Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews

Fay Crawford; Donald J Nicolson; Aparna E Amanna; Marie Smith

doi:10.1186/s12874-022-01738-y

Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews

Fay Crawford^*
, Donald J Nicolson
, Aparna E Amanna
, Marie Smith

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

Background:
Reliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)].

Methods:
Medline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot
ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews.

Findings:
The overview identified 30 systematic reviews of patient education, footwear and of-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60%), weak search or selection strategies (70%) and quality appraisal methods (53%) and inexpert conduct and interpretation of quantitative and narrative
evidence syntheses (57%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap.

Interpretation:
The majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice.

Original language	English
Article number	274
Number of pages	21
Journal	BMC Medical Research Methodology
Volume	22
DOIs	https://doi.org/10.1186/s12874-022-01738-y
Publication status	Published - 20 Oct 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Overview
Systemic reviews
Evidence-based health care

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Crawford F Reliability of the evidence to guide decision-making
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Additional file 1 of Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews
Crawford, F. (Creator), Nicolson, D. J. (Creator), Amanna, A. E. (Creator) & Smith, M. (Creator), Figshare, 2022
DOI: 10.6084/m9.figshare.21376192.v1
Dataset

Cite this

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title = "Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews",

abstract = "Background: Reliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)]. Methods: Medline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews. Findings: The overview identified 30 systematic reviews of patient education, footwear and of-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60\%), weak search or selection strategies (70\%) and quality appraisal methods (53\%) and inexpert conduct and interpretation of quantitative and narrative evidence syntheses (57\%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap. Interpretation: The majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice. ",

keywords = "Overview, Systemic reviews, Evidence-based health care",

author = "Fay Crawford and Nicolson, \{Donald J\} and Amanna, \{Aparna E\} and Marie Smith",

note = "Funding: This overview was funded as part of a wider project by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (HTA project: 15/171/01). The views expressed are those of the authors and not necessarily those of the NIHR or UK Department of Health and Social Care.",

year = "2022",

month = oct,

day = "20",

doi = "10.1186/s12874-022-01738-y",

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journal = "BMC Medical Research Methodology",

issn = "1471-2288",

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T1 - Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes

T2 - an overview of systematic reviews

AU - Crawford, Fay

AU - Nicolson, Donald J

AU - Amanna, Aparna E

AU - Smith, Marie

N1 - Funding: This overview was funded as part of a wider project by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (HTA project: 15/171/01). The views expressed are those of the authors and not necessarily those of the NIHR or UK Department of Health and Social Care.

PY - 2022/10/20

Y1 - 2022/10/20

N2 - Background: Reliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)]. Methods: Medline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews. Findings: The overview identified 30 systematic reviews of patient education, footwear and of-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60%), weak search or selection strategies (70%) and quality appraisal methods (53%) and inexpert conduct and interpretation of quantitative and narrative evidence syntheses (57%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap. Interpretation: The majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice.

AB - Background: Reliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)]. Methods: Medline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews. Findings: The overview identified 30 systematic reviews of patient education, footwear and of-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60%), weak search or selection strategies (70%) and quality appraisal methods (53%) and inexpert conduct and interpretation of quantitative and narrative evidence syntheses (57%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap. Interpretation: The majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice.

KW - Overview

KW - Systemic reviews

KW - Evidence-based health care

U2 - 10.1186/s12874-022-01738-y

DO - 10.1186/s12874-022-01738-y

M3 - Review article

SN - 1471-2288

VL - 22

JO - BMC Medical Research Methodology

JF - BMC Medical Research Methodology

M1 - 274

ER -

Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews

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Additional file 1 of Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews

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