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Özgür S, Mum S, Benzer H, Toran MK, Toygar İ. A machine learning approach to predict foot care self-management in older adults with diabetes. Diabetol Metab Syndr 2024; 16:244. [PMID: 39375790 PMCID: PMC11457351 DOI: 10.1186/s13098-024-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 09/29/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Foot care self-management is underutilized in older adults and diabetic foot ulcers are more common in older adults. It is important to identify predictors of foot care self-management in older adults with diabetes in order to identify and support vulnerable groups. This study aimed to identify predictors of foot care self-management in older adults with diabetes using a machine learning approach. METHOD This cross-sectional study was conducted between November 2023 and February 2024. The data were collected in the endocrinology and metabolic diseases departments of three hospitals in Turkey. Patient identification form and the Foot Care Scale for Older Diabetics (FCS-OD) were used for data collection. Gradient boosting algorithms were used to predict the variable importance. Three machine learning algorithms were used in the study: XGBoost, LightGBM and Random Forest. The algorithms were used to predict patients with a score below or above the mean FCS-OD score. RESULTS XGBoost had the best performance (AUC: 0.7469). The common predictors of the models were age (0.0534), gender (0.0038), perceived health status (0.0218), and treatment regimen (0.0027). The XGBoost model, which had the highest AUC value, also identified income level (0.0055) and A1c (0.0020) as predictors of the FCS-OD score. CONCLUSION The study identified age, gender, perceived health status, treatment regimen, income level and A1c as predictors of foot care self-management in older adults with diabetes. Attention should be given to improving foot care self-management among this vulnerable group.
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Affiliation(s)
- Su Özgür
- Translational Pulmonary Research Center-EGESAM, Ege University, Izmir, Turkey
| | - Serpilay Mum
- Institution of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Hilal Benzer
- Vocational School, Hasan Kalyoncu University, Gaziantep, Turkey
| | | | - İsmail Toygar
- Faculty of Health Sciences, Mugla Sıtkı Kocman University, Mugla, Turkey.
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Bhat SZ, Al-Hajri N, Kanbour S, Ahmadzada M, Borovoy A, Abusamaan MS, Canner JK, Nass C, Sherman RL, Hines KF, Hicks CW, Abularrage CJ, Mathioudakis N. Glycemic Control in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes. Can J Diabetes 2024:S1499-2671(24)00179-5. [PMID: 39260687 DOI: 10.1016/j.jcjd.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 08/21/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE Our aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019. METHODS We conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound and wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test. RESULTS Two hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively. CONCLUSIONS This retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.
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Affiliation(s)
- Salman Z Bhat
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Noora Al-Hajri
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sarah Kanbour
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Muzzammil Ahmadzada
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Alexander Borovoy
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Mohammed S Abusamaan
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Joseph K Canner
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Caitlin Nass
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ronald L Sherman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Kathryn F Hines
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
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3
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Zhang Y, Liu H, Yang Y, Feng C, Cui L. Incidence and risk factors for amputation in Chinese patients with diabetic foot ulcers: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1405301. [PMID: 39280008 PMCID: PMC11393406 DOI: 10.3389/fendo.2024.1405301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Objective This study aimed to comprehensively analyze the incidence of amputation in Chinese patients with diabetic foot ulcers (DFUs). Methods The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. The CNKI, Wanfang Data, VIP, PubMed, Web of Science, and Embase databases were searched to collect relevant literature on the incidence of amputation in Chinese patients with DFUs. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias. The data were systematically analyzed using Stata 17.0 software to determine the incidence of amputation in this patient population. Results A total of 25 papers were included in the study, revealing an incidence of amputation in Chinese patients with DFUs of 22.4% (95% confidence interval: 18.3-26.5%). The subgroup analysis revealed that a history of ulcers, Wagner grade >3, and diabetic peripheral vascular disease were the primary risk factors associated with a higher incidence of amputation in Chinese patients with DFUs (P<0.05). Among Chinese patients with DFUs, the amputation group and the non-amputation group showed significant differences in body mass index, duration of DFUs, total cholesterol, triglyceride, fasting blood glucose, white blood cell count, hemoglobin A1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and uric acid (P<0.05). Conclusion The high incidence of amputation among Chinese patients with DFUs indicates that interventions should be implemented to prevent or minimize amputations. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42023463976.
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Affiliation(s)
- Yujie Zhang
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hui Liu
- Department of Quality Management, Jining N0.1 People’s Hospital, Jining, Shandong, China
| | - Yadi Yang
- Department of Quality Management, Jining N0.1 People’s Hospital, Jining, Shandong, China
| | - Chaochen Feng
- Department of Quality Management, Jining N0.1 People’s Hospital, Jining, Shandong, China
| | - Liwei Cui
- Department of Quality Management, Jining N0.1 People’s Hospital, Jining, Shandong, China
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Hemler SL, Sommerich CM, Correia JC, Pataky Z. User perceptions of intelligent offloading diabetic footwear. Front Endocrinol (Lausanne) 2024; 15:1380525. [PMID: 39170738 PMCID: PMC11335636 DOI: 10.3389/fendo.2024.1380525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Aims Adherence to therapeutic footwear is vital for effective diabetic foot ulcer prevention and treatment. Understanding the key adherence factors and potential barriers is important for footwear design and implementation. Our team is creating intelligent offloading footwear to prevent lower extremity amputations in people living with diabetes (PLwD). This exploratory study assessed the ability of the established Unified Theory of Acceptance and Use of Technology (UTAUT) model to predict behavioral intention to use or recommend this intelligent offloading footwear by PLwD, caregivers of PLwD, or medical professionals treating PLwD. Methods Online and paper questionnaires were implemented to assess the impact of the UTAUT model factors (performance expectancy, effort expectancy, social influence, facilitating conditions) and psychosocial factors (attitude, anxiety, self-efficacy) on the overall behavioral intention to use the footwear. Furthermore, factors influencing potential acceptance and rejection of the footwear were explored. Results Patients (4.0/5) and medical professionals (4.1/5) showed a behavioral intention to "agree" to use or recommend the footwear when it becomes available. Structural equation modeling showed that the UTAUT constructed model may not be the best indicator for behavioral intention here based on a lack of statistical significance. However, the logistic regression modeling showed that the social influence for PLwD (p=0.004) and the attitude toward the footwear for medical professionals (p=0.001) may be the most important when designing and implementing the footwear, though several other factors (performance expectancy, effort expectancy, facilitating conditions, and self-efficacy) were also important for one or both of these populations. Additionally, cost and clinician support were shown to be important factors influencing potential acceptance of the footwear. Conclusions The study found promising intention to use the intelligent footwear in the future. This highlights the need to continue future development and implementation of the footwear to incorporate these results, thus improving the likelihood of high adherence of the footwear.
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Affiliation(s)
- Sarah L. Hemler
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Carolyn M. Sommerich
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, United States
| | - Jorge C. Correia
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
- Faculty Diabetes Centre, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Zoltan Pataky
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
- Faculty Diabetes Centre, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Highton P, Jeffers S, Butt A, O'Mahoney L, Jenkins S, Abdala R, Haddon L, Gillies C, Curtis F, Hadjiconstantinou M, Khunti K. Patient-reported outcomes in diabetes-related foot conditions: Is patient experience influenced by ethnicity? A mixed-methods systematic review. Diabet Med 2024:e15420. [PMID: 39102339 DOI: 10.1111/dme.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/07/2024]
Abstract
AIMS Research in diabetes-related foot conditions (DRFC) often focuses on ulcer-related care, whilst the patient experience and influence of sociodemographic factors are under-researched. This systematic review investigated patient-reported outcomes and experience in people with DRFC. METHODS Multiple databases were searched from inception to 16 August 2023. All original articles that assessed any patient-reported outcome or experience in DRFC and reported participant ethnicity were included. Data were synthesized using a sequential contingent approach. Study quality was assessed using study design-specific tools. RESULTS Twenty-three studies were included (11 qualitative, 11 quantitative and one mixed-methods). DRFC had a largely negative impact on various life dimensions, including social and daily life, work, emotional and psychological well-being, necessitating dependence on others in the form of emotional, social and/or religious support, which were experienced differently by different groups. Patient DRFC knowledge and self-care habits were typically suboptimal, and levels of hope and feeling of control over their condition varied between groups. Outcomes varied slightly between ethnicities across studies, with some ethnicity-specific themes identified such as beliefs about disease cause and footwear habits. Quantitative and qualitative findings were mostly congruent. CONCLUSIONS DRFC profoundly and negatively impacts patient-reported outcomes and experience, with limited evidence suggesting an influence of ethnicity.
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Affiliation(s)
- Patrick Highton
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Shavez Jeffers
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Ayesha Butt
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Lauren O'Mahoney
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Sian Jenkins
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ruksar Abdala
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Louise Haddon
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Ffion Curtis
- Liverpool Reviews & Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
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Zhuang HR, Yu HP, Gu YJ, Li LJ, Yao JL. The Effect of Telemedicine Interventions on Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Wound Care (New Rochelle) 2024. [PMID: 38618714 DOI: 10.1089/wound.2024.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Objective: The meta-analysis was performed to evaluate the effectiveness of telemedicine interventions on patients with diabetic foot ulcers (DFU). Approach: The authors conducted a comprehensive search across eight databases. The aim was to identify randomized controlled trials examining the effectiveness of telemedicine for patients with DFU. Methodological qualities of included studies were assessed using Cochrane Handbook for Systematic Reviews of Intervention. Subsequently, a meta-analysis was conducted using RevMan 5.3 to synthesize the findings. Results: Ten studies involving 1,678 patients with DFU were included in the meta-analysis. In comparison to the face-to-face intervention group, telemedicine interventions significantly reduced the amputation rate (risk ratio = 0.64, 95% confidence interval [CI] = 0.44-0.92, p = 0.02), decreased costs (mean difference [MD] = -4158.51, 95% CI = -7304.69 to -1012.34, p = 0.01), better controlled fasting blood glucose (MD = -0.89, 95% CI = -1.43 to -0.36, p = 0.001), and achieved superior glycated hemoglobin control (MD = -0.71, 95% CI = -1.01 to -0.41, p < 0.00001). No significant differences were observed between the telemedicine group and the face-to-face group in terms of healing rate, mortality, and healing time. Innovations: Our study suggests that telemedicine is a viable strategy for managing DFU. Conclusions: The meta-analysis indicates that telemedicine interventions have a positive effect on DFU. Nevertheless, more well-designed and high-quality studies are needed to reach a conclusion with greater confidence.
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Affiliation(s)
- Hui-Ren Zhuang
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hai-Ping Yu
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying-Jie Gu
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ling-Jun Li
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia-Li Yao
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Simonsen NV, Klassen AF, Rae C, Mundy LR, Poulsen L, Pusic AL, Fan KL, Sørensen JA. The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study. Adv Wound Care (New Rochelle) 2024. [PMID: 38775456 DOI: 10.1089/wound.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.
