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Søndergaard SF, Christensen JF, Dahl M, Drejer M, Høgh A. The interplay between patients and healthcare professionals in a cross-sectoral setting in connection with the treatment and care of patients with diabetic foot ulcers: a realistic evaluation. BMC Health Serv Res 2024; 24:782. [PMID: 38982462 PMCID: PMC11234555 DOI: 10.1186/s12913-024-11219-1] [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: 02/11/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Diabetes-related lower extremity complications such as diabetic foot ulcer (DFU) are a global disability burden. Treatment and care for patients with DFU call for a multisectoral approach that incorporates interdisciplinary care pathways. We aimed to explore the interplay between patients with DFU and healthcare professionals in cross-sectoral settings that address treatment and care and to determine "what works, for whom, and under what circumstances". METHOD The study was designed as a realistic evaluation. The data were generated from September 2022 to March 2023 and drew upon approximately 60 h of participant observation of 14 patients during the treatment and care of DFUs in their homes (primary care) and/or at outpatient clinics (wound specialist clinics in a hospital setting) in a Danish cross-sectoral setting. The Standards for Reporting Qualitative Research (SRQR) were applied in this study. RESULTS We identified three illuminating themes that described the interplay between patients with DFU and related healthcare professionals representing both primary and secondary health care systems: (1) humour is a relationship-enhancing element between nurses and patients; (2) support from patients' coping strategies promotes patient-centeredness and collaboration; and (3) patients and professionals occupy unnegotiated identity roles. CONCLUSION Our study led to a refined programme theory developed through the realistic evaluation process that allows us to propose an answer to the problem of "what works, for whom, and under what circumstances". The interplay between patients with DFU and healthcare professionals in a cross-sectoral setting for treatment and care is characterised by the use of humour as a relation-enhancing element and by improving support for patient coping strategies, which encourages healthcare professionals to promote health literacy. Future research should examine strategies for negotiating identity roles between patients with DFU and healthcare professionals to enhance collaboration, patient health literacy, and health promotion in cross-sectoral healthcare settings.
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Affiliation(s)
- Susanne Friis Søndergaard
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.
- Department of Health, Aarhus University, Aarhus, Denmark.
- Department of Human and Technology, Roskilde University, RUC, Roskilde, Denmark.
| | | | - Marie Dahl
- Vascular Research Unit, Department of Surgery, Viborg Regional Hospital, Vibor, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Cardiac, Thoracic, and Vascular Research Unit, 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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Wong YT, Morrison SC. Health Promotion Models for Improving Footcare in Older Adults: A Scoping Review. Gerontology 2024; 70:785-800. [PMID: 38636462 PMCID: PMC11309045 DOI: 10.1159/000538868] [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: 12/11/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Footcare is an important component of wellbeing in older adults and the promotion of appropriate footcare interventions is imperative for health professionals working with this population. In this scoping review, we describe the health promotion models informing footcare interventions for older adults. The objectives were to (i) understand the context(s) where health promotion models have informed footcare interventions; (ii) identify the health promotion models informing interventions; and (iii) document the effectiveness of theoretically informed health promotion interventions for improving footcare in older adults. METHODS Footcare interventions developed using health promotion models worldwide and published in English before July 2023 were searched using MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar. RESULTS A total of 2,078 articles were identified, of which 31 were retrieved and assessed for eligibility. Eight articles met the eligibility criteria, with most interventions delivered in Asia (n = 5) and using self-efficacy theory as their theoretical framework (n = 6). Most of the studies included people with diabetes (n = 6) and outcomes were measured using foot health outcomes, knowledge of foot health, and footcare behaviors and self-efficacy. CONCLUSION This scoping review has identified a range of footcare interventions, with evidence of promising outcomes on improving footcare in older adults. Approaches toward methods and dosage of intervention varied across the studies and more broadly, we identified that few studies report the health promotion model informing the design of intervention(s). Further research is required to ascertain which health promotion model, modality of promotion, and implementation approach are the most effective for improving footcare in older adults.
