Open AccessDeveloping an evidence‐based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro‐Arthropathy: a systematic review
Author(s) -
Milne Tamara E,
Rogers Joseph R,
Kinnear Ewan M,
Martin Helen V,
Lazzarini Peter A,
Quinton Thomas R,
Boyle Frances M
Publication year - 2013
Publication title -
journal of foot and ankle research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.763
H-Index - 39
ISSN - 1757-1146
DOI - 10.1186/1757-1146-6-30
Subject(s) - medicine , cinahl , medline , systematic review , cochrane library , intensive care medicine , evidence based medicine , clinical pathway , physical therapy , alternative medicine , pathology , psychological intervention , psychiatry , nursing , political science , law
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.