Introduction
Method
Search strategy
Database | Search String | Search | Outcome |
---|---|---|---|
PubMed | ((((Charcot) NOT Charcot Marie Tooth)) AND (((((((((Cost) OR Comparison) OR Study) OR Audit) OR Quality of Life) or Outcome) or Experience) OR Knowledge)) AND (((Assessment) OR Diagnosis) OR Management) | English language, Title | 314 |
Eligibility criteria
Review process, data extraction and themes of interest
Results
Author(s) | Study Design/Country | Level of Evidence | Themes | Assessment | Diagnosis | Management |
---|---|---|---|---|---|---|
Blume et al., 2014 [14]. | Literature review/United States of America | EO | Health Organisation Health Professional | Health professional knowledge to recognise symptoms of CN | Health professional knowledge to utilise the appropriate pathology and imaging to diagnose CN. Resource limitation leads to more use of x-ray | Health professional knowledge to utilise and apply the appropriate form of offloading |
Bullen et al,. 2018 [15]. | Delphi/ Scotland | EO | Individual Health Professional | Health professional knowledge to appropriately prepare individuals for the potential onset of CN | Nil | Health professional capacity to educate the patient to understand importance of offloading. Literacy capacity of individual |
Chantelau, 2005 [16]. | Case Controlled study/ Germany | III-2 | Health Professional | Health professional knowledge to recognise symptoms of CN | Delayed diagnosis. Health professional knowledge and confusion as to the appropriate form of imaging to use, Knowledge limitation leads to more use of x-ray | Delayed diagnosis leads to delayed treatment such as offloading |
Chantelau et al., 2007 [17]. | Case Series/ Germany | IV | Individual Health professional | Early symptoms such as deep dull aches often unrecognised by patient leading to delayed presentation. Health professional knowledge to recognise symptoms of CN | Health professional knowledge and confusion as to the appropriate form of imaging to use | Delayed diagnosis leads to delayed treatment. Health professional knowledge of utilizing the appropriate form of offloading impacts treatment duration |
Chantelau et al., 2013 [18]. | Retrospective Cohort study/ Germany | IV | Individual Health Professional | Early symptoms such as deep dull aches often unrecognised by patient | Delayed diagnosis. Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more use of x-ray | Delayed diagnosis leads to delayed treatment. Health professional knowledge as to when to transition patient between various forms of offloading. |
DiDomenico et al., 2018 [19]. | Literature review/ United States of America | EO | Individual Health Professional | Underlying comorbidities of the individual patient such as diabetes and obesity has an impact on implementation of best practice | Nil | Complex condition requiring complete lifestyle modification |
Dixon et al., 2017 [20]. | Retrospective case series/ New Zealand | IV | Individual Health Professional | Early symptoms such as deep dull aches often unrecognised by patient leading to delayed presentation (17 weeks). Health professional knowledge (GP) to recognise symptoms of CN and refer appropriate service | Delayed diagnosis. Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more under utilization of MRI | Health professional knowledge of when to transition patients to footwear |
Farid et al., 2008 [2]. | Case Study/ United States of America | IV | Individual Health Professional | Underlying comorbidities of the individual patient such as diabetes and obesity has an impact on implementation of best practice | Nil | Health professional limited experience in appropriately being able to apply TCCs. Health professional ability to properly explain the treatment regimen to individual. Individual compliance with lack of understanding of the complexities of treatment of CN |
Frykberg et al., 2012 [5]. | Round Table Discussion/ United States of America | EO | Individual Health Professional | Underlying comorbidities of the individual patient such as diabetes, obesity has an impact on implementation of best practice | Nil | Health professional confusion as to which surgical procedure to use. Concern regarding informed consent, litigation and compliance with treatment protocols |
Gil et al., 2013 [21]. | Case Controlled study/ United States of America | III-2 | Individual | Nil | Nil | Health professional confusion as to which surgical procedure to use. Concern regarding informed consent, litigation and compliance with treatment protocols |
Gooday et al., 2020 [22]. | Systematic Review/ United Kingdom | EO | Health professional | Nil | Nil | Health professional monitoring techniques inconsistent. |
