de mais pesquisas clínicas que elucidem outros desfechos relacionados.

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

“…Over the last decade there have been over 20 systematic reviews on different offloading interventions in people with DFU 27,30–33,52,56,173–185 . Therefore, we limit our comparisons of findings in our new review to those of our previous review of all offloading interventions, 33 and all other reviews performing meta‐analyses on different offloading interventions 27,29–32,52,174,183,184 …”

“…For other non‐surgical offloading interventions, only one review 52 pooled findings, and also found felted foam with removable devices may decrease plantar pressure more than a device alone (Other: MD 107 kPa lower vs. Our: MD 98 kPa lower). Further, they assessed the CoE as moderate certainty due to serious imprecision, whereas we assessed CoE as very low certainty as these findings were based on non‐controlled studies only and had serious indirectness.…”

“…A validation set of 10 studies was created, 12,37,[46][47][48][49][50][51][52][53] that included key offloading studies published since our previous search (13 August 2018). 33 Using this set, the search strings were validated by ensuring each study in the set was identified, before the search strings were finalised and used in this review.…”

“…Over the last decade there have been over 20 systematic reviews on different offloading interventions in people with DFU. 27,[30][31][32][33]52,56,[173][174][175][176][177][178][179][180][181][182][183][184][185] Therefore, we limit our comparisons of findings in our new review to those of our previous review of all offloading interventions, 33 and all other reviews performing meta-analyses on different offloading interventions. 27,[29][30][31][32]52,174,183,184 Compared to our previous review, 33 our new review has made many methodological improvements.…”

“…27,[30][31][32][33]52,56,[173][174][175][176][177][178][179][180][181][182][183][184][185] Therefore, we limit our comparisons of findings in our new review to those of our previous review of all offloading interventions, 33 and all other reviews performing meta-analyses on different offloading interventions. 27,[29][30][31][32]52,174,183,184 Compared to our previous review, 33 our new review has made many methodological improvements. These include investigating additional comparisons and outcomes, identifying additional included studies, performing meta-analyses, more rigorously assessing effect sizes and certainty of evidence, and using SoF tables in line with the GRADE approach.…”