***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues is reduced . Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk . The type of insole best suited to achieve this is unknown . This trial compared custom-made functional insoles with prefabricated insoles to reduce risk factors for ulceration of neuropathic diabetic feet . Method A participant-blinded r and omised controlled trial recruited 119 neuropathic participants with diabetes who were r and omly allocated to custom-made functional or prefabricated insoles . Data were collected at issue and six month follow-up using the F-scan in-shoe pressure measurement system . Primary outcomes were : peak pressure , forefoot pressure time integral , total contact area , forefoot rate of load , duration of load as a percentage of stance . Secondary outcomes were patient perceived foot health ( Bristol Foot Score ) , quality of life ( Audit of Diabetes Dependent Quality of Life ) . We also assessed cost of supply and fitting . Analysis was by intention-to-treat . Results There were no differences between insoles in peak pressure , or three of the other four kinetic measures . The custom-made functional insole was slightly more effective than the prefabricated insole in reducing forefoot pressure time integral at issue ( 27 % vs. 22 % ) , remained more effective at six month follow-up ( 30 % vs. 24 % , p=0.001 ) , but was more expensive ( UK £ 656 vs. £ 554 , p<0.001 ) . Full compliance ( minimum wear 7 hours a day 7 days per week ) was reported by 40 % of participants and 76 % of participants reported a minimum wear of 5 hours a day 5 days per week . There was no difference in patient perception between insoles . Conclusion The custom-made insoles are more expensive than prefabricated insoles evaluated in this trial and no better in reducing peak pressure . We recommend that where clinical ly appropriate , the more cost effective prefabricated insole should be considered for use by patients with diabetes and neuropathy . Trial registration Clinical trials.gov ( NCT00999635 ) . Note : this trial was registered on completion Background Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy . AIM : To investigate the effects of strengthening , stretching , and functional training on foot rollover process during gait . Methods A two-arm parallel-group r and omized controlled trial with a blinded assessor was design ed . Fifty-five patients diagnosed with diabetic polyneuropathy , 45 to 65 years-old were recruited .  Exercises for foot-ankle and gait training were administered twice a week , for 12 weeks , to 26 patients assigned to the intervention group , while 29 patients assigned to control group received recommended st and ard medical care : pharmacological treatment for diabetes and foot care instructions . Both groups were assessed after 12 weeks , and the intervention group at follow-up ( 24 weeks ) . Primary outcomes involved foot rollover changes during gait , including peak pressure ( PP ) . Secondary outcomes involved time-to-peak pressure ( TPP ) and pressure – time integral ( PTI ) in six foot- areas , mean center of pressure ( COP ) velocity , ankle kinematics and kinetics in the sagittal plane , intrinsic and extrinsic muscle function , and functional tests of foot and ankle . Results Even though the intervention group primary outcome ( PP ) showed a not statistically significant change under the six foot areas , intention-to-treat comparisons yielded softening of heel strike ( delayed heel TPP , p=.03 ) , better eccentric control of forefoot contact ( decrease in ankle extensor moment , p<.01 ; increase in function of ankle dorsiflexion , p<.05 ) , earlier lateral forefoot contact with respect to medial forefoot ( TPP anticipation , p<.01 ) , and increased participation of hallux ( increased PP and PTI , p=.03 ) and toes ( increase in PTI , medium effect size ) . A slower COP mean velocity ( p=.05 ) , and an increase in overall foot and ankle function ( p<.05 ) were also observed . In most cases , the values returned to baseline after the follow-up ( p<.05 ) . Conclusions Intervention discreetly changed foot rollover towards a more physiological process , supported by improved plantar pressure distribution and better functional condition of the foot ankle complex . Continuous monitoring of the foot status and patient education are necessary , and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy . Trial registration Clinical Trials.gov Identifier : NCT01207284 , registered in 20th September 2010 Aims /hypothesisGait characteristics and balance are altered in diabetic patients . Little is known about possible treatment strategies . This study evaluates the effect of a specific training programme on gait and balance of diabetic patients . Methods This was a r and omised controlled trial ( n = 71 ) with an intervention ( n = 35 ) and control group ( n = 36 ) . The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening ( twice weekly over 12 weeks ) . Controls received no treatment . Individuals were allocated to the groups in a central office . Gait , balance , fear of falls , muscle strength and joint mobility were measured at baseline , after intervention and at 6-month follow-up . Results The trial is closed to recruitment and follow-up . After training , the intervention group increased habitual walking speed by 0.149 m/s ( p < 0.001 ) compared with the control group . Patients in the intervention group also significantly improved their balance ( time to walk over a beam , balance index recorded on Biodex balance system ) , their performance-oriented mobility , their degree of concern about falling , their hip and ankle plantar flexor strength , and their hip flexion mobility compared with the control group . After 6 months , all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength . Two patients developed pain in their Achilles tendon : the progression for two related exercises was slowed down . Conclusions /interpretationSpecific