Jansen et al., 2016 [23]. | Qualitative, Survey/ Denmark | IV | Health Professional | Health professional knowledge to recognise symptoms of CN | Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more use of x-ray | Health professional monitoring techniques inconsistent. Health professional limited experience in appropriately being able to apply TCCs |
Jeffcoate, 2015 [24]. | Literature review/ United Kingdom | EO | Individual Health Professional | Early symptoms such as deep dull aches often unrecognised by patient leading to delayed presentation. Health professional knowledge to recognise symptoms of CN | Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more use of x-ray | Health professional limited experience in appropriately being able to apply TCCs. Inconsistent treatment protocols and lack of agreed outcome measures |
Loupa et al., 2019 [25]. | Case study/ Greece | IV | Individual Health Professional | Health professional misdiagnosis and delayed diagnosis, lack of awareness | Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more use of x-ray | Delayed treatment as a result of delayed diagnosis. Individual compliance through treatment process impacted success |
McIntyre et al., 2007 [26]. | Retrospective audit - case control study. Qualitative structured interviews/ Canada | IV | Environment Individual | Cultural environment and proximity to services. Aboriginal patients younger, less education, employment, greater burden of disease, financial disadvantage, less patient understanding of their condition | Nil | Nil |
Metcalf et al., 2018 [27]. | Retrospective audit - case control study/ United Kingdom | IV | Health Professional | Health professional knowledge to recognise symptoms of CN and refer appropriate service | Nil | Nil |
Milne et al., 2013 [6]. | Systematic review/ Australia | EO | Health Organisation Environment Individual Health Professional | Health professionals require a high index of clinical suspicion otherwise mis/delayed diagnosis occurs. Critical gap in education of the community and health professional knowledge of CN and prompt referral to a multidisciplinary clinic | Health professional knowledge to utilise the appropriate pathology and imaging to diagnose CN. Resource limitation leads to more use of x-ray | Management driven by expert consensus rather than rigorous evidence-based practice. Health professional expertise in the application of TCC critical and resource intensive. Variability in the advice provided by health professionals regarding protected weightbearing. Adherence of patients to the use of removable cast walkers variable. Geographical location is a consideration in the treatment of CN |
O'Loughlin et al., 2017 [28]. | Retrospective audit - case series/ Ireland | III-2 | Health Professional | Health professional knowledge of CN results in mis/delayed diagnosis. Patient presentation not timely and the urgent nature of condition not clear when they experience symptoms. There is an underrepresentation of CN in the community. | Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more use of x-ray | Health professional knowledge gap leads to delayed treatment. More frequent ulceration in the context of acute CN with removable cast walkers than non-removable cast walkers. Outcomes better with non-removable cast walkers. Significant health burden once ulcer occurs |
Pakarinen wt al., 2009 [29]. | Cross Sectional study/ Finland | III-2 | Individual | Nil | Diagnosis made within three months associated with better patient physical and social outcomes. | Social functioning and physical condition of the patient decreases with non-surgical treatment |
Perrin et al., 2010 [30]. | Case Study/ Australia | IV | Health Professional | Health professional misdiagnosis and delayed diagnosis, lack of awareness | Health professional knowledge and confusion as to the appropriate form of imaging to use. Knowledge limitation leads to more use of x-ray | Delayed treatment as a result of delayed diagnosis Early implementation of offloading of TCC would have been more ideal |
Petrova et al., 2017 [31]. | Literature review/ United Kingdom | EO | UK/Kings College NHS Trust Foundation | Health professionals high index of suspicion necessary. | Nil | Health professional limited experience in appropriately being able to apply TCCs. Inconsistent treatment protocols |
Rettedal et al., 2018 [32]. | Retrospective audit - case series/ United States of America | IV | Individual Health Professional | Nil | Nil | Anatomic location of CN and patient medical factors such as glycated haemoglobin, nutrition can determine outcome of surgical reconstruction, patient psychosocial factors and family support |
