{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:32:18Z","timestamp":1792801938138,"version":"4.5.0"},"reference-count":202,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Offloading treatment is crucial to heal diabetes\u2010related foot ulcers (DFU). This systematic review aimed to assess the effectiveness of offloading interventions for people with DFU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, EMBASE, Cochrane databases, and trials registries for all studies relating to offloading interventions in people with DFU to address 14 clinical question comparisons. Outcomes included ulcers healed, plantar pressure, weight\u2010bearing activity, adherence, new lesions, falls, infections, amputations, quality of life, costs, cost\u2010effectiveness, balance, and sustained healing. Included controlled studies were independently assessed for risk of bias and had key data extracted. Meta\u2010analyses were performed when outcome data from studies could be pooled. Evidence statements were developed using the GRADE approach when outcome data existed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 19,923 studies screened, 194 eligible studies were identified (47 controlled, 147 non\u2010controlled), 35 meta\u2010analyses performed, and 128 evidence statements developed. We found non\u2010removable offloading devices likely increase ulcers healed compared to removable offloading devices (risk ratio [RR] 1.24, 95% CI 1.09\u20131.41;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a014,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01083), and may increase adherence, cost\u2010effectiveness and decrease infections, but may increase new lesions. Removable knee\u2010high offloading devices may make little difference to ulcers healed compared to removable ankle\u2010high offloading devices (RR 1.00, 0.86\u20131.16;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a06,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0439), but may decrease plantar pressure and adherence. Any offloading device may increase ulcers healed (RR 1.39, 0.89\u20132.18;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a05,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0235) and cost\u2010effectiveness compared to therapeutic footwear and may decrease plantar pressure and infections. Digital flexor tenotomies with offloading devices likely increase ulcers healed (RR 2.43, 1.05\u20135.59;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a01,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a016) and sustained healing compared to devices alone, and may decrease plantar pressure and infections, but may increase new transfer lesions. Achilles tendon lengthening with offloading devices likely increase ulcers healed (RR 1.10, 0.97\u20131.27;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a01,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a064) and sustained healing compared to devices alone, but likely increase new heel ulcers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non\u2010removable offloading devices are likely superior to all other offloading interventions to heal most plantar DFU. Digital flexor tenotomies and Achilles tendon lengthening in combination with offloading devices are likely superior for some specific plantar DFU locations. Otherwise, any offloading device is probably superior to therapeutic footwear and other non\u2010surgical offloading interventions to heal most plantar DFU. However, all these interventions have low\u2010to\u2010moderate certainty of evidence supporting their outcomes and more high\u2010quality trials are needed to improve our certainty for the effectiveness of most offloading interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3650","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T01:50:20Z","timestamp":1686275420000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Effectiveness of offloading interventions for people with diabetes\u2010related foot ulcers: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-7964","authenticated-orcid":false,"given":"P. A.","family":"Lazzarini","sequence":"first","affiliation":[{"name":"School of Public Health and Social Work Queensland University of Technology  Brisbane Queensland Australia"},{"name":"Allied Health Research Collaborative The Prince Charles Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery Keck School of Medicine of University of Southern California (USC)  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. T.","family":"Crews","sequence":"additional","affiliation":[{"name":"Dr. William M. 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