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Topical oxygen therapy for diabetes‐related foot ulcers: A systematic review and meta‐analysis
Author(s) -
Thanigaimani Shivshankar,
Singh Tejas,
Golledge Jonathan
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14585
Subject(s) - medicine , meta analysis , funnel plot , publication bias , diabetic foot ulcer , relative risk , confidence interval , amputation , diabetic foot , randomized controlled trial , strictly standardized mean difference , number needed to treat , subgroup analysis , diabetes mellitus , surgery , physical therapy , endocrinology
Topical oxygen therapy (TOT) has been suggested as a treatment for diabetes‐related foot ulcer (DFU) but no prior meta‐analyses of randomised clinical trials (RCT) have been reported. This systematic review and meta‐analysis examined the randomised evidence for the benefit of TOT in healing DFU. Methods Publicly available databases were searched for RCTs investigating the effect of TOT on wound healing in participants with a DFU. The primary outcome was ulcer healing defined as full epithelialisation. Meta‐analyses were performed using random effect models and reported as risk ratios (RR) and 95% confidence intervals (CI). Study quality and publication bias were assessed using a modified version of the Cochrane Collaboration's tool and funnel plots, respectively. Results Six RCTs involving 530 participants with a DFU testing TOT were included. Meta‐analysis suggested that TOT significantly increased the likelihood of ulcer healing compared to controls (Risk ratio [RR] 1.94; 95% CI 1.19, 3.17; I 2 = 57%; NNT = 5.33) and findings were robust in sensitivity analyses. Risk of bias was high, moderate and low in two, one and three studies, respectively. Analysis of the three trials judged to be at low risk of bias suggested that TOT increased the likelihood of ulcer healing compared to controls (RR 2.37; 95% CI 1.52, 3.68; I 2 = 0%). Funnel plots suggested the possibility of publication bias. Data on amputation were too limited for meta‐analysis. Conclusion This meta‐analysis suggests that TOT improves the likelihood of DFU healing; however, its effect on amputation and cost‐effectiveness are unclear.