Article Title: Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study
Journal: Journal of Foot and Ankle Research
Issue/Page No: 14:44 1-12
Discussion Date: 20/7/2022
Study objective, hypothesis and question?
The median TCC duration for the resolution of an acute Charcot foot in Australia. Exploring clinical factors.
Rationale and relevance of the question?
(Why was the study done?)
There was varying TCC treatment lengths in different countries and limited Australian data in regards to the duration of TCC treatment.
Study was done to present more Australian data and identify any clinical factors affecting its duration.
Relevance of this topic/question to FH Podiatrists?
(Is it urgent or essential reading for a podiatrist working in an acute hospital?
What methodological approach (design, analysis, etc.) has been used?
(RCT, Case control, case study series, meta analysis etc.)
Retrospective cohort study over a 3 years period. The cohort was from a large metropolitan hospital.
The study group was small consisting of 27 participants.
The study’s eligibility criteria were strict where current ulcers were excluded from the study.
What were the results of the study? (What did the investigators find?)
The study showed a median of 4.3 months of treatment time in TCC.
Patients diagnosed with osteoarthritis before they had an active Charcot’s foot showed a TCC treatment time-frame of more than 4 months - had more incidents of osteoarthritis (in any joint) post treatment.
Identified a high misdiagnosis of Charcot’s foot before attending the high risk foot service.
The greatest reduction in temperature was at the affected Charcot site.
Strengths & weaknesses of this study? Are the results valid? Look at study design, appropriateness of the method(s), population and sample size, appropriate study conduct, data gathering, subject follow‐up, influences of bias, methods of analysis, discussion, currentness and comprehensiveness of the listed references
Strengths:
Weakness:
Do the conclusions follow logically from the design and results?
Yes, duration of TCC treatment is shorter or comparable to data reported in the UK, US, Europe and Asia Pacific countries.
How do the results relate to current practice and how might they influence future practice? (What does the answer mean anyway? So what? Who cares?)
The study supports change in podiatry practice by giving podiatrists the ability to provide better informed consent and education for TCC treatment.
Ability to estimate time-frames and setting expectations.
Advising patients of risk factors.
Article Title: Evaluating Cognitive Impairment in People with Diabetes-Related Foot Ulceration
Journal: Journal of Clinical Medicine
Issue/Page No: 2021, 10 (13)
Discussion Date: 03/03/2022
Study Objective: To determine whether there is an excess of cognitive impairment in patients with T2DM and foot ulceration.
Hypothesis Question: Whether DFUs in people with T2DM is associated with greater cognitive impairment, compared with T2DM without DFU.
Patients with a Diabetic Foot Ulcer often do not complete what is required to manage their DFU. Is there some Cognitive Impairment in patients with a Diabetic Foot Ulcer that impedes ability to carry out what’s required to manage DFU?
Should tools be used to assess/explore cognitive impairment to improve patient education and patient outcomes?
Highly relevant across all HRFS. Patients provided with instructions and information, yet are unable to complete instructions. Essential reading for podiatrists working in HRFS/with patients presenting with DFUs.
Methodological approach used: observational cross-sectional study which was the most pragmatic design based on the resources available.
No difference found between the two groups assessed regarding cognitive scores. The study did not show an excess of cognitive impairment in patients with T2DM and DFU compared with patients with T2DM and no DFU.
50% of participants across both groups had mild cognitive impairment.
Prior studies conducted and compared results between population with T2DM and DFUs vs no diabetes – Found disparity between co-morbidities, potentially influencing causation and pathway for cognitive impairment.
Strengths
Weakness
Yes
Future research is needed to establish whether cognitive impairment impacts DFU healing/LEA outcomes.
Detailed assessment of self-care behaviour currently under review, not yet published.
Non-adherence and adverse DFU outcomes may potentially be driven by other factors such as behavioural aspects, personality constructs, social disadvantage, education aspects, work commitments, family commitments, health literacy impacting self-care behaviour.
Clinicians need to adjust how patient education is delivered to this vulnerable cohort of patients who have challenges regarding memory and retention – Change delivery of education to be succinct and clear, being mindful of prevalence in patient cohort.
Improved access to Health Psychology within a High-Risk Foot Service is required to improve outcomes for patients.