Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL, et al.
Diabetes/metabolism research and reviews. Date of publication 2013 Mar 1;volume 29(3):183-93.
1. Diabetes Metab Res Rev. 2013 Mar;29(3):183-93. doi: 10.1002/dmrr.2386.
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(1), Buckley ES, Jones S, Reddin EA, Merlin TL.
Author information:
(1)Adelaide Health Technology Assessment, Discipline of Public Health, School of
Population Health, University of Adelaide, Adelaide, South Australia, Australia.
judy.morona@adelaide.edu.au
Effective off-loading is considered to be an important part of the successful
clinical management of diabetic foot ulcers. 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. The medical literature was extensively
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 to determine their risk of methodological bias,
and data were extracted. Results were pooled using random effects meta-analysis
and tested for heterogeneity. When compared with removable devices, non-removable
off-loading devices were found, on average, to be more effective at promoting the
healing of diabetic foot ulcers (RRp = 1.43; 95% CI 1.11, 1.84; I(2) = 66.9%; p
= 0.001; k = 10). Analysis, stratified by type of removable device, did not
detect a statistically significant difference between non-removable off-loading
devices and removable cast walkers; however, on average non-removable off-loading
devices performed better than therapeutic shoes at promoting the healing of
diabetic foot ulcers (RRp = 1.68; 95% CI 1.09, 2.58; I(2) = 71.5%; p = 0.004; k
= 6). The two types of non-removable off-loading devices i.e. total contact casts
and instant total contact casts (removable cast walker rendered irremovable by
securing with bandage or lace), were found to be equally effective (RRp = 1.06;
95% CI 0.88, 1.27; I(2) = 3.3%; p = 0.31; k = 2). In conclusion, non-removable
off-loading devices 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 © 2013 John Wiley & Sons, Ltd.
DOI: 10.1002/dmrr.2386
PMID: 23303652 [Indexed for MEDLINE]