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Affiliation(s)
- Yuen-Ting Wong
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Stewart C Morrison
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
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Drovandi A, Seng L, Golledge J. Effectiveness of educational interventions for diabetes-related foot disease: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3746. [PMID: 37926437 DOI: 10.1002/dmrr.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
This systematic review and meta-analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes-related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot-care knowledge and self-care behaviours. Meta-analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB-2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2 = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2 = 38%) and HbA1c levels (standardized mean difference -0.73; 95% CI -1.26, -0.20, I2 = 93%) without affecting all-cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2 = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self-care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self-care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow-up are needed.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Akça Doğan D, Efil S, Kalkan Uğurlu Y, Camci GB. Knowledge and Behaviors of Foot Care in Muslims With Diabetes Mellitus: Does Islamic Ritual Ablution Make a Difference? J Transcult Nurs 2024; 35:21-29. [PMID: 37909460 DOI: 10.1177/10436596231209046] [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: 11/03/2023] Open
Abstract
INTRODUCTION This study aimed to determine the relationship between ablution ritual and foot knowledge, self-care behaviors, and the presence of diabetic foot ulcers in Muslims with type 2 diabetes mellitus (T2DM). METHODOLOGY A descriptive, comparative method was utilized to identify ablution ritual and foot knowledge, self-care behaviors, and the presence of diabetic foot ulcers. RESULTS There were 228 persons with T2DM, with 162 participants (71.1%) in the ablution group and 66 participants (28.9%) in the no-ablution group, with 19.7% having diabetic foot ulcers. Diabetic foot knowledge and foot self-care behaviors of persons with T2DM were below a medium level, and there was a significant difference between ablution behavior and the presence of diabetic foot ulcers (x2 =6.646, p<.05). DISCUSSION Culturally congruent interventions that acknowledge and understand the cultural practices and beliefs of Muslims with T2DM may be recommended to enhance their knowledge levels and promote positive behavior changes.
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Affiliation(s)
| | - Sevda Efil
- Canakkale Onsekiz Mart University, Turkey
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Burucu R, Güngör C. A Descriptive Study of Spiritual Well-Being and Foot Care Practices Administered to Turkish Patients Diagnosed with Type 2 Diabetes. JOURNAL OF RELIGION AND HEALTH 2023; 62:4417-4435. [PMID: 36971901 DOI: 10.1007/s10943-023-01787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The aim of the study is the determination of factors affecting the moral well-being of individuals with type 2 diabetes, their foot care behaviors, and the relationship between their spiritual well-being and foot care behaviors. This is a descriptive and relationship-seeking study. The population of the study was comprised of patients with type 2 diabetes who continued their treatment in the same hospital. The sample group consisted of 157 people determined by power analysis (0.05 margin of error, 0.85 power, and 0.447 effect size). For data collection, the Participant Information Form, Spiritual Well-being Scale, and the Foot Care Behavior Scale were used. The mean age of the participants was 59.50 ± 4.858, the body cure index was 29.97 ± 4.233, the foot care awareness score was 51.04 ± 9.884, and the spiritual well-being score was 19.44 ± 7.423. The spiritual well-being subdimension scores were as follows: meaning: 5.17 ± 3.226, belief: 9.79 ± 4.277, and peace and tranquility: 4.48 ± 2.608. Foot care awareness and spiritual well-being scores of the patients were moderate. Individuals' awareness of foot care is affected by their willingness to use medication and to receive education about diabetes; while the income level affects their moral well-being. There is a weak and positive relationship between the two scale scores. It would be appropriate to address the patients spiritually and to provide care with an integrated understanding of care. The adoption of foot care by nurses will make nursing more visible and will be effective for the protection of public health.
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Affiliation(s)
- Rukiye Burucu
- Faculty of Health Sciences, Internal Medicine, Necmettin Erbakan University Seydişehir Kamil Akkanat, Konya, Turkey
| | - Canan Güngör
- Mumtaz Koru Tuberculosis War Dispensary, Konya, Turkey.
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Firdaus MKZH, Jittanoon P, Boonyasopun U, Che Hasan MK. The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study. BELITUNG NURSING JOURNAL 2023; 9:437-447. [PMID: 37901368 PMCID: PMC10600709 DOI: 10.33546/bnj.2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/26/2023] [Accepted: 09/23/2023] [Indexed: 10/31/2023] Open
Abstract
Background Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system. Objective This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus. Methods A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis. Results Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01). Conclusion The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions. Clinical trial registration number NCT04260100 (registered at https://clinicaltrials.gov/ct2/show/NCT04260100).