Robinson et al., 2015 [33]. | Literature review and case review/ United States of America | EO | Individual | Nil | Nil | Patient education and clinician understanding of clinical parameters underpinning CN management imperative and could increase compliance |
Sanders, 2008 [34]. | Literature review/ United States of America | EO | Health professional | Health professional observation is paramount, high level of clinical suspicion necessary, recognition of acute CN is variable | Nil | Health professional confusion as to which surgical procedure to use. Concern regarding informed consent, litigation and compliance with treatment protocols |
Schmidt et al., 2017 [7]. | Survey/ United States of America | IV | Individual Health Professional | Health professional poor knowledge leads to misdiagnosis Early stages of the condition not recognised by the patient as they are neuropathic resulting in referral delay | Ambiguous diagnosis criteria means actual incidence and prevalence may not be known | Nil |
Schmidt et al., 2018 [35] | Literature review/ United States of America | EO | Individual Health Professional | Health professionals must rely on clinical judgement. Health professional poor knowledge leads to misdiagnosis. Non-specific clinical findings. Patient unable to detect symptoms | Ambiguous diagnostic criteria | Nil |
Schmidt et al., 2019 [36] | Observational Cohort study/ United States of America | III-2 | Health Professional | Health professional poor knowledge leads to misdiagnosis | Nil | Primary outcomes improved with dedicated specialist care. Improved patient education and compliance improves outcomes. |
Sinacore et al., 1999 [37]. | Literature review/ United States of America | EO | Individual Health professional | Patients delay in seeking assessment/management, identification and appropriate referral by clinicians. Patient understanding of acute CN a risk factor | Nil | No clear indicators of when a patient can transition between the varies stages of restricted mobilisation, extent of injury and pattern, greater weightbearing mid foot and hindfoot-healing longer |
Wade, 2016 [38]. | Literature review/ United States of America | EO | Individual Health professional | Health professionals require a high index of clinical suspicion otherwise mis/delayed diagnosis occurs. Critical gap in education of the community and health professional knowledge of CN and prompt referral to a multidisciplinary clinic | Negative x-ray can delay healing, diagnosis not always confirmed by imaging | Patient education and clinician understanding of clinical parameters underpinning CN management imperative and could increase compliance |
Welch et al., 2014 [39]. | Survey/ United Kingdom | IV | Health Organisation Health professional | Health professional knowledge, lack of confidence, unwillingness to perform crucial foot assessments if clinical indicators not present, poor resource, lack of time, incomplete assessments | Health professional knowledge to utilise the appropriate pathology and imaging to diagnose CN. Resource limitation leads to more use of x-ray | Nil |
Wennberg et al., 2017 [40]. | Cross Sectional study/ Sweden | III-2 | Health Organisation Individual Health professional | Lack of recognition, delayed assessment/diagnosis | Health professional knowledge to utilise the appropriate pathology and imaging to diagnose CN. Resource limitation leads to more use of x-ray | Limited treatment options, MRI would provide earlier diagnosis, anxiety and depression of patient |
Wukich et al., 2009 [41]. | Literature review/ United States of America | EO | Health Organisation Individual Health professional | Missed cases, high index of suspicion, clinician dependant, delayed patient presentation, | Health professional knowledge to utilise the appropriate pathology and imaging to diagnose CN. Resource limitation leads to more use of x-ray | Patient education and clinician understanding of clinical parameters underpinning CN management imperative and could increase compliance |
Baker IDI, 2011 [4]. | Guideline/ Australia | EO | Australia | Access to health services in rural remote areas | Nil | Nil |
Diabetes Canada, 2008 [42]. | Guideline/ Canada | EO | Canada/ Diabetes Canada | High degree of suspicion necessary | Nil | Nil |
IWGDF, 2019 [3] | Guideline/ Netherlands | EO | Netherlands/Meeting of experts | High degree of suspicion necessary | Nil | Nil |
Rogers et al., 2011 [1]. | Expert Opinion/ France | EO | Paris/Meeting of experts | Early detection on inflammation. Health professional knowledge | Nil | Nil |