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01-12-2013 | Review | Uitgave 1/2013 Open Access

Journal of Foot and Ankle Research 1/2013

Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy: a systematic review

Tijdschrift:
Journal of Foot and Ankle Research > Uitgave 1/2013
Auteurs:
Tamara E Milne, Joseph R Rogers, Ewan M Kinnear, Helen V Martin, Peter A Lazzarini, Thomas R Quinton, Frances M Boyle
Belangrijke opmerkingen

Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-6-30) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no relevant conflict of interest to disclose.

Authors’ contributions

TM conceived, designed, performed literature search, quality assessments, contributed to discussion, wrote and reviewed/edited the manuscript. JR conceived, designed, performed quality assessments, contributed to the discussion, and reviewed/edited the manuscript. EK, HM, PL, TQ performed quality assessments, contributed to discussion and reviewed/edited the manuscript. FB designed, contributed to discussion and reviewed/edited the manuscript. All authors have read and approved the final manuscript.

Abstract

Background

Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors’ knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes.

Methods

Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway.

Results

The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN.

Conclusions

This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.

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Extra materiaal
Additional file 1: Search strategies.(DOC 25 KB)
13047_2013_570_MOESM1_ESM.doc
Additional file 2: Level II evidence.(DOC 31 KB)
13047_2013_570_MOESM2_ESM.doc
Additional file 3: Level III-IV evidence.(DOC 112 KB)
13047_2013_570_MOESM3_ESM.doc
Additional file 4: Level EO evidence.(DOC 192 KB)
13047_2013_570_MOESM4_ESM.doc
Authors’ original file for figure 1
13047_2013_570_MOESM5_ESM.pdf
Literatuur
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