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Meta-Analysis
. 2023 Mar 25;16(1):16.
doi: 10.1186/s13047-023-00614-2.

Rehabilitation for people wearing offloading devices for diabetes-related foot ulcers: a systematic review and meta-analyses

K Jones  1 , M R Backhouse  2   3 , J Bruce  2   3
Affiliations
Meta-Analysis

Rehabilitation for people wearing offloading devices for diabetes-related foot ulcers: a systematic review and meta-analyses

K Jones et al. J Foot Ankle Res. .

Abstract

Background: Offloading devices improve healing of diabetes-related foot ulcers (DFUs) but they can limit mobilisation. Rehabilitation during or after removal of these devices may promote physical activity in a population at risk of poor health outcomes for which inactivity is a reversible risk factor.

Methods: This systematic review examined the effectiveness of rehabilitation interventions to promote physical activity during and/or after wearing an offloading device to treat diabetes-related foot ulcers. Searches using MESH terms and free-text combinations: 'foot ulcer', 'diabetic foot', 'casts, surgical', 'orthotic devices' were applied to MEDLINE, Embase, The Cochrane Library and clinical trial registers for randomised and observational studies published to September 2022. Methodological quality assessment of included studies was undertaken using the Cochrane Risk of Bias (RoB 2.0) and Risk of Bias In Non-randomised studies of Interventions (ROBINS-I) tools.

Results: Of 3332 records identified, eight studies (441 participants), four clinical trials and four cohort studies, were included. None delivered or tested a structured rehabilitation programme, but all reported physical activity outcomes during or after device use. People wearing non-removable total contact casts were less active than those wearing devices (SMD -0.45; 95% CI - 0.87 to - 0.04; p = 0.03; I2 56%; 4 trials). Diabetes-related foot ulcers in people wearing total contact casts were more likely to heal compared to removable devices at 12 weeks (OR 2.69; 95% CI 0.97 to 7.45; p = 0.06; I2 = 64%; 4 trials) and 20 weeks (OR 2.35; 95% CI 0.95 to 5.82; p = 0.07; I2 = 65%; 4 trials).

Conclusions: Despite physical activity being low throughout off-loading treatment, no studies have specifically tested rehabilitation. There is a need to investigate the clinical and cost-effectiveness of rehabilitation programmes in this population. High quality trials are needed to provide robust evidence to support to rehabilitation after DFU treatment.

Keywords: Diabetes-related foot ulcer; Offloading device; Rehabilitation.

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Conflict of interest statement

MB is a member of the Journal of Foot and Ankle Research Editorial Board.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of literature search and phases of study selection; n, number; CENTRAL, Cochrane Central Register of Controlled Trials
Fig. 2
Fig. 2
Forest plot comparing physical activity by type of offloading device at 12 weeks. SD, Standard Deviation; Std, Standard; IV, Weight Mean Difference; CI, Confidence Interval; TCC: Total contact cast
Fig. 3
Fig. 3
Forest plot of ulcer healing after wearing an offloading device at 12 weeks. TCC, Total Contact Cast; CI, Confidence Interval; M-H, Mantel Haenszel
See this image and copyright information in PMC

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