Offloading Wounds: Harder to remove = easier to heal?

Here’s an intriguing meta analysis from a team in Adelaide in South Australia. Enjoy.

Comparison of the clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta-analysis.

Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL.
Diabetes Metab Res Rev. 2013 Jan 10. doi: 10.1002/dmrr.2386. [Epub ahead of print]

Adelaide Health Technology Assessment, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, South Australia, Australia.

BACKGROUND: Effective off-loading is considered to be an important part of the successful clinical management of people with diabetes, as between 15% and 25% of them will suffer from a foot ulcer during their lifetime. The aim of this systematic review is to investigate the safety and effectiveness of different off-loading devices for the treatment of diabetic foot ulcers.

METHODS: Medical bibliographic databases, the internet and reference lists were searched from January 1966 to May 2012. Systematic reviews and controlled studies that compared the use of different off-loading devices formed the evidence-base. Studies were critically appraised according to their risk of bias and data were extracted. Results were pooled using random effects meta-analysis and tested for heterogeneity.

RESULTS: When compared to removable devices, non-removable off-loading devices (NRDs) were found, on average, to be more effective at promoting the healing of diabetic foot ulcers (RR(p)  = 1.43; 95% CI 1.11, 1.84; I(2)  = 66.9%; p = 0.001; k = 10). Analysis, stratified by type of removable device, lacked power to find a statistically significant difference between NRDs and RCWs; however, on average NRDs performed better than therapeutic shoes at promoting the healing of diabetic foot ulcers (RR(p)  = 1.68; 95% CI 1.09, 2.58; I(2)  = 71.5%; p = 0.004; k = 6). The two types of NRDs (ie. total contacts casts (TCC) and instant TCCs) were found to be equally effective (RR(p)  = 1.06; 95% CI 0.88, 1.27; I(2)  = 3.3%; p = 0.31; k = 2).

CONCLUSION: NRDs, regardless of type, are more likely to result in ulcer healing than removable off-loading devices, presumably because patient compliance with off-loading is facilitated. Copyright © 2012 John Wiley & Sons, Ltd.

Copyright © 2012 John Wiley & Sons, Ltd.

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