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Study objective, hypothesis and question?
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The median TCC duration for the resolution of an acute Charcot foot in Australia. Exploring clinical factors.
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Rationale and relevance of the question?
(Why was the study done?)
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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.
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Relevance of this topic/question to FH Podiatrists?
(Is it urgent or essential reading for a podiatrist working in an acute hospital?
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- Podiatrists are not able to provide guidance on time-frames in TCC treatment length. This study is relevant to set patient expectations and providing informed consent for treatment. It also assists patients with organising social supports, finances and work.
- There is varying data in duration around the world.
- It is important to gather Australian data for Australian podiatrists and patients.
- Highly relevant to HRF podiatrists in acute and community
- The study also highlights the high number of misdiagnosed patients when signs and symptoms first appeared.
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What methodological approach (design, analysis, etc.) has been used?
(RCT, Case control, case study series, meta analysis etc.)
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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.
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What were the results of the study? (What did the investigators find?)
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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.
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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
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Strengths:
- Robust screening and strict criteria, study is easily repeated.
- Strengths in identifying risks in TCC treatment were only minor skin rubbing and irritation.
- Findings were generalisable to those with diabetes and peripheral neuropathy, therefore applicable to similar patients.
- Realistic representation of the population – patients were not using assistive ambulating devices (crutches, walkers, knee scooters) and continuing daily activities of living whilst receiving treatment.
Weakness:
- Time that patients were out of the TCC treatment was still included in the treatment time. However, this was justified by the patient only spending 1 week out of a TCC for flying and were in appropriate offloading such as a removable walker.
- Osteoarthritis prevalence could be in any joint.
- The osteoarthritis was not measurable via imaging before or after, it was dependent on medical history
- Study did report that the increase in osteoarthritis was difficult to be explained, but maybe from biomechanical factors
- Small sample size
- Retrospective study – medical documentation flaws
- External factors that can influence TCC duration length
- Medical specialty led clinics
- Experienced/trained clinician in identifying Charcot foot status
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Do the conclusions follow logically from the design and results?
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Yes, duration of TCC treatment is shorter or comparable to data reported in the UK, US, Europe and Asia Pacific countries.
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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?)
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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.
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