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Affiliation(s)
- Nina Vestergaard Simonsen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
| | - Andrea L Pusic
- Department of Surgery and Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar, MedStar Plastic and Reconstructive Surgery, Washington, USA
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Ferreira G, Carvalho A, Pereira MG. Relaxation intervention to improve diabetic foot ulcer healing: protocol for a pilot study with a nested qualitative study. J Wound Care 2024; 33:clxxi-clxxxi. [PMID: 38980125 DOI: 10.12968/jowc.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVE A mixed-methods approach nested in a pilot three-arm randomised controlled trial (RCT) was conducted to evaluate the feasibility and acceptability of an intervention of progressive muscle relaxation with guided imagery (experimental group) compared to a neutral guided imagery placebo (active control group) and a group that did not receive any psychological intervention (passive control group). The purpose was to inform a future definitive RCT that will test its effectiveness. Qualitatively, this study examined patients and health professionals' perspectives regarding the relaxation intervention, in order to assess the acceptability and applicability of relaxation as an adjuvant therapy. METHOD Participants must have had a diagnosis of diabetes and diabetic foot disease; one or two active hard-to-heal ulcers at the time of the assessment; and clinical levels of stress or anxiety or depression. Participants were randomised and assessed at three timepoints after the first hospital consultation for hard-to-heal diabetic foot ulcer (DFU). RESULTS Rates of eligibility, recruitment, refusal, adherence to study protocol, participation in follow-up and dropout, and patients' satisfaction with the relaxation intervention were assessed as primary outcomes. Secondary outcomes were DFU healing; patients' DFU-related quality of life; physical and mental quality of life; perceived stress; emotional distress; adherence to DFU care; perceptions of DFU; as well as arterial systolic/diastolic pressure and heart rate. CONCLUSION The results of this pilot study contributed to clarification and better elucidation of the benefits of relaxation techniques regarding patients' HRQoL and DFU healing. DECLARATION OF INTEREST Funding: This study was conducted at the Psychology Research Centre (CIPsi/UM) School of Psychology, University of Minho, Portugal and supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (UIDB/01662/2020) and by a PhD fellowship from FCT assigned to GF (SFRH/BD/131780/2017) and an FCT grant (PTDC/PSI-GER/28163/2017) assigned to MGP. The authors have no conflicts of interest to declare.
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Affiliation(s)
- Gabriela Ferreira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - André Carvalho
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M Graça Pereira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
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Huang J, Yang J, Qi H, Xu M, Xu X, Zhu Y. Prediction models for amputation after diabetic foot: systematic review and critical appraisal. Diabetol Metab Syndr 2024; 16:126. [PMID: 38858732 PMCID: PMC11163763 DOI: 10.1186/s13098-024-01360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Numerous studies have developed or validated prediction models aimed at estimating the likelihood of amputation in diabetic foot (DF) patients. However, the quality and applicability of these models in clinical practice and future research remain uncertain. This study conducts a systematic review and assessment of the risk of bias and applicability of amputation prediction models among individuals with DF. METHODS A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, EBSCO CINAHL Plus, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedical Literature Database (CBM), and Weipu (VIP) from their inception to December 24, 2023. Two investigators independently screened the literature and extracted data using the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was employed to evaluate both the risk of bias and applicability. RESULTS A total of 20 studies were included in this analysis, comprising 17 development studies and three validation studies, encompassing 20 prediction models and 11 classification systems. The incidence of amputation in patients with DF ranged from 5.9 to 58.5%. Machine learning-based methods were employed in more than half of the studies. The reported area under the curve (AUC) varied from 0.560 to 0.939. Independent predictors consistently identified by multivariate models included age, gender, HbA1c, hemoglobin, white blood cell count, low-density lipoprotein cholesterol, diabetes duration, and Wagner's Classification. All studies were found to exhibit a high risk of bias, primarily attributed to inadequate handling of outcome events and missing data, lack of model performance assessment, and overfitting. CONCLUSIONS The assessment using PROBAST revealed a notable risk of bias in the existing prediction models for amputation in patients with DF. It is imperative for future studies to concentrate on enhancing the robustness of current prediction models or constructing new models with stringent methodologies.
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Affiliation(s)
- Jingying Huang
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Yang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiou Qi
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Miaomiao Xu
- Orthopedics Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Xu
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiting Zhu
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Asadian F, Khani F, Derakhshesh A, Takhshid MA. Comparison of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and C-reactive protein in predicting osteomyelitis in patients with diabetic foot ulcer. J Diabetes Metab Disord 2024; 23:647-654. [PMID: 38932883 PMCID: PMC11196474 DOI: 10.1007/s40200-023-01327-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/28/2023] [Indexed: 06/28/2024]
Abstract
Introduction Neutrophil/lymphocyte ratio (NLR) and platelet/ lymphocyte ratio (PLR) are readily available and inexpensive biomarkers that have received great attention for diagnosing type 2 diabetes(T2DM) complications. The objective of the present cross-sectional study was to compare diagnostic values of these biomarkers with C-reactive protein(CRP) in detecting diabetic foot ulcer (DFU) and osteomyelitis (OS) and discriminating between the degree of DFU according to Wagner's classification. Methods A total of 217 individuals (42 healthy controls, 40 T2DM patients without DFU, and 135 patients with DFU) were enrolled. The DFU patients were classified according to Wagner's classification into grade 1, grade 2, and grade 3. Blood samples were obtained and various biochemical and hematological parameters including creatine, CRP, HbA1c, NLR, and PLR were measured. Results The levels of CRP, PLR, and NLR were significantly higher in the patients with DFU and OS compared to healthy controls and T2DM patients without DFU. The median values of CRP were correlated with the severity of DFU and increased with DFU grades. The highest values of CRP, NLR, and PLR were observed in the DFU patients with OS which were significantly higher than those of DFU patients with grades 1 and 2 as well as T2DM patients without DFU. The PLR and NLR had no significant performance in diagnosing DFU patients with grades 1 and 2 from the patients without DFU. Conclusion NLR and PLR could be useful for diagnosing OS but cannot be used for detecting lower grades of DFU. CRP showed higher performance in detecting OS compared to PLR and NLR. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01327-w.
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Affiliation(s)
- Fatemeh Asadian
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khani
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arya Derakhshesh
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Takhshid
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Zúnica-García S, Blanquer-Gregori J, Sánchez-Ortiga R, Jiménez-Trujillo MI, Chicharro-Luna E. Exploring the influence of dietary habits on foot risk in type 2 diabetes patients: An observational study. Clin Nutr 2024; 43:1516-1521. [PMID: 38729080 DOI: 10.1016/j.clnu.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND & AIM To date, there are no studies demonstrating the impact of the Mediterranean diet on the risk of diabetic foot ulcer. The aim of this research was to examine the connection between adherence to the Mediterranean diet and the level of risk of diabetic foot ulcers in individuals with type 2 diabetes. METHODS Observational pilot study collecting sociodemographic, anthropometric, lifestyle, and type 2 diabetes-related data. Loss of protective sensation was assessed using the Semmes Weinstein 5.07-10 g monofilament, considered altered when not perceived in four points. Vascular status was assessed by palpating pulses and ankle-brachial index, indicating peripheral arterial disease if ankle-brachial index was less than 0.9 or if both pulses were absent. Foot deformities were recorded. The risk of diabetic foot ulcers was stratified into two categories: no risk and risk of diabetic foot ulcers. Adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Screener-14 questionnaire (good adherence with score >7). RESULTS Of the 174 patients with type 2 diabetes mellitus who participated (61.5% men and 38.5% women) with a mean age of 69.56 ± 8.86 years and a mean duration of type 2 diabetes of 15.34 ± 9.83 years. Non-adherent patients to the Mediterranean diet exhibited a higher association of diabetic foot ulcers (p = 0.030) and a lower average score on the Mediterranean Diet Adherence Screener-14 (p = 0.011). Additionally, a lower incidence of diabetic foot ulcers was observed in those who consumed nuts three or more times a week (p = 0.003) and sautéed foods two or more times a week (p = 0.003). Multivariate analysis highlighted the importance of physical activity (OR = 0.25, 95% CI 0.11-0.54; p < 0.001), podiatric treatment (OR = 2.59, 95% CI 1.21-5.56; p = 0.014), and duration of type 2 diabetes (OR = 3.25, 95% CI 1.76-5.99; p < 0.001) as significantly associated factors related to the risk of diabetic foot ulcers. CONCLUSIONS Adhering to the Mediterranean diet correlates with a lower incidence of diabetic foot ulcers in individuals diagnosed with type 2 diabetes mellitus. Furthermore, factors such as regular physical activity, podiatric treatment, and the duration of type 2 diabetes mellitus emerge as pivotal in preventing diabetic foot ulcers.
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Affiliation(s)
- Sara Zúnica-García
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, Miguel Hernández University, Alicante, Spain.
| | | | - Ruth Sánchez-Ortiga
- Endocrinology and Nutrition Department, Dr. Balmis General University Hospital, Alicante, Spain.
| | - María Isabel Jiménez-Trujillo
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health and Medical Microbiology and Immunology, Nursing and Stomatology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
| | - Esther Chicharro-Luna
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, Miguel Hernández University, Institute of Health and Biomedical Research of Alicante (ISABIAL), Alicante, Spain.
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Riise HKR, Igland J, Graue M, Haugstvedt A, Østbye T, Søfteland E, Hermann M, Carlsson S, Åsvold BO, Iversen MM. Decreasing lifetime prevalence of diabetes-related foot ulcers in Norway: repeated cross-sectional population-based surveys from the HUNT study (1995-2019). Front Endocrinol (Lausanne) 2024; 15:1354385. [PMID: 38694943 PMCID: PMC11061349 DOI: 10.3389/fendo.2024.1354385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Background and aims Diabetes-related foot ulcers (DFU) are a persistent healthcare challenge, impacting both patients and healthcare systems, with adverse effects on quality of life and productivity. Our primary aim was to examine the trends in lifetime prevalence of DFU, as well as other micro- and macrovascular complications in the Trøndelag Health Study (HUNT) in Norway. Methods This study consists of individuals ≥20 years with diabetes participating in the population-based cross-sectional HUNT surveys (1995-2019). Prevalence ratios, comparing the lifetime prevalence of DFU and other relevant micro- and macrovascular complications between the HUNT surveys, were calculated using Poisson regression. Results The lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 11.0% (9.5-12.7) in HUNT2, 7.5% (6.3-8.8) in HUNT3 and 5.3% (4.4-6.3) in HUNT4. The decrease in DFU prevalence from 1995 to 2019 was observed in both men and women, for all age groups, and for both type 1 and type 2 diabetes. The highest lifetime prevalence of DFU was found among those with type 1 diabetes. The decrease in HbA1c from HUNT2 to HUNT4 did not differ between those with and without a DFU. The prevalence of chronic kidney disease (eGFR <60 mL/min/1.73 m2 (eGFR categories G3-G5)) increased in both individuals with and without a DFU. Conclusion Results from the HUNT surveys show a substantial decline in the lifetime prevalence of DFU from 1995 to 2019.
