Table 5.
Appraisal of the validity of the studies included for review using the AOTA scale
| Study | Level of Evidence† | Sample size | Internal validity | Possible threats to internal validity | External validity | Possible threats to external validity |
|---|---|---|---|---|---|---|
| Pollak [44] | IV | A | 2-Moderate | Unblinded | B-Moderate |
Treatment may not represents current practice: - Participants had to have toenails that the investigators believed were capable of regrowth - Onychomycosis must have been dermatophyte-caused - Patients may not be representative of the diabetic population: - Patients were not allowed to participants if they had abnormal laboratory results - Detail of diabetic population not provided (age, sex ratio, coexisting medical conditions, use of other medications etc. |
| Albreski [45] | II | B | 3-Low | Unblinded Duration of diabetes different between groups More people in the itraconazole group received insulin compared with palliative group |
B-Moderate |
Patients may not be representative of the diabetic population: - Participants were excluded if they were taking certain medication, such as medication for high cholesterol, which patients with diabetes are likely to be on - Only one female assessed |
| Brenner [43] | IV | B | 3-Low | Unblinded Attrition Patients were allowed to use other antifungal agents for coexisting tinea pedis Patients received also received nail care treatment |
B-Moderate |
Patients may not be representative of the diabetic population: - Patients had to have a good history of scheduled podiatric medical visits for nail care, be in good general health have good pulses. |
| Farkas [46] | IV | A | 2-Moderate | Unblinded Attrition |
A-High | nil |
| Gupta [42] | II | B | 1-High | nil | A-High | nil |
| Sadighha [41] | IV | C | 2-Moderate | Unblinded Selection criteria not clearly stated |
B-Moderate |
Patients may not be representative of the diabetic population: - Detail of diabetic population not provided (age, sex ratio, coexisting medical conditions, use of other medications etc.) |
† For consistency, the NHMRC study design classification system was used instead of the AOTA study design classification system