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Table 1 Overview of systematic reviews evaluating, for patients with diabetes, risk prediction tools for diabetic foot ulcer development or amputation

From: Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews

Author (year); Risk of Bias (ROBIS); Search Dates; Sources; Study type

Population

Outcome

#Studies/ #Models

Limitations

Authors’ Conclusions

Our Conclusions

Beulens et al. (2021) [9]; Low ROBa; Inception-10/21/2020; PubMed and EMBASE; Systematic review and external validation study; Funding: Dutch Diabetes Research Foundation

Patients with type 2 diabetes

Foot ulcer development, amputation, or neuropathy, or a combination of these over a minimal 1 year follow-up

21/34

(i) Low [5-year] incidence of amputation in the external validation cohort (70/7624; 0.9%), (ii) inability to differentiate between major and minor imputations (missing data), (iii) limited generalizability to populations/settings different from validation cohort (iv) inability to validate models including variables not available in validation cohort

The models by Boyko et al., [14] PODUS 2015, [15] and Martins-Mendes et al., [16] performed well to predict outcomes of either amputation or foot ulcer

PODUS 2015 was developed as a risk classification system with no time horizon for risk prediction. Hence, it was excluded from further consideration. The models by Boyko et al. and Martins-Mendes et al. are prognostic models

Fernandez-Torres et al. (2020) [10]; Moderate ROB; Inception- 12/30/2019; PubMed, Scopus, SciELO, CINAHL, Cochrane, PEDro, and EMBASE; Systematic review; Funding: None

Patients with diabetic foot disease including neuropathy, regardless of the type of diabetes

Neuropathy risk, ulceration risk, and diabetic foot ulcer outcome (amputation risk, healing, infection assessment, and measurement)

29/39

Exclusion of tools not published in English, French, Spanish, Portuguese, and Italian, or reporting psychometric characteristics not captured by the review’s inclusion criteria

The Queensland High Risk Foot Form (QHRFF) was valid and reliable for the assessment of ulceration risk

QHRFF was developed as a risk classification system with no time horizon for prediction. Hence, it was excluded from further consideration

Monteiro-Soares et al. (2011) [11]; Low ROB; Inception until 4/15/2010; MEDLINE; Systematic review; Funding: None

Patients with diabetes, type unspecified

Foot ulcer development

13/5

Quality assessment, data analysis, and extraction were performed by one reviewer who was not blinded to authors or institutions

The best method for assessment of risk stratification is not immediately apparent

Identical to the authors conclusions

  1. aRisk of Bias