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Affiliation(s)
- Hilde K. R. Riise
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Hermann
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bjørn Olav Åsvold
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, NTNU – Norwegian University of Science and Technology, Levanger, Norway
| | - Marjolein M. Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Lusendi FM, Vanherwegen AS, Doggen K, Nobels F, Matricali GA. Evidence-based interventions for identifying candidate quality indicators to assess quality of care in diabetic foot clinics: a scoping review. BMC Public Health 2024; 24:996. [PMID: 38600498 PMCID: PMC11005120 DOI: 10.1186/s12889-024-18306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology. METHODS A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the "Preferred Reported Items for Systematic reviews and Meta-Analysis" (PRISMA) statements and its extension for scoping reviews. RESULTS In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs. CONCLUSIONS An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders.
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Affiliation(s)
- Flora Mbela Lusendi
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium.
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - An-Sofie Vanherwegen
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Kris Doggen
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Giovanni Arnoldo Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Multidisciplinary Diabetic Foot Clinic, University Hospital Leuven, Leuven, Belgium
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14
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Lusendi FM, Vanherwegen AS, Nobels F, Matricali GA. A multidisciplinary Delphi consensus to define evidence-based quality indicators for diabetic foot ulcer care. Eur J Public Health 2024; 34:253-259. [PMID: 38276880 PMCID: PMC10990505 DOI: 10.1093/eurpub/ckad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Valid measures to assess quality of care delivered to patients with diabetes suffering from diabetic foot ulcer (DFU) are scarce. This study aimed to achieve consensus on relevant and feasible quality indicators (QIs) among stakeholders involved in DFU care and was conducted as the second part of a Belgian QI selection study that sought to identify QIs for DFU care. METHODS A stakeholder panel, including caregivers from primary care and specialized disciplines active in diabetic foot care as well as a patient organization representative, was recruited. By using the RAND/UCLA Appropriateness Method, stakeholders were asked to rate a list of 42 candidate evidence-based indicators for appropriateness through a 9-point Likert scale. QIs were classified based on the median ratings and the disagreement index, calculated by the inter-percentile range adjusted for symmetry. RESULTS At the end of a three-phase process, 17 QIs were judged as appropriate. Among them, five were not previously described, covering the following topics: integration of wound care specialty in the multidisciplinary team, systematic evaluation of the nutritional status of the patient, administration of low-density lipoprotein-cholesterol lowering medication and protocolized care (implementation of care and prevention management protocols). CONCLUSIONS The identified evidence-based QIs provide an assessment tool to evaluate and monitor quality of care delivered to DFU patients. Future research should focus on their complementarity with the existing QIs and their implementation in clinical practice.
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Affiliation(s)
- Flora Mbela Lusendi
- Department of Epidemiology and Public Health, Health Services Research, Sciensano, Brussels, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - An-Sofie Vanherwegen
- Department of Epidemiology and Public Health, Health Services Research, Sciensano, Brussels, Belgium
| | - Frank Nobels
- Department of Internal Medicine-Endocrinology, Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouw Ziekenhuis Aalst, Aalst, Belgium
| | - Giovanni Arnoldo Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Multidisciplinary Diabetic Foot Clinic, University Hospital Leuven, Leuven, Belgium
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15
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Hancox JE, Chaplin WJ, Hilton C, Gray K, Game F, Vedhara K. Development of a Motivation Communication Training to Aid Diabetes-Specialist Podiatrists With Adherence Discussions. HEALTH EDUCATION & BEHAVIOR 2024; 51:240-250. [PMID: 38097512 PMCID: PMC10981181 DOI: 10.1177/10901981231216744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient-practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in postprogram telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.
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Affiliation(s)
- Jennie E. Hancox
- University of Nottingham, Nottingham, UK
- Loughborough University, Loughborough, UK
| | | | | | - Katie Gray
- Derbyshire Community Health Services NHS, Bakewell, UK
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Highton P, Almaqhawi A, Oroko M, Sathanapally H, Gray L, Davies M, Webb D, Game F, Petrie J, Tesfaye S, Valabhji J, Gillies C, Khunti K. Non-pharmacological interventions to improve cardiovascular risk factors in people with diabetic foot disease: A systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 209:111590. [PMID: 38403175 DOI: 10.1016/j.diabres.2024.111590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Cardiovascular disease (CVD) risk in those with diabetic foot disease is very high. Non-pharmacological interventions may improve this risk, though no previous evidence synthesis has been completed. This systematic review aimed to investigate the impact of non-pharmacological interventions on CVD risk factors in diabetic ulcer disease. Multiple databases and trials registers were searched from inception to December 6th 2023. We included reports of randomised controlled trials investigating the impact of non-pharmacological interventions on cardiovascular risk in those with type 1 or type 2 diabetes and current or previous diabetic foot disease. Twenty studies were included. Extracted data included: study design and setting; participant sociodemographic factors; and change in cardiovascular risk factors. Data were synthesised using random effects meta-analyses and narrative syntheses. Interventions included nutritional supplementation, collaborative care, hyperbaric oxygen therapy, patient education, nurse-led intervention, self-management, family support, relaxation and exercise, over a median duration of 12 weeks. Significant post-intervention changes were observed in fasting plasma glucose, serum insulin levels, insulin sensitivity and resistance, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein-cholesterol and C-reactive protein. No effects were detected in very low- or high-density lipoprotein-cholesterol or body mass index. Non-pharmacological interventions show promise in improving CVD risk in diabetic foot disease.
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Affiliation(s)
- Patrick Highton
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK.
| | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Hofuf, Saudi Arabia
| | - Maroria Oroko
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Harini Sathanapally
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Laura Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - David Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
| | - John Petrie
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Jonathan Valabhji
- NHS England, Wellington House, 133-135 Waterloo Road, London SE1 8UG, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London W2 1NY, UK; Division of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London SW7 2BU, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
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Álvaro-Afonso FJ, García-Madrid M, García-Morales E, López-Moral M, Molines-Barroso RJ, Lázaro-Martínez JL. Health-related quality of life among Spanish patients with diabetic foot ulcer according to Diabetic Foot Ulcer Scale - Short Form. J Tissue Viability 2024; 33:5-10. [PMID: 38065828 DOI: 10.1016/j.jtv.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/07/2023] [Accepted: 11/30/2023] [Indexed: 03/17/2024]
Abstract
AIM The aim of this study was to investigate the health-related quality of life of Spanish outpatients with diabetic foot ulcer using the Diabetic Foot Scale-Short Form (DFS-SF). MATERIALS AND METHODS This cross-sectional observational study included 141 outpatients with diabetic foot ulcers (DFU). The DFS-SF was applied in personal interviews conducted by a trained investigator to assess health-related quality of life (HRQoL). RESULTS The domain related to "worried about ulcers" had the lowest in score [50 (27.5-65.0)], and the highest score was in the physical health domain [76 (60.0-88.0)]. There was a statistically significant difference in the ulcer type and the physical health subscale, finding the lowest values in the physical health subscale in patients with ischaemic diabetic foot ulcers [58 (39.0-70.0), p = 0.007]. In the multivariable analysis the domains Leisure (OR 0.98, 95% CI 0.97-0.99) and worried about ulcers/feet (OR 0.98, 95% CI 0.96-0.99) were identified as significant independent domains in patients with the experience of a previous minor amputation. A significant negative correlation was observed between the SINBAD DFU score and leisure (r = -0.181, p = 0.032), physical health (r = -0.202, p = 0.016), dependence/daily life (r = -0.232, p = 0.006), and the "bothered by ulcer care" (r = -0.239, p = 0.004) domains of the DFS-SF. The ulcer duration had a significant negative correlation with all the domains of DFS-SF. CONCLUSION The DFS-SF survey is a specific instrument that could be implemented in diabetic foot units as part of the management of patients with DFU to evaluate HRQoL. The domain of "worried about ulcers" had the lowest score in our population suggesting that clinicians should try to work on the emotional state of patients with DFU. The mean duration of DFU was the most influential factor related to worse scores followed by previous amputations. The SINBAD score had significant negative correlations suggesting that HRQoL may be related to the severity of DFU in this study population.
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Affiliation(s)
- Francisco Javier Álvaro-Afonso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - Esther García-Morales
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - Raúl J Molines-Barroso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
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Waibel FWA, Uçkay I, Soldevila-Boixader L, Sydler C, Gariani K. Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review. Front Endocrinol (Lausanne) 2024; 14:1323315. [PMID: 38298183 PMCID: PMC10829909 DOI: 10.3389/fendo.2023.1323315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.
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Affiliation(s)
- Felix W. A. Waibel
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Soldevila-Boixader
- Infectious Diseases, Internal Medicine Department, Consorci Sanitari Integral-CSI, Sant Joan Despí Hospital, Barcelona, Spain
| | - Christina Sydler
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic Education, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
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Byrnes J, Ward L, Jensen S, Sagoo M, Charles D, Mann R, Nghiem S, Finch J, Gavaghan B, McBride LJ, Lazzarini PA. Health-related quality of life in people with different diabetes-related foot ulcer health states: A cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states. Diabetes Res Clin Pract 2024; 207:111061. [PMID: 38104903 DOI: 10.1016/j.diabres.2023.111061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
AIMS Diabetes-related foot ulcers (DFU) are a leading cause of infection, hospitalisation and amputation. However, to our knowledge no studies have compared the health-related quality of life (HRQoL) of people with DFU that were infected, hospitalised or amputated. This study aimed to investigate and compare the HRQoL of different groups of people with healed, non-infected, infected, hospitalised, or amputated DFU. METHODS This was a multi-centre cross-sectional study measuring the HRQoL of patients, attending one of 18 Diabetic Foot Services across Queensland, Australia, with one of five DFU health states: healed, non-infected, infected, hospitalised, amputated. HRQoL was measured using the EQ-5D-5L to estimate age-sex adjusted utility values. RESULTS Of 376 included patients (mean age 63 (12) years, 75% male), age-sex adjusted HRQoL utility estimates (95% CIs) were: healed DFU 0.57 (0.51-0.64), non-infected DFU 0.55 (0.49-0.62), infected DFU 0.45 (0.36-0.55), hospitalised DFU 0.53 (0.42-0.64), and amputated DFU 0.55 (0.46-0.63). CONCLUSION People in any DFU health state have considerably reduced HRQoL, with greatest reductions in those with infected DFU. These findings provide valuable HRQoL estimates and comparisons for several different important DFU health states, adding to our understanding of the impact of DFU on HRQoL and facilitating future economic evaluations.
