Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
Department of Emergency Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon.
Foot (Edinb). 2022 Mar;50:101872. doi: 10.1016/j.foot.2021.101872. Epub 2021 Oct 25.
Telemedicine (TM) has been advanced as an effective approach to wound care management. In this era of COVID-19 pandemic, it is paramount to assess the evidence behind the use of TM in treating diabetic foot ulcers (DFU). This meta-analysis aims at evaluating the efficacy of TM versus face-to-face attendance in managing DFU. In total, four controlled studies were included in the meta-analysis comprising 3 randomized trials. The total pooled sample comprised 816 patients (816 ulcers): 337 in TM group and 479 in the control group. The results were as follows: (a) healing rate OR was 1.35, in favor of TM (p = 0.4), (b) time to heal with means of 73 ± 24.1 days and 83.5 ± 28.4 days, for the TM and control group, respectively (p = 0.35), c) the amputation rate OR was 0.48 (p = 0.007) in favor of the TM group, d) the mortality rate OR was 1.66 (p = 0.2), and e) a trend for lesser cost than face-to-face group (p = 0.4). While future research using large-sampled controlled studies is warranted, the present meta-analysis demonstrated that treating DFU via TM could be at least as effective as to face-to-face attendance. In times where clinic visits are reduced or not possible such as during this COVID-19 pandemic and the likely-to-happen future outbreaks, TM could be a valuable alternative.
远程医疗（TM）已被作为一种有效的伤口护理管理方法得到推广。在 COVID-19 大流行的时代，评估 TM 在治疗糖尿病足溃疡（DFU）中的应用证据至关重要。本荟萃分析旨在评估 TM 与面对面就诊在管理 DFU 方面的疗效。共有四项对照研究被纳入荟萃分析，包括三项随机试验。总共有 816 名患者（816 个溃疡）纳入汇总样本：TM 组 337 例，对照组 479 例。结果如下：（a）愈合率 OR 为 1.35，有利于 TM（p=0.4），（b）愈合时间的平均值分别为 TM 组 73±24.1 天和对照组 83.5±28.4 天（p=0.35），（c）TM 组截肢率 OR 为 0.48（p=0.007），（d）TM 组死亡率 OR 为 1.66（p=0.2），（e）TM 组比面对面组的成本趋势更低（p=0.4）。虽然需要进行使用大样本对照研究的未来研究，但本荟萃分析表明，通过 TM 治疗 DFU 至少与面对面就诊一样有效。在诊所就诊减少或不可能的情况下，例如在 COVID-19 大流行期间和可能发生的未来疫情爆发期间，TM 可能是一种有价值的替代方法。