training can improve gait speed , balance , muscle strength and joint mobility in diabetic patients . Further studies are needed to explore the influence of these improvements on the number of reported falls , patients ’ physical activity levels and quality of life . Trial registration : Clinical Trials.gov NCT00637546 Funding : This work was supported by the Swiss National Foundation ( SNF ) : AIMS To assess whether a programme of nurse education increased the frequency with which nurses conducted foot checks on people with diabetes undergoing haemodialysis and to evaluate whether this influenced self-reported foot care behaviour . METHODS A non-r and omized stepped-wedge design was used to evaluate a nurse education programme implemented in four UK National Health Service dialysis units . People with diabetes undergoing haemodialysis were invited to complete a question naire on the frequency of foot examination by health professionals , on the presence of foot problems and on their own foot care behaviour , using the Nottingham Assessment of Functional Foot-care ( NAFF ) . An education session for nurses , including procedures for foot examination , was conducted sequentially in each of four haemodialysis units . The question naire was repeated at 2-monthly intervals . RESULTS The education session result ed in a significant increase in the reported number of foot examinations by nurses ( P = 0.007 ) . There was also a significant improvement in reported foot care behaviour ( P < 0.001 ) , but this occurred between the first and second 2-monthly assessment s and was unrelated to the timing of the intervention . CONCLUSIONS A single education session can improve the routine checking of the feet of people with diabetes undergoing haemodialysis . The administration of the Nottingham Assessment of Functional Foot-care question naire was associated with improved self-reported foot care behaviour , reflecting greater awareness of risk in this population Abstract Aims /hypothesisThis observer-blind , r and omised controlled trial was design ed to determine the effect of a foot care education programme in the secondary prevention of foot ulcers . Methods People with newly healed foot ulcers attending one of three specialist clinics were allocated to receive either targeted , one-to-one education or usual care , using a computer-generated r and om allocation sequence that had been prepared in advance but which was concealed from the clinical research er . The primary outcome was ulcer incidence at 12 months . Secondary outcomes were ulcer incidence at 6 months and incidence of amputation , mood ( Hospital Anxiety and Depression Scale ) and quality of life ( Diabetic Foot Ulcer Scale ) at 6 and 12 months . Protective foot care behaviours ( Nottingham Assessment of Functional Footcare ) were assessed at 12 months . Results There were 87 ( mean [ SD ] age 63.5 [ 12.1 ] years ) patients in the intervention group and 85 control patients ( mean [ SD ] age 64.9 [ 10.9 ] years ) . The groups were comparable at baseline . No significant differences ( p > 0.05 ) were observed between groups in ulcer incidence at either 6 months ( intervention 30 % , control 21 % ) or 12 months ( intervention 41 % , control 41 % ) . Recommended foot care behaviours at 12 months were better in the intervention than in the control group ( p = 0.03 ) , but education had no significant ( p > 0.05 ) effect on mood , quality of life or amputations . Conclusions /interpretationEven though the intervention was associated with improved foot care behaviour , there was no evidence that this programme of targeted education was associated with clinical benefit in this population when compared with usual care . The usefulness and optimal delivery of education to such a high-risk group requires further evaluation . Trial registration : Clinical Trials.gov NCT00729456 Funding : Diabetes UK project grant BACKGROUND We aim ed to investigate whether a home exercise for self-care program that consists of range of motion ( ROM ) , stretching , and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications . METHODS Seventy-six diabetic patients were recruited ( 38 with neuropathy and 38 without neuropathy ) . Neuropathy and nonneuropathy groups were r and omly divided into a home exercise group ( n = 19 ) and a control group ( n = 19 ) . Exercise groups performed their own respective training programs for 4 weeks , whereas no training was done in the control group . Total contact area and plantar pressure under six foot areas before and after the exercise program were measured . Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program . RESULTS In the exercise group , there were significant improvements in ROM for the ankle and first metatarsophalangeal joints ( P < .001 ) ; static pedobarographic values showed significant reduction in right forefoot-medial pressure ( P = .010 ) ; and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial ( P = .007 ) , right forefoot lateral ( P = .018 ) , left midfoot ( P < .001 ) , and right hindfoot ( P = .021 ) after exercise . No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups ( P > .05 ) . CONCLUSIONS A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords 
    Output:
    
We found that structured education may improve foot self-care behaviour of patients , yearly foot examinations , and foot disease knowledge of health care professionals .
Callus removal reduces peak plantar pressure .
Custom-made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus .
Foot- and mobility-related exercises may improve neuropathy symptoms and foot and ankle joint range of motion , while they do not seem to reduce peak plantar pressure ; evidence for their effect on foot strength is conflicting .
Structured education for patients and health care professionals , callus removal , custom-made therapeutic footwear , and foot- and mobility-related exercises may be beneficial for improving modifiable risk factors for foot ulceration .