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Affiliation(s)
- Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia.
| | - Lauren Ward
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Sarah Jensen
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Manjeet Sagoo
- Diabetes Resource Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Danielle Charles
- Cairns Diabetes Centre, Cairns and Hinterland Hospital and Health Service, and Metro North Hospital and Health Service, Queensland, Australia
| | - Rebecca Mann
- Chronic Disease Brisbane South, Community and Oral Health, Inala Community Health Centre, Metro South Health, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Finch
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Belinda Gavaghan
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Liza-Jane McBride
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Peter A Lazzarini
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Manalu NV, Yunitasari E, Kotijah S, Yusuf A, Malinti E. How Diabetic Foot Ulcer Patients Can Self-Treat Wound Care: An Integrative Literature Review. SAGE Open Nurs 2024; 10:23779608241274219. [PMID: 39239385 PMCID: PMC11375663 DOI: 10.1177/23779608241274219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction To improve the capacity of diabetic foot ulcer (DFU) patients for self-management of wound care, there is a renewed need for self-care on their part, as well as an increase in their readiness to deal with issues and heal their wounds. Therefore, this review empirically assessed contemporary evidence on how patients with DFU can perform self-treat wound care. Methods This integrative literature review assessed how patients with DFU could perform self-treat wound care. Whittemore and Knafl integrative information literature review involved searching four databases (Scopus, PubMed, Web of Science, and Google Scholar), which resulted in 2,595 published articles, between 2010 and 2023. Nineteen articles satisfied the requirements for inclusion and quality assessment, and the PRISMA review checklist was followed. Results No research has addressed DFU patients' self-treatment of wound care. The integration of evidence from quantitative and qualitative studies was achieved in three categories: (1) motivation, (2) self-wound care strategy, and (3) self-wound care performance by DFU patients. Conclusion To equip themselves to perform wound care independently, patients with DFU must receive training to clean wounds, apply wound medication, and perform dressings. There is a need for research that develops a self-treat wound care intervention model in patients with DFU.
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Affiliation(s)
- Novita Verayanti Manalu
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Nursing, Adventist University of Indonesia, Bandung, Indonesia
| | - Esti Yunitasari
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
| | - Siti Kotijah
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Nursing, Bina Sehat PPNI University, Mojokerto, Jawa Timur, Indonesia
| | - Ah Yusuf
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
| | - Evelin Malinti
- Faculty of Nursing, Adventist University of Indonesia, Bandung, Indonesia
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21
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Pouwer F, Mizokami-Stout K, Reeves ND, Pop-Busui R, Tesfaye S, Boulton AJM, Vileikyte L. Psychosocial Care for People With Diabetic Neuropathy: Time for Action. Diabetes Care 2024; 47:17-25. [PMID: 38117989 DOI: 10.2337/dci23-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 12/22/2023]
Abstract
Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
- Lieutenant Colonel Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester, U.K
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Andrew J M Boulton
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
| | - Loretta Vileikyte
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
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22
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Frescos N, Stopher L, Jansen S, Kaminski MR. The financial burden of diabetes-related foot disease in Australia: a systematic review. J Foot Ankle Res 2023; 16:92. [PMID: 38151723 PMCID: PMC10751954 DOI: 10.1186/s13047-023-00688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. METHODS Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. RESULTS Three economic evaluations were included in the review. One study was rated as 'poor', one as 'very good' and one as 'excellent' when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. CONCLUSION There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. TRIAL REGISTRATION PROSPERO Registration No. CRD42022290910.
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Affiliation(s)
- Nicoletta Frescos
- Austin Health, Melbourne, VIC, Australia.
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - Lucy Stopher
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Shirley Jansen
- Sir Charles Gairdner Hospital, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Department of Podiatry, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied healthcare, Monash University, Melbourne, VIC, Australia
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23
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Hellstrand Tang U, Scandurra I, Sundberg L, Annersten Gershater M, Zügner R. Patients' Expectations of Evidence-Based Service at the Pharmacy Regarding Information on Self-Care of the Feet for Persons with Diabetes at Risk of Developing Foot Ulcers - A Cross-Sectional Observational Study in Sweden. Patient Prefer Adherence 2023; 17:3557-3576. [PMID: 38169667 PMCID: PMC10758569 DOI: 10.2147/ppa.s435632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients' expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet. Patients and Methods The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade. Results Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU. Conclusion The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use. Clinical Trial NCT05692778.
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Affiliation(s)
- Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabella Scandurra
- Centre of Empirical Research in Information Systems, Örebro University, Örebro, Sweden
| | | | | | - Roland Zügner
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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24
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Hancox JE, Hilton C, Gray K, Game F, Vedhara K. Adherence to limiting weight-bearing activity in patients with diabetic foot ulcers: A qualitative study. Int Wound J 2023; 20:3945-3954. [PMID: 37312664 PMCID: PMC10681470 DOI: 10.1111/iwj.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/01/2023] [Indexed: 06/15/2023] Open
Abstract
Patients with diabetic foot ulcers are advised to limit weight-bearing activity for ulcers to heal. Patients often disregard this advice although the reasons are not yet fully understood. This study explored (1) patients' experiences of receiving the advice and (2) factors influencing adherence to the advice. Semi-structured interviews were conducted with 14 patients with diabetic foot ulcers. Interviews were transcribed and analysed using inductive thematic analysis. Advice regarding limiting weight-bearing activity was described by patients as directive, generic and conflicting with other priorities. Rapport, empathy and rationale supported receptivity to the advice. Barriers and facilitators to limiting weight-bearing activity included demands of daily living, enjoyment of exercise, sick/disabled identity and burden, depression, neuropathy/pain, health benefits, fear of negative consequences, positive feedback, practical support, weather and active/passive role in recovery. It is important that healthcare professionals pay attention to how limiting weight-bearing activity advice is communicated. We propose a more person-centred approach in which advice is tailored to individuals' specific needs with discussion around patient priorities and constraints.
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Affiliation(s)
- Jennie E. Hancox
- School of MedicineUniversity of NottinghamNottinghamUK
- Loughborough UniversityLoughboroughUK
| | | | - Katie Gray
- Derbyshire Community Health Services NHSBakewellUK
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
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25
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Eckert KA, Fife CE, Carter MJ. The Impact of Underlying Conditions on Quality-of-Life Measurement Among Patients with Chronic Wounds, as Measured by Utility Values: A Review with an Additional Study. Adv Wound Care (New Rochelle) 2023; 12:680-695. [PMID: 37815559 PMCID: PMC10615090 DOI: 10.1089/wound.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 10/11/2023] Open
Abstract
Significance: Quality of life (QoL) is important to patients with chronic wounds and is rarely formally evaluated. Understanding what comorbidities most affect the individual versus their wounds could be a key metric. Recent Advances: The last 20 years have seen substantial advances in QoL instruments and conversion of patient data to a single value known as the health utilities index (HUI). We review these advances, along with wound-related QoL, and analyze real-world comorbidities challenging wound care. Critical Issues: To understand the impact of underlying comorbidities in a real-world patient population, we examined a convenience sample of 382 patients seen at a hospital-based outpatient wound center. This quality reporting study falls outside the regulations that govern human subject research. Comorbid conditions were used to calculate HUIs using a variety of literature-reported approaches, while Wound-Quality-of-Life (W-QoL) questionnaire data were collected from patients during their first visit. The mean number of conditions per patient was 8; 229 patients (59.9%) had utility values for comorbidities/conditions, which were worse/lower than their wounds' values. Sixty-three (16.5%) patients had depression and/or anxiety, 64 (16.8%) had morbid obesity, and 204 (53.4%) had gait and mobility disorders, all of which could have affected W-QoL scoring. The mean minimum utility value (0.5) was within 0.05 units of an average of 13 studies reporting health utilities from wound care populations using the EuroQol 5 Dimension instrument. Future Directions: The comorbidity associated with the lowest utility value is what might most influence the QoL of patients with chronic wounds. This finding needs further investigation.
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Affiliation(s)
| | - Caroline E. Fife
- Intellicure, LLC, The Woodlands, Texas, USA
- U.S. Wound Registry (501 3C Nonprofit), The Woodlands, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
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26
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Yoshida K, Miura Y, Nakanishi S, Tanaka S, Kuniyasu K, Matsumoto S, Hanayama K. The impact of diabetic polyneuropathy on toe grip strength in patients with type 2 diabetes mellitus: a cross-sectional study. J Diabetes Metab Disord 2023; 22:1391-1397. [PMID: 37969917 PMCID: PMC10638331 DOI: 10.1007/s40200-023-01260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/01/2023] [Indexed: 11/17/2023]
Abstract
Purpose Type 2 diabetes mellitus (T2DM) and concomitant diabetic polyneuropathy (DPN) induce muscle weakness. Muscle weakness in the foot is associated with foot deformities and falls. However, factors affecting toe grip strength (TGS) are not well known. Therefore, the present study investigated factors related to TGS in patients with T2DM. Methods This was a cross-sectional study involving 100 patients with T2DM who were hospitalized for the treatment of T2DM and 50 healthy adults. The subjects were divided into three groups: a group of healthy subjects, a group of T2DM patients without DPN, and a group of T2DM patients with DPN. Hierarchical multiple regression analysis was performed with TGS and the TGS-to-weight ratio (TGS/Wt%) as dependent variables and with age, the presence of T2DM, and DPN as independent variables, and sex and BMI as confounders. Results There were no significant differences in age or sex among the three groups. In the final regression analysis, age and presence of T2DM and DPN were associated in both models with TGS and TGS/Wt% as dependent variables. Conclusion DPN, T2DM, and age were found to be related to TGS. The findings of this study could contribute to healthcare providers developing foot care and rehabilitation programs for diabetic patients. Trial registration This study was registered with UMIN-CTR (UMIN000034320) on 1 November 2018.
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Affiliation(s)
- Koji Yoshida
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
- Department of Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Yasushi Miura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| | - Shigeharu Tanaka
- School of Rehabilitation, Kanagawa University of Human Services, Yokosuka, Japan
| | - Katsushi Kuniyasu
- Department of Physical Therapist, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Shinsuke Matsumoto
- Department of Physical Therapist, Kawasaki Junior College of Rehabilitation, Kurashiki, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki, Japan
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27
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Moattari M, King EC, Ruco A. Whole versus hole: enabling community nurses to implement holistic wound care. J Wound Care 2023; 32:748-757. [PMID: 37907360 DOI: 10.12968/jowc.2023.32.11.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To improve wound-related quality of life (QoL) in clients with hard-to-heal wounds in their lower limbs and to increase referrals to multidisciplinary teams in the management of care for these clients. METHOD This was a quality improvement project with a two-group pretest-posttest interventional evaluation design. We implemented a package of interventions including the WounDS app, education related to wound care, and client engagement through a QoL self-assessment. Wound-related QoL was measured using the Cardiff Wound Impact Schedule and referrals to the multidisciplinary team were tracked through chart audits. We explored nurses' experiences with the interventions through semi-structured interviews. RESULTS Clients' average ratings for 'wellbeing', 'physical symptoms and daily living', and 'overall QoL' improved by 27%, 38% and 54%, respectively. The number of referrals increased by 78% post intervention. Nurses described the interventions as effective strategies that motivated them to implement a holistic approach to care. CONCLUSION The project was successful in creating a culture shift to practice holistic wound care. This package of interventions (WounDS app, education and client self-assessment of QoL) led to improvements in the QoL of clients with hard-to-heal wounds. Further studies are needed to generalise the findings. Strategies for sustainability include forming a champion group and providing the education and decision supports based on nurses' educational needs assessment.
