背景:压力卸载治疗对于治愈糖尿病相关的足部溃疡(DFU)至关重要。然而,2011年澳大利亚DFU关于卸载处理的指南已经过时。一个国家专家小组旨在通过调整经评估为适合澳大利亚国情的国际准则,为DFU患者制定一项新的澳大利亚卸载治疗准则。
方法:国家卫生和医学研究委员会的程序被用来使糖尿病足国际工作组(IWGDF)指南适应澳大利亚的情况。我们系统地筛选,使用最佳实践ADAPTE和GRADE框架评估和判断所有IWGDF卸载建议,以决定应采用哪些建议,适应或排除在澳大利亚的背景下。对于每个建议,我们重新评估了措辞,证据质量,推荐的力量,并提供了理由,理由和实施考虑,包括地理位置偏远的原住民和托雷斯海峡岛民。这个准则,连同五个随附的澳大利亚DFU指南,进行了公众咨询,十个国家高峰机构(专业组织)进一步修订和批准。
结果:在IWGDF最初的13项卸载治疗建议中,我们采用了四个,改编了九个。适应IWGDF建议的主要原因包括证据评级质量的差异以及针对澳大利亚背景的建议中干预措施和对照治疗的澄清。对于有足底DFU的澳大利亚人来说,根据禁忌症和耐受性,我们建议采用逐步卸载治疗方法。我们强烈建议使用不可拆卸的膝盖高卸载装置作为一线治疗,可移动膝盖高卸载装置作为第二线,第三线可拆卸脚踝高卸载装置,和医疗级鞋类作为最后一行。我们建议考虑将毡状泡沫与所选的卸载装置或鞋类结合使用,以进一步降低足底压力。如果卸载设备选项无法治愈患有足底DFU的人,我们建议考虑各种手术卸载程序。对于非足底DFU的人,根据DFU的类型和位置,我们建议使用可移动卸载设备,毛毡泡沫,脚趾垫片或矫形器,或医疗级鞋类。六项新准则和完整协议可在以下网址找到:https://diabetfeetaustralia.org/new-guidelines/。
结论:我们制定了一项新的澳大利亚基于证据的DFU患者卸载治疗指南,该指南已得到十个主要国家高峰机构的认可。在澳大利亚实施这些卸载建议的卫生专业人员应该为患者提供更好的DFU治疗结果,社区,和国家。
BACKGROUND: Pressure offloading treatment is critical for healing diabetes-related foot ulcers (DFU). Yet the 2011 Australian DFU guidelines regarding offloading treatment are outdated. A national expert panel aimed to develop a new Australian
guideline on offloading treatment for people with DFU by adapting international guidelines that have been assessed as suitable to adapt to the Australian context.
METHODS: National Health and Medical Research Council procedures were used to adapt suitable International Working Group on the Diabetic Foot (IWGDF) guidelines to the Australian context. We systematically screened, assessed and judged all IWGDF offloading recommendations using best practice ADAPTE and GRADE frameworks to decide which recommendations should be adopted, adapted or excluded in the Australian context. For each recommendation, we re-evaluated the wording, quality of evidence, strength of recommendation, and provided rationale, justifications and implementation considerations, including for geographically remote and Aboriginal and Torres Strait Islander peoples. This
guideline, along with five accompanying Australian DFU
guidelines, underwent public consultation, further revision and approval by ten national peak bodies (professional organisations).
RESULTS: Of the 13 original IWGDF offloading treatment recommendations, we adopted four and adapted nine. The main reasons for adapting the IWGDF recommendations included differences in quality of evidence ratings and clarification of the intervention(s) and control treatment(s) in the recommendations for the Australian context. For Australians with plantar DFU, we recommend a step-down offloading treatment approach based on their contraindications and tolerance. We strongly recommend non-removable knee-high offloading devices as first-line treatment, removable knee-high offloading devices as second-line, removable ankle-high offloading devices third-line, and medical grade footwear as last-line. We recommend considering using felted foam in combination with the chosen offloading device or
footwear to further reduce plantar pressure. If offloading device options fail to heal a person with plantar DFU, we recommend considering various surgical offloading procedures. For people with non-plantar DFU, depending on the type and location of the DFU, we recommend using a removable offloading device, felted foam, toe spacers or orthoses, or medical grade footwear. The six new
guidelines and the full protocol can be found at: https://diabetesfeetaustralia.org/new-
guidelines/ .
CONCLUSIONS: We have developed a new Australian evidence-based
guideline on offloading treatment for people with DFU that has been endorsed by ten key national peak bodies. Health professionals implementing these offloading recommendations in Australia should produce better DFU healing outcomes for their patients, communities, and country.