{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:47:03Z","timestamp":1754164023381,"version":"3.41.2"},"reference-count":23,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2022,4,22]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Healing time for neuropathic planter foot ulcers (NPFUs) in persons with diabetes may be reduced through use of non-removable fiberglass total contact casting (F-TCC) compared with removable cast walkers (RCWs), although the evidence base is still growing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>We conducted a rapid review and systematically searched for, and critically assessed, randomized controlled trials (RCTs) that compared the efficacy of F-TCC versus RCW, focusing on the time to ulcer healing in adult persons (18+ years) with NPFUs and type 1 or type 2 diabetes. We meta-analysed the mean differences and associated 95% CIs using an inverse variance, random-effects model. We also conducted a trial sequential analysis (TSA) to assess if the available evidence is up to the required information size for a robust conclusion. We assessed and quantified statistical heterogeneity between the included studies using the <jats:italic>I<jats:sup>2<\/jats:sup>\n                     <\/jats:italic> statistic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 102 retrieved citations, five RCTs met the eligibility criteria. Participants\u2019 inclusion in relation to stage of ulcer was highly variable as was peripheral neuropathy complicating comparisons. F-TCC appeared to present a shorter ulcer healing time (\u22125.42\u2009days, 95%\u2009CI \u22129.66 days to \u22121.17 days; <jats:italic>I<jats:sup>2<\/jats:sup>\n                     <\/jats:italic> 9.9%; 5 RCTs; 169 participants) compared with RCW. This finding was supported by the TSA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There is limited evidence from RCTs to suggest that F-TCC has a shorter ulcer healing time compared with RCW among adults with diabetic NPFUs. Properly designed and conducted RCTs are still required for a stronger evidence base.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2022-002822","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T13:13:15Z","timestamp":1653311595000},"page":"e002822","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Offloading devices for neuropathic foot ulcers in adult persons with type 1 or type 2 diabetes: a rapid review with meta-analysis and trial sequential analysis of randomized controlled trials"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6437-930X","authenticated-orcid":false,"given":"George N","family":"Okoli","sequence":"first","affiliation":[{"name":"George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasheda","family":"Rabbani","sequence":"additional","affiliation":[{"name":"George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Otto L T","family":"Lam","sequence":"additional","affiliation":[{"name":"George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Askin","sequence":"additional","affiliation":[{"name":"Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Horsley","sequence":"additional","affiliation":[{"name":"Research Unit, The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorraine","family":"Bayliss","sequence":"additional","affiliation":[{"name":"Transdisciplinary Understanding and Training on Research (TUTOR) Primary Health Care, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ildiko","family":"Tiszovszky","sequence":"additional","affiliation":[{"name":"Independent Collaborator, Waterloo, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M","family":"Embil","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M","family":"Abou-Setta","sequence":"additional","affiliation":[{"name":"George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"2025073111384787000_10.3.e002822.1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-3930.62596"},{"key":"2025073111384787000_10.3.e002822.2","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-9021"},{"key":"2025073111384787000_10.3.e002822.3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/dmrr.2695","article-title":"Prevention and management of foot problems in diabetes: a summary guidance for daily practice 2015, based on the IWGDF guidance documents","volume":"32 Suppl 1","author":"Schaper","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"2025073111384787000_10.3.e002822.4","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/jdi.12335","article-title":"Corneal confocal microscopy: recent progress in the evaluation of diabetic neuropathy","volume":"6","author":"Papanas","year":"2015","journal-title":"J Diabetes Investig"},{"key":"2025073111384787000_10.3.e002822.5","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1016\/j.clinthera.2021.04.003","article-title":"Corneal confocal microscopy: a biomarker for diabetic peripheral neuropathy","volume":"43","author":"Petropoulos","year":"2021","journal-title":"Clin Ther"},{"key":"2025073111384787000_10.3.e002822.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-014-0081-9"},{"key":"2025073111384787000_10.3.e002822.7","first-page":"1","article-title":"Fibreglass total contact casting, removable cast walkers, and Irremovable cast walkers to treat diabetic neuropathic foot ulcers: a health technology assessment","volume":"17","author":"Ontario","year":"2017","journal-title":"Ont Health Technol Assess Ser"},{"key":"2025073111384787000_10.3.e002822.8","doi-asserted-by":"crossref","first-page":"560","DOI":"10.12968\/jowc.2015.24.12.560","article-title":"Treatment of the diabetic foot by offloading: a systematic review","volume":"24","author":"de Oliveira","year":"2015","journal-title":"J Wound Care"},{"key":"2025073111384787000_10.3.e002822.9","unstructured":"Tricco AC , Langlois EV , Straus SE . Rapid reviews to strengthen health policy and systems: a practical guide, 2017. Available: https:\/\/bit.ly\/3CH8ZwZ"},{"key":"2025073111384787000_10.3.e002822.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"2025073111384787000_10.3.e002822.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2016.01.021"},{"key":"2025073111384787000_10.3.e002822.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"2025073111384787000_10.3.e002822.13","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"2025073111384787000_10.3.e002822.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.03.013"},{"key":"2025073111384787000_10.3.e002822.15","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-0990"},{"key":"2025073111384787000_10.3.e002822.16","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1708"},{"key":"2025073111384787000_10.3.e002822.17","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.clinbiomech.2011.03.010","article-title":"Removable cast Walker boots yield greater forefoot off-loading than total contact casts","volume":"26","author":"Gutekunst","year":"2011","journal-title":"Clin Biomech"},{"key":"2025073111384787000_10.3.e002822.18","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716643429"},{"key":"2025073111384787000_10.3.e002822.19","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-1750"},{"key":"2025073111384787000_10.3.e002822.20","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2386"},{"key":"2025073111384787000_10.3.e002822.21","doi-asserted-by":"crossref","first-page":"59S","DOI":"10.1016\/j.jvs.2015.10.006","article-title":"A systematic review and meta-analysis of off-loading methods for diabetic foot ulcers","volume":"63","author":"Elraiyah","year":"2016","journal-title":"J Vasc Surg"},{"key":"2025073111384787000_10.3.e002822.22","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3275","article-title":"Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review","volume":"36 Suppl 1","author":"Lazzarini","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"2025073111384787000_10.3.e002822.23","unstructured":"Majid U , Argaez C . Off-Loading devices for people with diabetic neuropathic foot ulcers: a rapid qualitative review. Ottawa, ON, 2020."}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2022-002822","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T18:40:00Z","timestamp":1753987200000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2022-002822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,5,12]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bmjdrc-2022-002822"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2022-002822","relation":{},"ISSN":["2052-4897"],"issn-type":[{"type":"electronic","value":"2052-4897"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}