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Affiliation(s)
- Marzieh Moattari
- VHA Home HealthCare, Toronto, Canada
- Humber River Health, Toronto, Canada
| | - Emily C King
- VHA Home HealthCare, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Arlinda Ruco
- VHA Home HealthCare, Toronto, Canada
- St. Francis Xavier University, Antigonish, Canada
- Women's College Hospital, Toronto, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, Canada
- Nova Scotia Health, Nova Scotia, Canada
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28
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Vossen LE, van Netten JJ, Bakker CD, Berendsen HA, Busch-Westbroek TE, Peters EJG, Sabelis LWE, Dijkgraaf MGW, Bus SA. An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:663. [PMID: 37828618 PMCID: PMC10568814 DOI: 10.1186/s13063-023-07635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person's needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes. METHODS In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively. DISCUSSION This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.
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Affiliation(s)
- Lisa E Vossen
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Chantal D Bakker
- Department of Rehabilitation Medicine, Máxima Medisch Centrum Veldhoven, de Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Heleen A Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis Delft, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Edgar J G Peters
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Internal Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Louise W E Sabelis
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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29
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Haryanto H, Amrullah S, Jais S, Supriadi S, Imran I, Sari Y. INDIFURUTO: A novel tool for assessing diabetic foot recurrence risk in type 2 diabetes. J Med Life 2023; 16:1514-1518. [PMID: 38313180 PMCID: PMC10835566 DOI: 10.25122/jml-2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024] Open
Abstract
This study aimed to evaluate diabetic foot ulcer recurrence using the Indonesia Diabetic Foot Ulcer Recurrence Assessment Tool (INDIFURUTO), a new diabetic foot risk recurrence assessment tool. This study used a prospective cohort design. A total of thirty-three participants met the inclusion criteria. We used sensitivity, specificity values, AUC, and, respectively, a 95% confidence interval (CI) to calculate prognostic accuracy measures. The results showed that this study had an AUC of 0,97 [95% confidence interval (CI) 0.91-1.00]. The cut-off point (Youden Index) was <45, with sensitivity and specificity values of 100% and 90%, respectively. The utilization of this model can facilitate the monitoring and enhancement of foot ulcer recurrence prevention in individuals diagnosed with diabetes. This study showed that the new model had a high prediction. Therefore, this model better stratifies people at high risk of foot ulceration.
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Affiliation(s)
- Haryanto Haryanto
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Syahid Amrullah
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Suriadi Jais
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Supriadi Supriadi
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Imran Imran
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Yunita Sari
- Department of Nursing, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
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30
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Borderie G, Foussard N, Larroumet A, Blanco L, Barbet-Massin MA, Ducos C, Rami-Arab L, Domenge F, Mohammedi K, Ducasse E, Caradu C, Rigalleau V. The skin autofluorescence of advanced glycation end-products relates to the development of foot ulcers in type 2 diabetes: A longitudinal observational study. J Diabetes Complications 2023; 37:108595. [PMID: 37647711 DOI: 10.1016/j.jdiacomp.2023.108595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES The long-term glycemic memory contributes to vascular complications in type 2 diabetes, including those patients with Diabetic Foot Ulcers (DFU). We investigated whether the skin autofluorescence (SAF) of Advanced Glycation End-products related to later DFUs. RESEARCH DESIGN & METHODS SAF was measured with an AGE-Reader in a retrospective cohort of patients hospitalized from 2009 to 2017 for Type 2 Diabetes. New DFUs were registered until the year 2020 and survival analyses were performed. RESULTS The 517 patients (men: 58.0 %), were 62 ± 9 years old at baseline, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 %, complications included 33.8 % macroangiopathies, 44.9 % diabetic kidney diseases and 26.7 % retinopathies. According to the IWGDF classification, the grades of risk for DFU were 0 for 43.2 %, 1 for 23.9 %, 2 for 7.2 %, and 3 for 25.7 %. During the 53 months of follow-up, 58 new DFUs occurred, mostly in patients with SAF higher than its median value (2.65 AU). Adjusted for age and sex, conventional risk factors (duration and control of diabetes, arterial hypertension, dyslipidemia, smoking), and other complications (macroangiopathy, diabetic kidney disease, retinopathy), SAF related to later DFUs. Adjusted for the IWGDF classification, SAF related to new DFUs (HR: 1.81, 95%CI:1.25-2.62). This relationship was significant for the 403 subjects without previous history of DFU (HR: 2.32, 95%CI: 1.36-3.95). SAF did not predict recurrence for patients with a previous history of DFUs. CONCLUSION SAF, a simple non-invasive marker of glycemic memory, independently predicts the occurrence of a first foot ulcer in patients with Type 2 Diabetes.
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Affiliation(s)
- Gauthier Borderie
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Ninon Foussard
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Alice Larroumet
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Laurence Blanco
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | | | - Claire Ducos
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Lila Rami-Arab
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Frédéric Domenge
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Kamel Mohammedi
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France
| | - Eric Ducasse
- Bordeaux CHU and University, Vascular Surgery, 33000 Bordeaux, France
| | - Caroline Caradu
- Bordeaux CHU and University, Vascular Surgery, 33000 Bordeaux, France
| | - Vincent Rigalleau
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition, 33000 Bordeaux, France.
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Jongebloed-Westra M, Exterkate SH, van Netten JJ, Kappert KDR, Koffijberg H, Bode C, van Gemert-Pijnen JEWC, Ten Klooster PM. The effectiveness of motivational interviewing on adherence to wearing orthopedic shoes in people with diabetes at low-to-high risk of foot ulceration: A multicenter cluster-randomized controlled trial. Diabetes Res Clin Pract 2023; 204:110903. [PMID: 37704109 DOI: 10.1016/j.diabres.2023.110903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
AIM To evaluate the effectiveness of motivational interviewing (MI) performed by MI-trained podiatrists in improving adherence to wearing orthopedic shoes in comparison to usual care in people with diabetes at low-to-high risk of ulceration. METHODS People with diabetes with loss of protective sensation and/or peripheral artery disease, and with orthopedic shoes prescription were allocated to receive one MI-consultation by a podiatrist randomized to MI training (n = 53) or usual care only (n = 68). Adherence was measured as the percentage of steps taken while wearing orthopedic shoes, determined using an insole temperature microsensor and wrist-worn activity tracker during one week at 3 and 6 months. RESULTS The proportion of participants ≥80 % adherent to wearing their orthopedic shoes was higher in the control group than in the MI-intervention group at 3 months (30.9 % versus 15.1 %; p = 0.044), and not significantly different at 6 months (22.1 % versus 13.2 %; p = 0.210). Average adherence was also higher in the control group than the intervention group at both 3 months (60.9 % versus 50.9 %; p = 0.029) and 6 months (59.9 % versus 49.5 %; p = 0.025). CONCLUSIONS One podiatrist-led MI-consultation in its current form did not result in higher adherence to wearing orthopedic shoes in people with diabetes 3 and 6 months after inclusion. TRIAL REGISTRATION Netherlands Trial Register NL7710 (available on the International Clinical Trials Registry Platform).
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Affiliation(s)
- M Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands.
| | - S H Exterkate
- Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands; Voetmax Orthopedie, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands
| | - J J van Netten
- Amsterdam UMC, Location University of Amsterdam, Department of Rehabilitation, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - K D R Kappert
- Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, PO Box 7600, 7600 SZ Almelo, The Netherlands
| | - H Koffijberg
- Department of Health Technology and Services Research, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - C Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - J E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - P M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
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Dardari D, Franc S, Charpentier G, Orlando L, Bobony E, Bouly M, Xhaard I, Amrous Z, Sall KL, Detournay B, Penfornis A. Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100686. [PMID: 37520145 PMCID: PMC10384180 DOI: 10.1016/j.lanepe.2023.100686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Methods Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. Findings In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. Interpretation The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. Funding This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- LBEPS, Université d’Evry, IRBA, Université de Paris-Saclay, Evry, France
| | - Sylvia Franc
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Guillaume Charpentier
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Laurent Orlando
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Elise Bobony
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Marie Bouly
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| | - Ilham Xhaard
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Zohra Amrous
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Khadijatou Ly Sall
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France
| | - Alfred Penfornis
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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Bilal A, Amarasena DK, Pillai A. Socioeconomic Deprivation as a Predictor of Lower Limb Amputation in Diabetic Foot Disease. Cureus 2023; 15:e44426. [PMID: 37786571 PMCID: PMC10543925 DOI: 10.7759/cureus.44426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/04/2023] Open
Abstract
Objective The prevalence of diabetes and its complications are on the rise worldwide. This is particularly prevalent in low- and middle-income countries. The Index of Multiple Deprivation (IMD) is a measure of relative social deprivation. This index classifies England into small subsets called lower layer super output areas (LSOAs) and then ranks these LSOAs into deciles from the most deprived to the least deprived area. We used this to analyse the relationship between deprivation and outcomes in diabetic foot disease (DFD). Methods We evaluated patients admitted to our multidisciplinary unit with DFD over a five-year period. Their postal codes were used to classify these patients into IMD deciles with decile 1 representing the 10% of most deprived LSOAs and decile 10 the least deprived areas in the country. We used this classification to analyse the relationship between deprivation and its influence on surgical outcomes and lower limb amputation. We specifically compared those falling in the top five against the bottom five deciles. Results Our cohort consisted of 70 patients with diabetes who had surgery on their diabetic foot. Of this cohort, 33 (47%) of these underwent amputation. The majority of these procedures were minor amputations conducted on the forefoot (75.6%) and there were no below knee amputations. Of those requiring an amputation, 27 patients (81.8%) had an IMD decile of 5 or below, and only six (18.2%) patients had above 5. Conclusion Our study shows that the likelihood of amputations related to diabetic foot disease is inversely proportional to the index of multiple deprivation.
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Affiliation(s)
- Ahmad Bilal
- Orthopaedics and Traumatology, Wythenshawe Hospital, Manchester, GBR
| | | | - Anand Pillai
- Orthopaedics and Traumatology, Wythenshawe Hospital, Manchester, GBR
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Chen P, Callisaya M, Wills K, Greenaway T, Winzenberg T. Health Literacy predicts incident foot ulcers after 4 years - the SHELLED cohort study. J Foot Ankle Res 2023; 16:45. [PMID: 37501178 PMCID: PMC10373326 DOI: 10.1186/s13047-023-00644-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS/HYPOTHESIS To determine whether health literacy is associated with an index diabetes-related foot ulcer (DFU). METHODS The SHELLED Study is a 4-year prospective study of people with diabetes aged over 40 with no history of DFU. The primary outcome was development of a first foot ulcer. Health Literacy was measured using the short form Test of Functional Health Literacy in Adults (s-TOFHLA) and nine domains of the Health Literacy Questionnaire (HLQ). RESULTS Of 222 participants, 191 (86.0%) completed the study, of whom 13 (5.9%) developed an incident ulcer. In multivariable models, every unit increase in S-TOFHLA was associated with a reduced odds of foot ulcer development by 6% (OR 0.94, 95% CI 0.88 to 0.99). Better scores on two HLQ domains reduced the odds of foot ulcer (actively managing my health (OR 0.23, 95% CI 0.08 to 0.65) and understanding health information well enough to know what to do (OR 0.39, 95% CI 0.19 to 0.78). This was independent of baseline risk for foot disease. CONCLUSIONS/INTERPRETATION These data provide novel evidence that health literacy is an important clinical risk factor for index foot ulceration. This is an area of potential focus for research and development of educational programs or policy aimed at reducing development of incident foot ulceration.