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Affiliation(s)
- Mohd Khairul Zul Hasymi Firdaus
- Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
- Faculty of Nursing, Prince of Songkla University, Thailand
| | | | | | - Muhammad Kamil Che Hasan
- Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
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Annersten Gershater M, Apelqvist J, Alm Roijer C. Re-Ulceration Is Common in Persons with Diabetes and Healed Foot Ulcer After Participant-Driven Education in Group: A Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2023; 12:117-126. [PMID: 35088617 DOI: 10.1089/wound.2021.0007] [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: 11/01/2022] Open
Abstract
Objective: To compare the number of ulcer-free days during 24 months in persons with diabetes and a healed foot ulcer below the ankle provided with adjusted therapeutic shoes who were given standard information and participated in participant-driven group education compared with standard information alone. Methods: A randomized controlled trial was designed to evaluate the number of ulcer-free days after participant-driven group education in addition to standard information compared with standard information alone. The number needed to treat (N = 174) was not met, as only 138 persons with diabetes and previously healed foot ulcer were recruited (age median 63 years [34-79], 101 men/37 women). Results: A total of 138 persons were recruited, of whom 107 (77.5%) completed the study, 7 (5%) dropped out, and 12 (9%) deceased. No statistically significant difference was found between the intervention group compared with the control group after 6, 18, or 24 months. After 12 months, more patients in the intervention group had developed ulcers. Seventy-seven participants (56%) developed new foot ulcers, irrespective of side and site. Development of one ulcer appeared in 36 participants, two ulcers in 19, and 22 participants developed three ulcers. Forty-eight participants remained ulcer-free (35%) during the 24-month follow-up. Median ulcer-free days until first ulceration were 368 (4-720); until second ulceration, 404 (206-631); and until third ulceration, 660 (505-701). The participants wore prescribed therapeutic shoes during 88% of the follow-up visits. Conclusions: One-third of the participants remained ulcer-free for 24 months. Patient-driven education in groups did not give better results than standard information in this underpowered study. This study illustrates the challenges to perform comparative preventive studies in this group of patients with extensive comorbidity. Further studies are needed to evaluate interventions on ulceration in persons with a healed foot ulcer.
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Affiliation(s)
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Malmö, Sweden
| | - Carin Alm Roijer
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Tekir O, Cevik C, Ozsezer G. The effects of education on foot care behaviors and self-efficacy in type 2 diabetes patients. Niger J Clin Pract 2023; 26:138-144. [PMID: 36876601 DOI: 10.4103/njcp.njcp_690_20] [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: 03/05/2023]
Abstract
Background Diabetic foot significantly affects the quality of life of patients with diabetes. It leads to loss of labor force, psychosocial trauma, and high treatment costs due to serious morbidity and mortality. Nurses have an important responsibility to improve the metabolic status of individuals with diabetes, to protect them from foot complications, and to teach patients foot care skills. Aim This study investigated the effects of education on type 2 diabetes patients regarding diabetic foot care and self-efficacy. Materials and Methods This quasi-experimental study was conducted from February to July 2016 in hospitals located in the city of Balıkesir in Turkey with type 2 diabetes patients who were admitted to the internal medicine clinic and monitored by the endocrinology and internal medicine outpatient clinics. G*power 3.1.9.2 software was used to calculate the sample size of 94 people with a 5% type 1 error, and 90% power. The study was carried out with stratified randomization, and a questionnaire was administered to the experimental and control groups. The experimental group received training, and both groups' scores on the Diabetic Foot Behavior Questionnaire [Appendix 1] and the Diabetic Foot Care Self-Efficacy Scale [Appendix 2] were compared after three months. The t-test, the paired t-test, and the Chi-square test were used. Results While the self-efficacy and the foot care behavior scores of the control group did not show any differences (P > 0.05), the experimental group's scores were significantly higher (P < 0.05). The control group's self-efficacy and foot care behavior scores on the pre-test and final test were similar, while the experimental group's scores increased (P < 0.05). Conclusions Starting from the diagnosis of diabetes, it is advisable to carry out foot assessments and to follow up with diabetics who received foot care education to increase their self-efficacy, to make foot care a habit, and to re-evaluate missing or incorrect practices during check-ups.
