Summary of findings 3. Hyaluronic acid compared with lyophilised collagen for foot ulcers in people with diabetes.
| Hyaluronic acid compared with lyophilised collagen for foot ulcers in people with diabetes | ||||||
| Patient or population: foot ulcers in people with diabetes Setting: not reported Intervention: hyaluronic acid Comparison: lyophilised collagen | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with lyophilised collagen | Risk with hyaluronic acid | |||||
| Complete ulcer healing | ‐ | 20 (1 RCT) | ‐ | Study authors followed all participants until complete healing. | ||
| Time to complete healing | The mean time to complete healing was 32.4 days. | The mean time to complete healing was 49.0 days. | MD 16.60 days higher (7.95 higher to 25.25 higher) | 20 (1 RCT) | ⊕⊝⊝⊝ Very low 1 2 | It is uncertain if lyophilised collagen decreases time to complete healing when compared with hyaluronic acid. |
| Adverse events ‐ not reported | No studies provided evidence for this outcome. | |||||
| Health‐related quality of life ‐ not reported | No studies provided evidence for this outcome. | |||||
| Pain | Study authors did not provide quantitative analysis of pain, only a subjective assessment stating improvement of pain, itch, and paraesthesias in the collagen group. | ‐ | ‐ | ⊕⊝⊝⊝ Very low 1 2 | It is uncertain if lyophilised collagen decreases pain when compared with hyaluronic acid. | |
| Change in ulcer size | No studies provided evidence for this outcome. | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Downgraded twice for risk of bias due to unclear risk of bias for randomisation, allocation, and blinding, and high risk of bias for attrition and selective reporting. 2Downgraded twice for imprecision due to small numbers of participants and events.