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Affiliation(s)
- Pamela Chen
- School of Medicine, Faculty of Health, University of Tasmania, 17 Liverpool Street, Hobart, TAS, Australia.
- Present Address: Joondalup Health Campus, Ramsay Healthcare Australia, Corner Shenton Ave and Grand Boulevard, Joondalup, WA, 6027, Australia.
| | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, Australia
| | - Timothy Greenaway
- School of Medicine, Faculty of Health, University of Tasmania, 17 Liverpool Street, Hobart, TAS, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, Australia
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Şahin F, Pirouzpanah MB, Farshbaf-Khalili A, Ayşan E, Doğan A, Demirci S, Ostadrahimi A, Mobasseri M. The effect of the boron-based gel on the treatment of diabetic foot ulcers: A prospective, randomized controlled trial. J Trace Elem Med Biol 2023; 79:127261. [PMID: 37421808 DOI: 10.1016/j.jtemb.2023.127261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Chronic ulcers represent impaired healing capacity with high mortality in the elderly or patients with systemic disorders such as diabetes. Boron is an effective agent in wound healing by promoting cell migration and proliferation and reducing inflammation in the wound area. This study aimed to evaluate the therapeutic effect of a sodium pentaborate-based topical formulation compared to control on the treatment of diabetic foot ulcers. METHODS A prospective, double-blind, randomized controlled trial was conducted to apply randomly the topical sodium pentaborate 3% gel or topical conventional remedy (control) by patients diagnosed with diabetic foot ulcers. The 171 eligible participants aged 18-75 years received the allocated medicines twice a day for a month with an allocation ratio of 3:1. Twenty-five days and two months after the end of the trial, participants were reinvestigated for their ulcer condition and any recurrence. Wagner's classification of diabetic foot ulcers was applied to this purpose (0-5). RESULTS 161 participants (57 females, 104 males; mean age: 59.37) completed this study. After the intervention, most participants in the intervention group had a lower ulcer grade than the control group (adjusted mean difference (95% CI): - 0.91 (-1.1 to -0.73); p < 0.001). Moreover, most participants in the intervention group (n = 109 (90.8%)) were treated at a higher rate than the control group (n = 5 (12.2%)) after intervention (adjusted odds ratio (95% CI): 0.008 (0.002-0.029); p < 0.001). There was no case of recurrence in the intervention group while its rate was (n = 2 (40%)) in the control group (p < 0.001). CONCLUSION The present study suggests that topical sodium pentaborate gel may help treat and decrease the grade of diabetic foot ulcers and prevent the recurrence of diabetic foot ulcers.
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Affiliation(s)
- Fikrettin Şahin
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey
| | | | - Azizeh Farshbaf-Khalili
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Science, Tabriz, Iran
| | - Erhan Ayşan
- Faculty of Medicine, Department of General Surgery, Yeditepe University, Istanbul, Turkey
| | - Ayşegül Doğan
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey
| | - Selami Demirci
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20814, USA
| | - Alireza Ostadrahimi
- Nutrition Research Center, Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mobasseri
- Endocrine Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Hemler SL, Ntella SL, Jeanmonod K, Köchli C, Tiwari B, Civet Y, Perriard Y, Pataky Z. Intelligent plantar pressure offloading for the prevention of diabetic foot ulcers and amputations. Front Endocrinol (Lausanne) 2023; 14:1166513. [PMID: 37469988 PMCID: PMC10352841 DOI: 10.3389/fendo.2023.1166513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
The high prevalence of lower extremity ulceration and amputation in people with diabetes is strongly linked to difficulties in achieving and maintaining a reduction of high plantar pressures (PPs) which remains an important risk factor. The effectiveness of current offloading footwear is opposed in part by poor patient adherence to these interventions which have an impact on everyday living activities of patients. Moreover, the offloading devices currently available utilize primarily passive techniques, whereas PP distribution is a dynamically changing process with frequent shifts of high PP areas under different areas of the foot. Thus, there is a need for pressure offloading footwear capable of regularly and autonomously adapting to PPs of people with diabetes. The aim of this article is to summarize the concepts of intelligent pressure offloading footwear under development which will regulate PPs in people with diabetes to prevent and treat diabetic foot ulcers. Our team is creating this intelligent footwear with an auto-contouring insole which will continuously read PPs and adapt its shape in the forefoot and heel regions to redistribute high PP areas. The PP-redistribution process is to be performed consistently while the footwear is being worn. To improve adherence, the footwear is designed to resemble a conventional shoe worn by patients in everyday life. Preliminary pressure offloading and user perceptions assessments in people without and with diabetes, respectively, exhibit encouraging results for the future directions of the footwear. Overall, this intelligent footwear is designed to prevent and treat diabetic foot ulcers while enhancing patient usability for the ultimate prevention of lower limb amputations.
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Affiliation(s)
- Sarah L. Hemler
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals, Geneva, Switzerland
| | - Sofia Lydia Ntella
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Kenny Jeanmonod
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Christian Köchli
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Bhawnath Tiwari
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Yoan Civet
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Yves Perriard
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Zoltan Pataky
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals, Geneva, Switzerland
- Faculty Diabetes Centre, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Lalieu RC, Bol Raap RD, Smit C, Dubois EFL, van Hulst RA. Hyperbaric Oxygen Therapy for Nonhealing Wounds-A Long-term Retrospective Cohort Study. Adv Skin Wound Care 2023; 36:304-310. [PMID: 37017408 DOI: 10.1097/01.asw.0000922696.61546.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To analyze wound healing results of hyperbaric oxygen therapy (HBOT) for a variety of different wound types. METHODS This retrospective cohort study included all patients treated with HBOT and wound care at a single hyperbaric center between January 2017 and December 2020. The primary outcome was wound healing. Secondary outcome measures were quality of life (QoL), number of sessions, adverse effects, and treatment cost. Investigators also examined possible influencing factors, including age, sex, type and duration of wound, socioeconomic status, smoking status, and presence of peripheral vascular disease. RESULTS A total of 774 treatment series were recorded, with a median of 39 sessions per patient (interquartile range, 23-51 sessions). In total, 472 wounds (61.0%) healed, 177 (22.9%) partially healed, 41 (5.3%) deteriorated, and 39 (5.0%) minor and 45 (5.8%) major amputations were performed. Following HBOT, median wound surface area decreased from 4.4 cm 2 to 0.2 cm 2 ( P < .01), and patient QoL improved from 60 to 75 on a 100-point scale ( P < .01). The median cost of therapy was €9,188 (interquartile range, €5,947-€12,557). Frequently recorded adverse effects were fatigue, hyperoxic myopia, and middle ear barotrauma. Attending fewer than 30 sessions and having severe arterial disease were both associated with a negative outcome. CONCLUSIONS Adding HBOT to standard wound care increases wound healing and QoL in selected wounds. Patients with severe arterial disease should be screened for potential benefits. Most reported adverse effects are mild and transient.
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Affiliation(s)
- Rutger C Lalieu
- At Hyperbaric Medical Center, Rijswijk, South Holland, the Netherlands, Rutger C. Lalieu, MD, PhD, is Physician and René D. Bol Raap, MD, is Diving Medical Physician. Casper Smit, MD, PhD, is Vascular Surgeon, Reinier de Graaf Hospital, Delft, South Holland, and Vascular Surgeon at the Hyperbaric Medical Center, Rijswijk. Emile FL Dubois, MD, PhD, is Pulmonary Physician and Consultant, Hyperbaric Medical Center, Rijswijk. Rob A. van Hulst, MD, PhD, is Head of the Hyperbaric Department, Amsterdam University Medical Center
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Graça Pereira M, Vilaça M, Pedras S, Carvalho A, Vedhara K, Jesus Dantas M, Machado L. Wound healing and healing process in patients with diabetic foot ulcers: A survival analysis study. Diabetes Res Clin Pract 2023; 198:110623. [PMID: 36907358 DOI: 10.1016/j.diabres.2023.110623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
AIMS This study aimed to identify demographic, clinical, and psychological contributors to DFU healing and favorable healing process. METHODS Patients with a chronic DFU were evaluated at baseline (T0; n = 153), two months later (T1; n = 108), and six months later (T2; n = 71). Patients were evaluated on health literacy, perceived stress, anxiety, depression, and illness perceptions. Cox proportional hazard models were built to analyze the predictors of DFU healing and favorable healing process (wound area reduction), including the assessment of time to achieve those outcomes. RESULTS More than half of patients had their DFU healed (56.1%) or showed a favorable healing process (83.6%). Median time for healing was 112 days, while for favorable process was 30 days. Illness perceptions were the only predictor of wound healing. Being female , with adequate health literacy, and a first DFU predicted a favorable healing process. CONCLUSIONS This is the first study showing that beliefs about DFU are significant predictors of DFU healing, and that health literacy is a significant predictor of a favorable healing process. Brief, comprehensive interventions should be implemented, at the treatment initial stage, in order to change misperceptions and to promote DFU literacy and better health outcomes.
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Affiliation(s)
- M Graça Pereira
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Margarida Vilaça
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Susana Pedras
- Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
| | - André Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Centro Hospitalar Universitário do Porto (CHUP), Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
| | - Kavita Vedhara
- Division of Primary Care, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - M Jesus Dantas
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007 Penafiel, Portugal.
| | - Luis Machado
- Department of Mathematics, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal.
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Haryanto H, Makmuriana L, Hartono H, Dwi Arini D, Ariyanti S, Sari Y, Ronas MR, Junaidi J, Ervita L. Quality of life in patients with recurrent diabetic foot ulcers. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2023. [DOI: 10.15452/cejnm.2022.13.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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Tavassolmand SS, Montazeri A, Madadizadeh F, Dehghan HR, Ranjbar M, Ameri H. Translation and validation of the Persian version of diabetic foot ulcer scaleshort form (DFS-SF). Int Wound J 2023; 20:822-830. [PMID: 36787274 PMCID: PMC9927893 DOI: 10.1111/iwj.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
Foot ulcer in diabetic patients could often result in significantly impaired quality of life. This study aimed to translate and validate the DFS-SF in Iran. The DFS-SF was translated into Persian, and then its validity and reliability were tested in 262 patients with DFUs. Content validity was evaluated using content validity ratio (CVR) and content validity index (CVI), and criterion validity was assessed through Spearman's correlation between dimensions of the DFS-SF and the EQ-5D-5L. Construct validity was measured using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and convergent-discriminant validity was examined by calculating the average variance extracted (AVE) and composite reliability (CR). Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to evaluate the reliability of the measure. CVR ≥0.66 and CVI = 0.81 were calculated. Spearman's correlation ranged from 0.23 to 0.78 across all dimensions. The results of EFA showed that all six dimensions of the DFS-SF had an eigenvalue more than 1; accounting for 68.88% of the total variance. CFA confirmed the DFS-SF as a six-dimension structure with good fit indices of χ2/df = 2.15 < 5, RMSEA = 0.06 < 0.08, CFI = 0.91 ≥ 0.90, TLI = 0.90 ≥ 0.90, and RMR = 0.04, as well as with adequate fit indices of GFI = 0.84 ≤ 0.90, NFI = 0.86 ≤ 0.90. Estimates of ≥0.50 for AVE were not observed in two of the six dimensions and CR ≥0.70 was obtained for all dimensions. The reliability was calculated with a Cronbach's alpha of 0.89 and ICC >0.69 for all dimensions. Our findings confirmed the validity and reliability of the Persian DFS-SF; therefore, it can be used to assess QoL in patients with DFSs in clinical and research settings in Iran.
