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Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review

Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review
Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review

Background:

Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health.

Methods:

A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library) for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II) instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health.

Results:

The data collected revealed 166 publications in which the majority (102) were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests), followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II scores with 62 publications falling into the category of high quality (scores 6–7). The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166).

Conclusions:

It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field.
1757-1146
Edwards, Katherine
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Borthwick, Alan
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McCulloch, Louise
872abd51-3514-4522-8bf2-b601de8b167b
Redmond, Anthony
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Pinedo-Villanueva, Rafael
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Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Arden, Nigel
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Bowen, Catherine
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Edwards, Katherine
4c1691ce-c418-4a6c-9637-b5dd76b0be79
Borthwick, Alan
b4d1fa51-182d-4296-b5fe-5b7c32ef6f9d
McCulloch, Louise
872abd51-3514-4522-8bf2-b601de8b167b
Redmond, Anthony
c8d932ed-512b-477b-9d28-bf891bab8e21
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Bowen, Catherine
fd85c3c5-96d9-49b8-86c6-caa94e1a222b

Edwards, Katherine, Borthwick, Alan, McCulloch, Louise, Redmond, Anthony, Pinedo-Villanueva, Rafael, Prieto-Alhambra, Daniel, Judge, Andrew, Arden, Nigel and Bowen, Catherine (2017) Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review. Journal of Foot and Ankle Research, 10 (51). (doi:10.1186/s13047-017-0232-3).

Record type: Article

Abstract


Background:

Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health.

Methods:

A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library) for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II) instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health.

Results:

The data collected revealed 166 publications in which the majority (102) were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests), followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II scores with 62 publications falling into the category of high quality (scores 6–7). The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166).

Conclusions:

It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field.

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More information

Accepted/In Press date: 9 November 2017
e-pub ahead of print date: 22 November 2017

Identifiers

Local EPrints ID: 415914
URI: http://eprints.soton.ac.uk/id/eprint/415914
ISSN: 1757-1146
PURE UUID: def11cc0-6690-4c23-8577-4c00b79f544b
ORCID for Catherine Bowen: ORCID iD orcid.org/0000-0002-7252-9515

Catalogue record

Date deposited: 28 Nov 2017 17:30
Last modified: 22 Nov 2021 02:47

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Contributors

Author: Katherine Edwards
Author: Alan Borthwick
Author: Louise McCulloch
Author: Anthony Redmond
Author: Rafael Pinedo-Villanueva
Author: Daniel Prieto-Alhambra
Author: Andrew Judge
Author: Nigel Arden
Author: Catherine Bowen ORCID iD

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