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Affiliation(s)
- O Tekir
- Departments of Nursing, Faculty of Health Sciences, İzmir Demokrasi University, İzmir, Turkey
| | - C Cevik
- Departments of Nursing, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - G Ozsezer
- Department of Public Health Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
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Yıldırım Ayaz E, Dincer B, Oğuz A. The Effect of Foot Care Education for Patients with Diabetes on Knowledge, Self-Efficacy and Behavior: Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2022; 21:234-253. [PMID: 35711163 DOI: 10.1177/15347346221109047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: -0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
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Affiliation(s)
- Elif Yıldırım Ayaz
- University of Health Sciences, 506079Sultan Abdülhamid Han Training and Research Hospital, Internal Medicine Clinic, İstanbul, Turkey
| | - Berna Dincer
- Faculty of Health Sciences, Department of Medical Nursing, Istanbul 226842Medeniyet University, İstanbul, Turkey
| | - Aytekin Oğuz
- 64071Istanbul Medeniyet University Göztepe Prof. Dr Süleyman Yalçın City Hospital, Internal Medicine Clinic, İstanbul, Turkey
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Fields B, Smallfield S. Occupational Therapy Practice Guidelines for Adults With Chronic Conditions. Am J Occup Ther 2022; 76:23263. [PMID: 35311934 DOI: 10.5014/ajot.2022/762001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Demand is increasing for occupational therapy practitioners to help the growing population of adults with chronic conditions manage their conditions. OBJECTIVE This Practice Guideline, which is informed by systematic reviews of the literature on the use of self-management interventions, is meant to guide occupational therapy practitioners' clinical decision making when working with community-dwelling adults with chronic conditions. The chronic conditions included heart disease, chronic lung conditions, diabetes, and kidney disease. The self-management interventions addressed ADLs and sleep and rest; IADLs; education, work, volunteering, leisure, and social participation; and the caregiver role. METHOD We reviewed, discussed, and integrated the clinical recommendations developed from four systematic reviews, supporting literature, and expert opinion to provide recommendations for practice. RESULTS A total of 102 articles were included in the systematic reviews, which served as the primary basis for the practice recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports clinical recommendations for the use of self-management interventions when working with clients with chronic conditions. We recommend the use of a multimodal approach that includes three components-education, goal setting, and problem solving-over an extended period to assist clients in establishing self-management habits and routines. On the basis of emerging evidence and expert opinion, we recommend that occupational therapy practitioners consider using a prevention approach, helping clients establish habits and routines, and emphasizing shared goal setting when addressing clients' self-management of chronic conditions. What This Article Adds: This Practice Guideline provides a summary of strong to moderate evidence that supports clinical recommendations for the use of self-management interventions with clients with chronic conditions. When guided by this evidence, occupational therapy practitioners are better able to help clients meet their occupational challenges.
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Affiliation(s)
- Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology Occupational Therapy Program, University of Wisconsin-Madison;
| | - Stacy Smallfield
- Stacy Smallfield, DrOT, MSOT, OTR/L, BCG, FAOTA, is Associate Director and Capstone Coordinator, Division of Occupational Therapy, College of Allied Health Professions, University of Nebraska Medical Center, Omaha
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Kes D, Sahin F, Ertinmaz Ozkan A, Erem Basmaz S. Effectiveness of a Transtheoretical Model-Based Foot Care Program in Improving Foot Care Behaviors and Self-Efficacy in Adults With Type 2 Diabetes: An Assessor-Blinded Randomized Controlled Trial. Res Theory Nurs Pract 2022; 36:3-19. [PMID: 35173025 DOI: 10.1891/rtnp-d-21-00006] [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: 11/25/2022]
Abstract
This study aimed to evaluate the effects of a transtheoretical model (TTM)-based foot care program on foot self-care behaviors and self-efficacy among adults with type 2 diabetes (T2DM). A prospective, assessor-blinded, randomized controlled trial was conducted between January 2020 and October 2020 at the endocrinology outpatient unit of a hospital in the north-west Turkey. The sample was composed of 51 adults with T2DM randomly allocated to the intervention group (n = 25) and control group (n = 26). The intervention group received the TTM-based foot care program during a 6-month period. The data were analyzed using the two-way repeated measure analysis of variance (ANOVA). After intervention, the intervention group's the diabetic foot care self-efficacy scale scores increased significantly at 3 and 6 months, compared with the control group. Similarly, the intervention group's the foot self-care behavior scale scores also increased significantly at 3 months and 6 months.
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Affiliation(s)
- Duygu Kes
- Nursing Department, Karabuk University, Karabuk, Turkey
| | - Fatime Sahin
- Karabuk Training and Research Hospital, Karabuk University, Karabuk, Turkey
| | | | - Seda Erem Basmaz
- Department of Endocrinology and Metabolism, Karabuk University, Karabuk, Turkey
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Smallfield S, Fang L, Kyler D. Self-Management Interventions to Improve Activities of Daily Living and Rest and Sleep for Adults With Chronic Conditions: A Systematic Review. Am J Occup Ther 2021; 75:12523. [PMID: 34780611 DOI: 10.5014/ajot.2021.046946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Chronic conditions often cause functional impairments in activities of daily living (ADLs) and rest and sleep, leading to decreased independence and self-efficacy. OBJECTIVE To aid occupational therapy practitioners in making informed decisions regarding self-management interventions to improve ADLs and rest and sleep for community-dwelling adults with chronic conditions. DATA SOURCES We identified literature published from 1995 to 2019 through searches of the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract and assess data quality and validity. The review followed American Occupational Therapy Association Evidence-Based Practice Project methodology. Studies addressing self-management interventions for community-dwelling adults ages 18 and older with chronic cardiovascular disease, Type 2 diabetes, heart disease, hypertension, chronic respiratory problems, or kidney disease were included. FINDINGS Fifteen articles met inclusion criteria and were categorized into ADLs and sleep. Strong evidence supports education to improve diabetic foot self-care. Low evidence addresses exercise and education to improve ADLs for people with heart disease and chronic obstructive pulmonary disease. Moderate evidence supports mind-body self-care education to enhance sleep. CONCLUSIONS AND RELEVANCE Occupational therapy practitioners working with adults with diabetes are encouraged to routinely offer education that includes discussion of risk factors and daily foot inspections and hygiene. When addressing sleep, education that addresses sleep hygiene, nutrition, relaxation techniques, and physical activity should routinely be provided to adults with chronic conditions. Further research is needed to understand the dosage needed. What This Article Adds: This systematic review supports the role of occupational therapy in providing self-management interventions to address ADLs and sleep for adults with diabetes and other chronic conditions.