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Affiliation(s)
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research CenterIranian Institute for Health Sciences ResearchTehranIran
| | - Farzan Madadizadeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
| | - Hamid Reza Dehghan
- Department of Health Technology AssessmentShahid Sadoughi University of Medical SciencesYazdIran
| | - Mohammad Ranjbar
- Health Policy and Management Research Center, Department of health management and Economics, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
| | - Hosein Ameri
- Health Policy and Management Research Center, Department of health management and Economics, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
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McDermott KM, Srinivas T, Abularrage CJ. Multidisciplinary approach to decreasing major amputation, improving outcomes, and mitigating disparities in diabetic foot and vascular disease. Semin Vasc Surg 2023; 36:114-121. [PMID: 36958892 PMCID: PMC10928649 DOI: 10.1053/j.semvascsurg.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Major nontraumatic lower extremity amputation (LEA) is a morbid complication of longstanding or poorly controlled diabetes and/or end-stage peripheral artery disease. Incidence of major LEAs consistently declined during the 1990s and 2000s, but rates have plateaued or increased in many regions during the past decade. Marked racial, ethnic, socioeconomic, and geographic disparities in risk of LEA persist and are related to inequalities in access to care and differential rates of attempted limb preservation. Multidisciplinary diabetic foot care (MDFC) is increasingly recognized as a necessary model for optimal management of patients with diabetic foot and vascular disease. This article reviews the role of MDFC in reducing major LEAs and the specific ways in which MDFC can mitigate disparities in care delivery and limb preservation outcomes. Access to MDFC among vulnerable populations remains a significant barrier to systematic reduction in major LEAs.
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Affiliation(s)
- Katherine M McDermott
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Tara Srinivas
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287.
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Vanherwegen AS, Lauwers P, Lavens A, Doggen K, Dirinck E. Sex differences in diabetic foot ulcer severity and outcome in Belgium. PLoS One 2023; 18:e0281886. [PMID: 36795662 PMCID: PMC9934352 DOI: 10.1371/journal.pone.0281886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Sex differences are increasingly recognized to play an important role in the epidemiology, treatment and outcomes of many diseases. This study aims to describe differences between sexes in patient characteristics, ulcer severity and outcome after 6 months in individuals with a diabetic foot ulcer (DFU). METHODS A total of 1,771 patients with moderate to severe DFU participated in a national prospective, multicenter cohort study. Data were collected on demographics, medical history, current DFU and outcome. For data analysis, a Generalized Estimating Equation model and an adjusted Cox proportional hazards regression were used. RESULTS The vast majority of patients included were male (72%). Ulcers in men were deeper, more frequently displaying probe to bone, and more frequently deeply infected. Twice as many men presented with systemic infection as women. Men demonstrated a higher prevalence of previous lower limb revascularization, while women presented more frequently with renal insufficiency. Smoking was more common in men than in women. No differences in presentation delay were observed. In the Cox regression analysis, women had a 26% higher chance of healing without major amputation as a first event (hazard ratio 1.258 (95% confidence interval 1.048-1.509)). CONCLUSIONS Men presented with more severe DFU than women, although no increase in presentation delay was observed. Moreover, female sex was significantly associated with a higher probability of ulcer healing as a first event. Among many possible contributing factors, a worse vascular state associated with a higher rate of (previous) smoking in men stands out.
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Affiliation(s)
| | - Patrick Lauwers
- Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Astrid Lavens
- Health Services Research, Sciensano, Brussels, Belgium
| | - Kris Doggen
- Health Services Research, Sciensano, Brussels, Belgium
| | - Eveline Dirinck
- Endocrinology, Diabetology and Metabolism, University Hospital Antwerp, Edegem, Belgium
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Pereira MG, Pedras S, Louro A, Lopes A, Vilaça M. Stress reduction interventions for patients with chronic diabetic foot ulcers: a qualitative study into patients and caregivers' perceptions. J Foot Ankle Res 2023; 16:3. [PMID: 36747299 PMCID: PMC9901134 DOI: 10.1186/s13047-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/24/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The present study aimed to assess the perceptions of patients with chronic diabetic foot ulcers (DFUs) and their family caregivers regarding the impact of two stress reduction interventions on DFU and psychological wellbeing. The intervention included progressive muscle relaxation and hypnosis sessions. METHODS This study used a qualitative exploratory design and included individual interviews with eight patients with chronic DFUs and six family caregivers, using a semi-structured interview guide. Transcript analysis employed thematic content analysis. RESULTS Four key themes common to patients and their caregivers were found: 1) perspectives regarding the intervention; 2) intervention effectiveness; 3) perceived importance of psychology in the DFU treatment; and 4) emotional consequences associated with DFUs. Although themes were common to both intervention groups, sub-themes from the last two themes differed for patients that received muscle relaxation versus those who received hypnosis. CONCLUSION Patients and caregivers reported perceived benefits from both interventions, regarding DFU healing and emotional wellbeing. Patients who received hypnosis and their caregivers also reported lasting effects. Participants suggested that psychological interventions such as stress reduction interventions could be included in the DFU standard treatment as an adjuvant to the clinical protocol for DFU treatment, preferably offered early on, when patients begin treatment at the diabetic foot consultation.
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Affiliation(s)
- M. Graça Pereira
- grid.10328.380000 0001 2159 175XPsychology Research Centre (CIPsi), University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XSchool of Psychology, Department of Applied Psychology, University of Minho, Campus de Gualtar, Braga, 4710-057 Portugal
| | - Susana Pedras
- grid.5808.50000 0001 1503 7226Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
| | - André Louro
- grid.10328.380000 0001 2159 175XHealth & Family Research Group, Psychology Research Centre (CIPsi), University of Minho, Braga, Portugal
| | - Alberto Lopes
- Portuguese Association of Clinical Hypnosis and Hypnoanalysis (APHCH), Porto, Portugal
| | - Margarida Vilaça
- grid.10328.380000 0001 2159 175XPsychology Research Centre (CIPsi), University of Minho, Braga, Portugal
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Ma L, Chen J, Sun Y, Feng Y, Yuan L, Ran X. The perceptions of living with diabetic foot ulcers: A systematic review and meta-synthesis of qualitative studies. J Tissue Viability 2023; 32:39-50. [PMID: 36470779 DOI: 10.1016/j.jtv.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Diabetic foot ulcers are associated with decreased quality of life in patients with diabetes and impose a heavy burden on patients, their families, and the health care system. For health providers, a deeper understanding of the perceptions of patients is significant. They can provide better management and direction to patients with diabetic foot ulcers, thus improving their quality of life. OBJECTIVES To synthesize the findings of qualitative studies to explore the perceptions of individuals living with diabetic foot ulcers. DESIGN A systematic review and meta-synthesis of qualitative studies. METHODS Published qualitative research articles were identified in PubMed, CINAHL, Embase, ISI Web of Science, Ovid, and Scopus from inception to January 2022, and bibliographical reports were reviewed. In addition, combing with the search for unpublished studies in the Google Scholar ProQuest Dissertations and Theses Database, we conducted a meta-synthesis. RESULTS Fourteen articles were eligible for inclusion, and the total number of included individuals was 226, with ages ranging from 28 to 84 years. The perceptions of individuals with diabetic foot ulcers synthesized four overarching themes and their subthemes: perceptions of diabetic foot ulcers (Realization, Reasons), living with diabetic foot ulcers (Change in life, Physical burdens, Emotional burdens, Economic burdens), coping with diabetic foot ulcers (Hospital attendance, Attitude toward amputation, Treatment, Management), and expectations (Expectation of health-personnel, Future expectation). CONCLUSIONS Individuals with diabetic foot ulcers suffer greatly in their physical, psychological, and social aspects. Comprehensive and individualized patient-centered care and appropriate families and social support for patients with diabetic foot ulcers should be provided.
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Affiliation(s)
- Lin Ma
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, Sichuan, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Yue Feng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Yuan
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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45
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Stevens K, Moralejo D, Ersser S, MacLean C. Effectiveness of a foot self-management intervention that utilized commercially available infrared thermometers: Mixed methods research incorporating a pilot RCT. J Tissue Viability 2023; 32:33-38. [PMID: 36586765 DOI: 10.1016/j.jtv.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a foot self-management strategy that utilized a commercially-available infrared thermometer (CAIT) for prevention of diabetic foot ulcers. RESEARCH DESIGN AND METHODS In this six-month pilot randomized controlled trial, Phase 2 of a three-phase mixed methods research study, 62 participants were randomized to a thermometer and education group (n = 34) and an education-only group (n = 26). Both groups received foot care education and were assessed by a certified orthotist. All participants recorded their number of steps and recorded a foot assessment in a logbook daily. The thermometer and education group also recorded their daily temperature assessment. A temperature difference of >4° Fahrenheit (F) between the two feet prompted participants to rest their feet. Participants were directed to see their healthcare provider if the temperature difference did not decrease to below 4° F in two days. Phase 3 of the study explored the Phase 2 results to understand the findings further. RESULTS The strategy improved foot assessment and action: the thermometer and education group had significantly more days with any assessment completed than the education-only group (150.98/180 vs. 119.84/180, p = 0.02). Phase 3 findings showed that the thermometer engaged participants, prompted action, and offered reassurance regarding foot health. CONCLUSIONS A CAIT is a tool that could support foot self-management and may offer several benefits, such as promoting and providing structure for a foot assessment and direction for action. CLINICAL TRIAL REG NO NCT0306776 clinicaltrials.gov.
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Affiliation(s)
- Kathleen Stevens
- Memorial Univeristy Faculty of Nursing, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada.
| | - Donna Moralejo
- Memorial Univeristy Faculty of Nursing, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada.
| | - Steven Ersser
- Head of the Department of Nursing Science and Professor of Nursing and Dermatology, Bournemouth University, Department of Nursing Science, Bournemouth House B401, 19 Christchurch Rd, Bournemouth, BH1 3LH, UK.
| | - Cathy MacLean
- University of Saskatchewan, 3111 Fairlight Drive, Saskatoon, SK, S7M 3Y5, Canada.
