{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T16:03:32Z","timestamp":1774627412655,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:00:00Z","timestamp":1621814400000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["15\/171\/01"],"award-info":[{"award-number":["15\/171\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2021,4,3]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence\/absence of pulses, and participant history of previous ulcer and\/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2\u2009years of initial assessment and validated it in a fifth study (n=3324). The CPR\u2019s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>CPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2\u2009years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was \u22120.374 (95% CI \u22120.561 to \u22120.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2021-002150","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T12:27:31Z","timestamp":1621945651000},"page":"e002150","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7742-1757","authenticated-orcid":false,"given":"Francesca M","family":"Chappell","sequence":"first","affiliation":[{"name":"Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0473-9959","authenticated-orcid":false,"given":"Fay","family":"Crawford","sequence":"additional","affiliation":[{"name":"The School of Medicine, University of St Andrews, St Andrews, Fife, UK"},{"name":"Research, Development and Innovation, NHS Fife, Dunfermline, Fife, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7621-2462","authenticated-orcid":false,"given":"Margaret","family":"Horne","sequence":"additional","affiliation":[{"name":"Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0570-5678","authenticated-orcid":false,"given":"Graham P","family":"Leese","sequence":"additional","affiliation":[{"name":"Ninewells Hospital, NHS Tayside, Dundee, UK"}]},{"given":"Angela","family":"Martin","sequence":"additional","affiliation":[{"name":"Victoria Hospital, NHS Fife, Kirkcaldy, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8112-718X","authenticated-orcid":false,"given":"David","family":"Weller","sequence":"additional","affiliation":[{"name":"Usher Institute, University of Edinburgh, Edinburgh, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-1201","authenticated-orcid":false,"given":"Andrew J M","family":"Boulton","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester & Manchester Royal Infirmary, Manchester, UK"},{"name":"University of Miami, Miami, Florida, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4506-2235","authenticated-orcid":false,"given":"Caroline","family":"Abbott","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University, Manchester, Greater Manchester, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro-Soares","sequence":"additional","affiliation":[{"name":"MEDICIDS, CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3901-4405","authenticated-orcid":false,"given":"Aristidis","family":"Veves","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8699-0735","authenticated-orcid":false,"given":"Richard D","family":"Riley","sequence":"additional","affiliation":[{"name":"School of Primary, Community and Social Care, Keele University, Keele, UK"}]}],"member":"239","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"key":"2025073112491487000_9.1.e002150.1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13973"},{"key":"2025073112491487000_9.1.e002150.2","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1111\/dme.13054","article-title":"Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom","volume":"33","author":"Walsh","year":"2016","journal-title":"Diabet Med"},{"key":"2025073112491487000_9.1.e002150.3","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1380"},{"key":"2025073112491487000_9.1.e002150.4","unstructured":"Centers for Disease Control and Prevention . 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