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Affiliation(s)
- Stacy Smallfield
- Stacy Smallfield, DrOT, MSOT, OTR/L, BCG, FAOTA, is Associate Program Director and Capstone Coordinator, Division of Occupational Therapy, College of Allied Health Professions, University of Nebraska Medical Center, Omaha. At the time of the study, Smallfield was Associate Professor of Occupational Therapy and Medicine and Assistant Director, Occupational Therapy Entry-Level Professional Programs, Washington University School of Medicine, St. Louis, MO;
| | - Lea Fang
- Lea Fang, OTD, OTR/L, is Occupational Therapist, SSM Health Physical Therapy, St. Louis, MO. At the time of the study, Fang was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Darby Kyler
- Darby Kyler, OTD, OTR/L, is Occupational Therapist. At the time of the study, Kyler was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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Lambert S, Schaffler JL, Ould Brahim L, Belzile E, Laizner AM, Folch N, Rosenberg E, Maheu C, Ciofani L, Dubois S, Gélinas-Phaneuf E, Drouin S, Leung K, Tremblay S, Clayberg K, Ciampi A. The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1608-1635. [PMID: 33573916 DOI: 10.1016/j.pec.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To review the effectiveness of health education interventions adapted for culturally and linguistically diverse (CALD) populations with a chronic illness. METHODS A systematic review and meta-analysis were conducted. Eligible studies were identified across six databases. Data were extracted and intervention effect was summarized using standardized mean difference. If there were insufficient data for meta-analysis, a descriptive summary was included. Modifying effects of intervention format, length, intensity, provider, self-management skills taught, and behavioral change techniques (BCTs) utilized were examined. RESULTS 58 studies were reviewed and data were extracted for 36 outcomes. Most interventions used multiple modes of delivery and were facilitated by bilingual health care professionals (HCPs). On average, interventions included 5.19 self-management skills and 4.82 BCTs. Interventions were effective in reducing BMI, cholesterol, triglycerides, blood glucose, HbA1C, and depression, and in increasing knowledge. Effectiveness was influenced partly by provider, with HCPs favored over lay providers or paraprofessionals in increasing knowledge; however, the opposite was noted for HbA1c. CONCLUSIONS Health education interventions are effective among CALD populations, particularly at improving objective, distal outcomes (e.g., anthropometric measures). These interventions may be equally effective in improving proximal patient-reported outcomes (PROs); however, diversity in PROs limited analyses. PRACTICE IMPLICATIONS Core outcome sets (COS) are needed to further investigate and compare health education intervention effectiveness on PROs.
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Affiliation(s)
- Sylvie Lambert
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada.
| | | | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| | | | | | - Nathalie Folch
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Luisa Ciofani
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | | | - Susan Drouin
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Katerina Leung
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Antonio Ciampi
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
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Manickum P, Mashamba-Thompson T, Naidoo R, Ramklass S, Madiba T. Knowledge and practice of diabetic foot care - A scoping review. Diabetes Metab Syndr 2021; 15:783-793. [PMID: 33838615 DOI: 10.1016/j.dsx.2021.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/07/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS This review aims to systematically map global evidence on foot-care knowledge and practices in relation to diabetes mellitus (DM) and identify areas that need further research. METHODS Database searches were undertaken using Google Scholar, Medline (PubMed), Academic Search Complete (EBSCOhost), and Medline (EBSCOhost). Studies were initially sought by title and focused on knowledge of diabetic foot ulcer burden. The framework by Arksey and O'Malley and the PRISMA-SCR guidelines were used to guide the methodology. The themes explored were principles of foot-care knowledge and practice and these were reported using content analysis. The mixed-methods appraisal tool (MMAT) was employed to appraise the quality of the primary studies. RESULTS Fifty-eight studies published between 2008 and 2018 met the inclusion criteria. Participants in various studies had varying degrees of foot-care knowledge and practice, including foot inspection, foot hygiene, glycaemic control, and foot protection. Many people had knowledge of the various aspects of foot care but fewer practiced proper foot care. The MMAT showed the majority of the articles to be of high quality. CONCLUSIONS Level of foot-care knowledge and practice varied in the studies. A need for intervention on foot care was highlighted.