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McDermott K, Fang M, Boulton AJ, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care 2023; 46:209-221. [PMID: 36548709 PMCID: PMC9797649 DOI: 10.2337/dci22-0043] [Citation(s) in RCA: 141] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022]
Abstract
Diabetic foot ulcers (DFU) are a major source of preventable morbidity in adults with diabetes. Consequences of foot ulcers include decline in functional status, infection, hospitalization, lower-extremity amputation, and death. The lifetime risk of foot ulcer is 19% to 34%, and this number is rising with increased longevity and medical complexity of people with diabetes. Morbidity following incident ulceration is high, with recurrence rates of 65% at 3-5 years, lifetime lower-extremity amputation incidence of 20%, and 5-year mortality of 50-70%. New data suggest overall amputation incidence has increased by as much as 50% in some regions over the past several years after a long period of decline, especially in young and racial and ethnic minority populations. DFU are a common and highly morbid complication of diabetes. The pathway to ulceration, involving loss of sensation, ischemia, and minor trauma, is well established. Amputation and mortality after DFU represent late-stage complications and are strongly linked to poor diabetes management. Current efforts to improve care of patients with DFU have not resulted in consistently lower amputation rates, with evidence of widening disparities and implications for equity in diabetes care. Prevention and early detection of DFU through guideline-directed multidisciplinary care is critical to decrease the morbidity and disparities associated with DFU. This review describes the epidemiology, presentation, and sequelae of DFU, summarizes current evidence-based recommendations for screening and prevention, and highlights disparities in care and outcomes.
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Affiliation(s)
- Katherine McDermott
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew J.M. Boulton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Ababneh A, Moosa S, Al Jarrah Q, Alsoufi Y, Abu Qamar MZ, Saleh M, Jarrah S, Younes NA. Factors Associated With Foot Self-Care in Patients With Diabetes-Related High-Risk Feet: A Cross-Sectional Design. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231220135. [PMID: 38140753 DOI: 10.1177/00469580231220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Foot self-care has been commonly studied among people with diabetes. Previous research on foot self-care among those with diabetes-related high-risk feet is almost unavailable or very limited. The current study aims to fill this gap and provide a contemporary unprecedented analysis of this area of specialization. To assess the levels of, and factors associated with foot self-care among people with diabetes-related high-risk feet. A multi-center cross-sectional study from Jordan assessed the foot self-care of 107 participants with diabetes-related high-risk feet. Multiple socio-demographic, physiological, and psychosocial factors were collected, and the Arabic version of the diabetes foot self-care behavior scale was used to estimate the foot self-care of the study population. A multiple linear regression model was employed to identify factors associated with foot self-care. The mean score of foot self-care was 25.4 ± 7.1 (35 is the highest) indicating ~73% of adherence to foot self-care. Factors associated with higher foot self-care were being treated at the King Abdullah University Hospital (β = .30, P < .01) and reporting higher scores of patients' interpretations about neuropathy physical causes of foot ulcers (β = ".22," P = .02). People with diabetes-related high-risk feet reported a relatively adequate foot self-care practice. However, clinicians are still required to enhance foot self-care among this population. Health promotion programs may benefit from engaging people in understanding the pathophysiology of diabetes-related foot ulcers to improve foot self-care practices.
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Affiliation(s)
- Anas Ababneh
- Yarmouk University, Irbid, Jordan
- Applied Science Private University, Amman, Jordan
| | - Sameh Moosa
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | | | - Yazan Alsoufi
- Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Nidal A Younes
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
- University of Jordan, Amman, Jordan
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Zügner R, Jarl G, Sundberg L, Tang UH. Experiences of using a digital tool, the D-foot, in the screening of risk factors for diabetic foot ulcers. J Foot Ankle Res 2022; 15:90. [PMID: 36514099 PMCID: PMC9746139 DOI: 10.1186/s13047-022-00594-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Individuals living with diabetes run an increased risk of developing diabetic foot ulcers (DFUs), leading to high costs to society and reduced quality of life for the individual. Regular screening is important to avoid complications. AIM To evaluate patients' and clinicians' experiences of using a digital tool, the D-Foot, in the screening of risk factors for developing DFUs. The secondary aims were to investigate whether patients had had their feet examined by a nurse or doctor during the past year, had been referred to podiatry and whether patients had received information about self-care. METHODS A prospective study was carried out, comprising 90 patients with diabetes visiting a Department of Prosthetics and Orthotics (DPO). Two Certified Prosthetists and Orthotists (CPOs) were included, and they assessed foot status and the risk of developing DFUs with the D-Foot software, prior to prescribing footwear. The quality of services at the DPO was assessed by the patients using the Orthotics and Prosthetics Users' Survey (OPUS). The CPOs answered the System Usability Scale (SUS) before and after the study to assess the usability of the D-Foot. RESULTS No patient had risk grade 1. One (1%) patient had risk grade 2, 78 (87%) patients had risk grade 3 and 11 (12%) patients had risk grade 4. Patients reported high levels of satisfaction on eight of ten OPUS items and the two items with lower scores were not related to the use of the D-Foot. The two CPOs reported levels above the mean regarding usability both before (77.5 and 90) and after (70 and 97.5) using the D-Foot. CONCLUSIONS Patients expressed a high level of satisfaction with the services when their feet were examined with the D-Foot prior to the provision of footwear. The CPOs found that the D-Foot system was usable. Several comments were made by patients and CPOs and will support the future development and testing of the D-Foot. There is a need to increase referrals for preventive podiatry and improve information on self-care for patients at risk of DFUs. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04054804.
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Affiliation(s)
- Roland Zügner
- grid.1649.a000000009445082XDepartment of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University, SE-413 45 Göteborg, Sweden ,Forskningsenhet Ortopedi, Göteborgsvägen 31, SE-431 80 Mölndal, Sweden
| | - Gustav Jarl
- grid.15895.300000 0001 0738 8966Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden ,grid.15895.300000 0001 0738 8966University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Ulla Hellstrand Tang
- grid.1649.a000000009445082XDepartment of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University, SE-413 45 Göteborg, Sweden ,grid.1649.a000000009445082XDepartment of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
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49
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Søndergaard SF, Vestergaard EG, Andersen AB, Kolbæk R, Dahl M, Høgh A. How patients with diabetic foot ulcers experience telemedicine solutions: A scoping review. Int Wound J 2022; 20:1796-1810. [PMID: 36453130 PMCID: PMC10088844 DOI: 10.1111/iwj.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a common, complex and severe complication of diabetes that is associated with severely decreased health-related quality of life. Treatment of DFUs calls for a multi-sectoral approach, incorporating interdisciplinary care pathways. Telemedicine (TM) may be used as a communication tool between caregivers across healthcare sectors to obligate the need for close follow-up, including early intervention in preventing the recurrence of DFU. The objective of this review was to identify, examine and conceptually map the available literature on patients' experiences and views regarding the use of TM solutions among patients with DFUs. We identified the Population, Concept and Context to pinpoint the focus of this review, word the research question and title as well as facilitate the literature search strategy. The literature examined stems from 13 sources. We imposed no restrictions on the methodological approach of the included studies, neither on the format. During the review process, four main maps emerged: "A whole human not merely a hole in a human," "Less of a burden on the family, the community and the environment," "Competences and continuity of care are essential for high-quality care" and "The quality and modality of the technology." Further investigation from both the patients' and the multi-sectoral caregivers' perspective is needed, focusing on whatever modifications of the TM intervention may fit the DFU care pathway better.
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Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing Regional Hospital Viborg Viborg Denmark
- VIA University College and Aarhus University, Health Aarhus Denmark
| | - Else Godsk Vestergaard
- Wound Nurse, Vascular Research Unit, Department of Surgery Viborg Regional Hospital Viborg Denmark
| | - Anne Bendix Andersen
- Centre for Research in Clinical Nursing Regional Hospital Viborg Viborg Denmark
- VIA University College and Aarhus University, Health Aarhus Denmark
| | | | - Marie Dahl
- Vascular Research Unit, Department of Surgery Viborg Regional Hospital Viborg Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Clinical Research University of Southern Denmark and Odense University Hospital Odense Denmark
| | - Annette Høgh
- Vascular Research Unit and Wound Centre. Department of Surgery Regional Hospital Viborg, Region Central Jutland Viborg Denmark
- Institute for Clinical Medicine Aarhus University Aarhus Denmark
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Effect of tibial cortex transverse transport in patients with recalcitrant diabetic foot ulcers: A prospective multicenter cohort study. J Orthop Translat 2022; 36:194-204. [PMID: 36263383 PMCID: PMC9576490 DOI: 10.1016/j.jot.2022.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 12/18/2022] Open
Abstract
Background Management of recalcitrant diabetic foot ulcer (DFU) remains difficult. Distraction osteogenesis mediates new bone formation and angiogenesis in the bone itself and the surrounding tissues. Recently it was reported that tibial cortex transverse transport (TTT) was associated with neovascularization and increased perfusion at the foot in patients with recalcitrant DFUs and facilitated healing and limb salvage. However, the findings were from several single-center studies with relatively small populations, which need to be confirmed in multicenter cohort studies with relatively large populations. Furthermore, the effect of this technique on patient's health-related quality of life is still unclear. Methods We treated patients with recalcitrant (University of Texas wound grading system 2-C to 3-D and not responding to prior routine conservative and surgical treatments for at least 8 weeks) DFUs from seven centers using TTT (a 5 cm × 1.5 cm corticotomy followed by 4 weeks of medial and lateral distraction) between July 2016 and June 2019. We analyzed ulcer healing, major amputation, recurrence, health-related quality of life (physical and mental component summary scores), and complications in the 2-year follow-up. Foot arterial and perfusion changes were evaluated using computed tomography angiography and perfusion imaging 12 weeks postoperatively. Results A total of 1175 patients were enrolled. Patients who died (85, 7.2%) or lost to follow-up (18, 1.7%) were excluded, leaving 1072 patients for evaluation. Most of the patients were male (752, 70.1%) and with a mean age of 60.4 ± 9.1 years. The mean ulcer size was 41.0 ± 8.5 cm2 and 187 (16.6%) ulcers extended above the ankle. During the follow-up, 1019 (94.9%) patients healed in a mean time of 12.4 ± 5.6 weeks, 53 (4.9%) had major amputations, and 33 (3.1%) experienced recurrences. Compared to preoperatively, the patients had higher physical (26.2 ± 8.3 versus 41.3 ± 10.6, p = 0.008) and mental (33.6 ± 10.7 versus 45.4 ± 11.3, p = 0.031) component summary scores at the 2-year follow-up. Closed tibial fracture at the corticotomy site was found in 8 (0.7%) patients and was treated using external fixation and healed uneventfully. There were 23 (2.1%) patients who had pin site infections and were treated successfully with dressing changes. Compared to preoperatively, the patients had more small arteries and higher foot blood flow (8.1 ± 2.2 versus 28.3 ± 3.9 ml/100 g/min, p = 0.003) and volume (1.5 ± 0.3 versus 2.7 ± 0.4 ml/100 g, p = 0.037) 12 weeks postoperatively. Conclusion TTT promotes healing, limb salvage, and health-related quality of life in patients with recalcitrant DFUs as demonstrated in this multicenter cohort study. The surgical procedure was simple and straightforward and the complications were few and minor. The effect of this technique was associated with neovascularization and improved perfusion at the foot mediated by the cortex distraction. The findings are required to confirm in randomized controlled trials.The Translational Potential of this Article: TTT can be used as an effective treatment in patients with recalcitrant DFUs. The mechanism is associated with neovascularization and consequently increased perfusion in the foot after operation.
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