A Systematic Review Examining the Association of Falls With Diabetes-Related Foot Ulcers

Abstract

Background: The aim of this study was to systematically review the risk of falls in people with diabetes-related foot ulcers (DFU). Methods: A systematic search of Medline, Pubmed, Embase, Cochrane and CINAHL was undertaken to identify observational studies reporting falls and containing a group of people with a DFU and a control group with diabetes but no DFU. Risk of bias was assessed by a modified Newcastle–Ottawa Scale. Meta-analysis was performed using a random effects model. Results: Four studies involving 3643 participants with a DFU and 42,436 participants with diabetes but no DFU were included. A meta-analysis showed high heterogeneity between studies (I2 = 95%) and an increased risk of falls in people with DFU (risk ratio 2.25 and 95% CI 1.05–4.84). One study had a low risk of bias and three studies had a high risk of bias. Leave-one-out analyses showed that exclusion of the study with the largest effect on heterogeneity resulted in a risk ratio of 1.80 (95% CI 1.33–2.43 and I2 = 0%). Conclusions: Currently available evidence suggests people with a DFU have a higher risk of falls but most past studies have a high risk of bias. Further well-designed cohort studies are required.