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Affiliation(s)
- Prabashni Manickum
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | | | - Rasmika Naidoo
- Department of Occupational Therapy, Addington Hospital, KwaZulu-Natal, South Africa
| | - Serela Ramklass
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thandinkosi Madiba
- Gastrointestinal Cancer Research Group, Department of General Surgery, University of KwaZulu-Natal, Durban, South Africa
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Ikura K, Kato H, Azuma H, Oda Y, Kato Y, Miura J, Babazono T. A fact-finding survey on self-efficacy of foot care behaviour in patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2017 (DIACET 2017). ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00219. [PMID: 33855219 PMCID: PMC8029546 DOI: 10.1002/edm2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 11/16/2022]
Abstract
Aim We aimed to determine the association between self‐efficacy of foot care behaviour and chronic complications in Japanese patients with diabetes. Methods We conducted a cross‐sectional study based on a questionnaire survey of 4571 patients with type 1 and type 2 diabetes who had (a) given consent to participate in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2017, and (b) completed all the questions of the Japanese Version of Foot Care Confidence Scale (J‐FCCS), consisting of 12 statements. Results A greater proportion of respondents answered that they were not confident in determining the condition of corns and/or calluses and the condition of toenails. The J‐FCCS total scores of the patients with retinopathy (p <.001) and numbness or pain in the feet (p <.001) were significantly lower than those of the patients without these complications. In both the multiple regression analysis and logistic regression analysis, lower J‐FCCS was significantly associated with retinopathy and numbness or pain in the feet. Conclusion Foot care education that emphasizes a psychological approach in improving confidence associated with foot self‐care is important for patients with advanced complications of diabetes.
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Affiliation(s)
- Kazuki Ikura
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Hayato Kato
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Haruna Azuma
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Yuri Oda
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Yuka Kato
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Junnosuke Miura
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Tetsuya Babazono
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
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McGloin H, Devane D, McIntosh CD, Winkley K, Gethin G. Psychological interventions for treating foot ulcers, and preventing their recurrence, in people with diabetes. Cochrane Database Syst Rev 2021; 2:CD012835. [PMID: 35653236 PMCID: PMC8095008 DOI: 10.1002/14651858.cd012835.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diabetic foot ulceration (DFU) can be defined as a full-thickness wound below the ankle and is a major complication of diabetes mellitus. Despite best practice, many wounds fail to heal, and when they do, the risk of recurrence of DFU remains high. Beliefs about personal control, or influence, on ulceration are associated with better engagement with self-care in DFU. Psychological interventions aim to reduce levels of psychological distress and empower people to engage in self-care, and there is some evidence to suggest that they can impact positively on the rate of wound healing. OBJECTIVES To evaluate the effects of psychological interventions on healing and recurrence of DFU. SEARCH METHODS In September 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, Ovid PsycINFO and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and reviewed reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated psychological interventions compared with standard care, education or another psychological intervention. Our primary outcomes were the proportion of wounds completely healed; time to complete wound healing; time to recurrence and number of recurrences. DATA COLLECTION AND ANALYSIS Four review authors independently screened titles and abstracts of the studies identified by the search strategy for eligibility. Three authors independently screened all potentially relevant studies using the inclusion criteria and carried out data extraction, assessment of risk of bias and GRADE assessment of the certainty of the evidence. MAIN RESULTS We identified seven trials that met the inclusion criteria with a total of 290 participants: six RCTs and one quasi-RCT. The studies were conducted in Australia, the USA, the UK, Indonesia, Norway and South Africa. Three trials used a counselling-style intervention and one assessed an intervention designed to enhance an understanding of well-being. One RCT used a biofeedback relaxation training intervention and one used a psychosocial intervention based on cognitive behavioural therapy. A quasi-RCT assessed motivation and tailored the intervention accordingly. Due to the heterogeneity of the trials identified, pooling of data was judged inappropriate, and we therefore present a narrative synthesis. Comparisons were (1) psychological intervention compared with standard care and (2) psychological intervention compared with another psychological intervention. We are uncertain whether there is a difference between psychological intervention and standard care for people with diabetic foot ulceration in the proportion of wounds completely healed (two trials, data not pooled, first trial RR 6.25, 95% CI 0.35 to 112.5; 16 participants, second trial RR 0.59, 95% CI 0.26 to 1.39; 60 participants), in