A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol
Abstract Background Charcot neuroarthropathy is a complication of peripheral neuropathy associated with diabetes which most frequently affects the lower limb. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Recommended treatment is immobilisat...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Pilot and Feasibility Studies |
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| Online Access: | http://link.springer.com/article/10.1186/s40814-020-00611-3 |
| _version_ | 1828292220779757568 |
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| author | Catherine Gooday Frances Game Jim Woodburn Fiona Poland Erika Sims Ketan Dhatariya Lee Shepstone Wendy Hardeman |
| author_facet | Catherine Gooday Frances Game Jim Woodburn Fiona Poland Erika Sims Ketan Dhatariya Lee Shepstone Wendy Hardeman |
| author_sort | Catherine Gooday |
| collection | DOAJ |
| description | Abstract Background Charcot neuroarthropathy is a complication of peripheral neuropathy associated with diabetes which most frequently affects the lower limb. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Recommended treatment is immobilisation and offloading, with a below knee non-removable cast or boot. Duration of treatment varies from six months to more than 1 year. Small observational studies suggest that repeated assessment with magnetic resonance imaging improves decision-making about when to stop treatment, but this has not been tested in clinical trials. This study aims to explore the feasibility of using serial magnetic resonance imaging without contrast in the monitoring of Charcot neuroarthropathy to reduce duration of immobilisation of the foot. A nested qualitative study aims to explore participants’ lived experience of Charcot neuroarthropathy and of taking part in the feasibility study. Methods We will undertake a two-arm, open study and randomise 60 people with a suspected or confirmed diagnosis of Charcot neuroarthropathy from five NHS, secondary care multidisciplinary Diabetic Foot Clinics across England. Participants will be randomised 1:1 to receive magnetic resonance imaging at baseline and remission up to 12 months, with repeated foot temperature measurements and X-rays (standard care plus), or standard care plus with additional three-monthly magnetic resonance imaging until remission up to 12 months (intervention). Time to confirmed remission of Charcot neuroarthropathy with off-loading treatment (days) and its variance will be used to inform sample size in a full-scale trial. We will look for opportunities to improve the protocols for monitoring techniques and the clinical, patient-centred and health economic measures used in a future study. For the nested qualitative study, we will invite a purposive sample of 10–14 people able to offer maximally varying experiences from the feasibility study to take part in semi-structured interviews to be analysed using thematic analysis. Discussion The study will inform the decision whether to proceed to a full-scale trial. It will also allow deeper understanding of the lived experience of Charcot neuroarthropathy, and factors that contribute to engagement in management and contribute to the development of more effective patient-centred strategies. Trial registration ISRCTN, ISRCTN74101606 . Registered on 6 November 2017. |
| first_indexed | 2024-04-13T11:05:11Z |
| format | Article |
| id | doaj.art-1b395f3a5784406c92b28b583bbd7fdc |
| institution | Directory Open Access Journal |
| issn | 2055-5784 |
| language | English |
| last_indexed | 2024-04-13T11:05:11Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Pilot and Feasibility Studies |
| spelling | doaj.art-1b395f3a5784406c92b28b583bbd7fdc2022-12-22T02:49:17ZengBMCPilot and Feasibility Studies2055-57842020-06-016111010.1186/s40814-020-00611-3A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocolCatherine Gooday0Frances Game1Jim Woodburn2Fiona Poland3Erika Sims4Ketan Dhatariya5Lee Shepstone6Wendy Hardeman7School of Health Sciences, University of East AngliaDepartment of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation TrustSchool of Health and Life Sciences, Glasgow Caledonian UniversitySchool of Health Sciences, University of East AngliaNorwich Clinical Trials Unit, Norwich Medical School, University of East AngliaElsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation TrustNorwich Medical School, University of East AngliaSchool of Health Sciences, University of East AngliaAbstract Background Charcot neuroarthropathy is a complication of peripheral neuropathy associated with diabetes which most frequently affects the lower limb. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Recommended treatment is immobilisation and offloading, with a below knee non-removable cast or boot. Duration of treatment varies from six months to more than 1 year. Small observational studies suggest that repeated assessment with magnetic resonance imaging improves decision-making about when to stop treatment, but this has not been tested in clinical trials. This study aims to explore the feasibility of using serial magnetic resonance imaging without contrast in the monitoring of Charcot neuroarthropathy to reduce duration of immobilisation of the foot. A nested qualitative study aims to explore participants’ lived experience of Charcot neuroarthropathy and of taking part in the feasibility study. Methods We will undertake a two-arm, open study and randomise 60 people with a suspected or confirmed diagnosis of Charcot neuroarthropathy from five NHS, secondary care multidisciplinary Diabetic Foot Clinics across England. Participants will be randomised 1:1 to receive magnetic resonance imaging at baseline and remission up to 12 months, with repeated foot temperature measurements and X-rays (standard care plus), or standard care plus with additional three-monthly magnetic resonance imaging until remission up to 12 months (intervention). Time to confirmed remission of Charcot neuroarthropathy with off-loading treatment (days) and its variance will be used to inform sample size in a full-scale trial. We will look for opportunities to improve the protocols for monitoring techniques and the clinical, patient-centred and health economic measures used in a future study. For the nested qualitative study, we will invite a purposive sample of 10–14 people able to offer maximally varying experiences from the feasibility study to take part in semi-structured interviews to be analysed using thematic analysis. Discussion The study will inform the decision whether to proceed to a full-scale trial. It will also allow deeper understanding of the lived experience of Charcot neuroarthropathy, and factors that contribute to engagement in management and contribute to the development of more effective patient-centred strategies. Trial registration ISRCTN, ISRCTN74101606 . Registered on 6 November 2017.http://link.springer.com/article/10.1186/s40814-020-00611-3Charcot neuroarthropathyDiabetesMRITemperature monitoringX-rayPatient experience |
| spellingShingle | Catherine Gooday Frances Game Jim Woodburn Fiona Poland Erika Sims Ketan Dhatariya Lee Shepstone Wendy Hardeman A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol Pilot and Feasibility Studies Charcot neuroarthropathy Diabetes MRI Temperature monitoring X-ray Patient experience |
| title | A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol |
| title_full | A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol |
| title_fullStr | A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol |
| title_full_unstemmed | A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol |
| title_short | A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol |
| title_sort | randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in charcot neuroarthropathy in people with diabetes cadom a protocol |
| topic | Charcot neuroarthropathy Diabetes MRI Temperature monitoring X-ray Patient experience |
| url | http://link.springer.com/article/10.1186/s40814-020-00611-3 |
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