foot ulcer recurrence after one year (two trials, data not pooled, first trial RR 0.67, 95% CI 0.32 to 1.41; 41 participants, second trial RR 0.63, 95% CI 0.05 to 7.90; 13 participants) or in health-related quality of life (one trial, MD 5.52, 95% CI -5.80 to 16.84; 56 participants). This is based on very low-certainty evidence which we downgraded for very serious study limitations, risk of bias and imprecision. We are uncertain whether there is a difference in the proportion of wounds completely healed in people with diabetic foot ulceration depending on whether they receive a psychological intervention compared with another psychological intervention (one trial, RR 2.33, 95% CI 0.92 to 5.93; 16 participants). This is based on very low-certainty evidence from one study which we downgraded for very serious study limitations, risk of bias and imprecision. Time to complete wound healing was reported in two studies but not in a way that was suitable for inclusion in this review. One trial reported self-efficacy and two trials reported quality of life, but only one reported quality of life in a manner that enabled us to extract data for this review. No studies explored the other primary outcome (time to recurrence) or secondary outcomes (amputations (major or distal) or cost). AUTHORS' CONCLUSIONS We are unable to determine whether psychological interventions are of any benefit to people with an active diabetic foot ulcer or a history of diabetic foot ulcers to achieve complete wound healing or prevent recurrence. This is because there are few trials of psychological interventions in this area. Of the trials we included, few measured all of our outcomes of interest and, where they did so, we judged the evidence, using GRADE criteria, to be of very low certainty.
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Affiliation(s)
- Helen McGloin
- Department of Nursing, Health and Disability Studies, St Angela's College, Sligo, Ireland
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Caroline D McIntosh
- Discipline of Podiatry, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Kirsty Winkley
- Diabetes & Mental Health, Department of Psychological Medicine, Kings College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Paton J, Abey S, Hendy P, Williams J, Collings R, Callaghan L. Behaviour change approaches for individuals with diabetes to improve foot self-management: a scoping review. J Foot Ankle Res 2021; 14:1. [PMID: 33407755 PMCID: PMC7788877 DOI: 10.1186/s13047-020-00440-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research. METHODOLOGY Arksey and Malley's (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function. RESULTS In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes. CONCLUSION This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.
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Affiliation(s)
- Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK.
| | - Sally Abey
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Phil Hendy
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Jennifer Williams
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Richard Collings
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Lynne Callaghan
- Penninsula Medical School, Faculty of Health, University of Plymouth, John Bull Building Plymouth Science Park, Plymouth, PL6 8BT, UK
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Çatıker A, Zincir H, Seviğ EÜ. The effect of foot care protocol applied to older people on foot health problems and foot care behaviours: a randomised controlled trial in a nursing home. Scand J Caring Sci 2021; 35:1278-1289. [PMID: 33393104 DOI: 10.1111/scs.12949] [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: 08/16/2020] [Revised: 11/11/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to develop a protective and improving protocol for foot health of the older people and to assess the effect of this protocol on foot problems, foot care knowledge levels and foot care behavior. METHODS This randomized controlled trial that was conducted in a nursing home in Turkey. The research was completed with 57 older people (28 intervention group, 29 control group) over the age of 60 living in a nursing home who met the eligibility criteria. Data were collected using the Older Person Identification Form, Foot Examination Form, Foot Care Knowledge Level Form, and Foot Care Behavior Scale at baseline and 6 months later. When assessing the study data; Descriptive statistics, Student t-test, Mann Whitney U test, Wilcoxon signed ranks test, chi-square test, continuity (Yates) correction, Fisher exact chi-square test, McNemar test and GEE were used. RESULTS At the end of the research, there were statistically significant improvements in problems related to dermatology (appearance, hygiene, and moisture); problems related to circulation (temperature); problems related to sensory issues (feeling and pain); problems related to footwear; and problems related to self-care between the intervention and control groups. Also, there were statistically significant improvements in problems related to dermatology (appearance and hygiene); problems related to circulation (temperature, color, and edema); and problems related to sensory issues (feeling and pain) for the posttest compared to the pretest in the intervention group (p < 0.05). In terms of foot care knowledge level and foot care behavior scale mean scores, statistically significant differences were found between the groups and for the intervention group pretest and posttest mean scores. CONCLUSION The foot care protocol applied to older people was identified to reduce foot problems by a significant level, and increase mean points for knowledge levels about foot care and the foot care behavior scale.
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Affiliation(s)
- Aslıhan Çatıker
- Department of Nursing, Ordu University Faculty of Health Sciences, Ordu, Turkey
| | - Handan Zincir
- Faculty of Health Sciences, Department of Nursing, Public Health Nursing Department, Erciyes University, Kayseri, Turkey
| | - Emine Ümit Seviğ
- Faculty of Nursing, Public Health Nursing Department, Near East University, Nicosia/TRNC, Cyprus
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Crawford F, Chappell FM, Lewsey J, Riley R, Hawkins N, Nicolson D, Heggie R, Smith M, Horne M, Amanna A, Martin A, Gupta S, Gray K, Weller D, Brittenden J, Leese G. Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model. Health Technol Assess 2020; 24:1-198. [PMID: 33236718 PMCID: PMC7768791 DOI: 10.3310/hta24620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation. OBJECTIVES Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis. DESIGN We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis. INTERVENTIONS The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated. MAIN OUTCOME MEASURE The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a 'treat-all' strategy. DATA SOURCES Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule. REVIEW METHODS We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019. RESULTS The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk. LIMITATIONS The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates. CONCLUSIONS There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable. FUTURE WORK RECOMMENDATIONS Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus. STUDY REGISTRATION This study is registered as PROSPERO CRD42016052324. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fay Crawford
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
- The Sir James Mackenzie Institute for Early Diagnosis, The School of Medicine, University of St Andrews, St Andrews, UK
| | - Francesca M Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Lewsey
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Neil Hawkins
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald Nicolson
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Smith
- Library & Knowledge Service, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | | | - Aparna Amanna
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Angela Martin
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Saket Gupta
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Karen Gray
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julie Brittenden
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Graham Leese
- Diabetes and Endocrinology, Ninewells Hospital, NHS Tayside, Dundee, UK
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20
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O'Connor JJ, Deroche CB, Wipke-Tevis DD. Foot Care Self-Management in Non-Diabetic Older Adults: A Pilot Controlled Trial. West J Nurs Res 2020; 43:751-761. [PMID: 33012276 DOI: 10.1177/0193945920962712] [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: 11/17/2022]
Abstract
Self-management can mitigate common foot problems; however, community-dwelling older adults without diabetes rarely receive foot care self-management training. This two-group pilot study examined feasibility and preliminary efficacy of the novel, nurse-led 2 Feet 4 Life intervention. Twenty-nine adults (M age 76 years ± 6.6 years) from two senior centers completed the study (90.6% retention rate). Intervention dosage was one hour/week for four consecutive weeks. Study procedures were safe and feasible. Intervention group participants found the intervention acceptable and valuable. Observed between-group effect sizes were the following: knowledge (4.339), self-efficacy (3.652), behaviors (3.403), pain (0.375) and foot health (0.376). Large effect sizes were observed within-groups and within their interaction for knowledge (1.316), behaviors (8.430), pain (9.796), and foot health (3.778). Effect sizes suggest the intervention impacted foot care outcomes between groups and within individuals over seven months' time. Fully powered studies are indicated to test the intervention in diverse samples with more complex foot problems.
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Affiliation(s)
| | - Chelsea B Deroche
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Fujii K, Komoda T, Maekawa A, Nishikawa M. Foot care knowledge and practices among Japanese nurses and care workers in home care and adult service center: a cross- sectional study. BMC Nurs 2020; 19:75. [PMID: 32782433 PMCID: PMC7412637 DOI: 10.1186/s12912-020-00467-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients. Methods This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman's rank correlation tests. Results Among the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status.Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale.For practice, both nurses and care workers had low mean scores for checking client's shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001). Conclusions Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation.
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Affiliation(s)
- Kashiko Fujii
- Graduate School of Medicine, School of Health Sciences, Nagoya University, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya City, Aichi Prefecture 461-8673 Japan
| | - Takuyuki Komoda
- Department of Plastic and Reconstructive Surgery, Gifu Heart Center, 4-14-4 Yabuta Minami, Gifu City, Gifu Prefecture 500-8384 Japan
| | - Atsuko Maekawa
- Faculty of Nursing, Shubun University, 6 Nikko-cho, Ichinomiya-City, Aichi Prefecture 491-0938 Japan
| | - Mariko Nishikawa
- Graduate School of Nursing, University of Human Environments, 3-220 Ebata-Cho, Obu City, Aichi Prefecture 4740035 Japan
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A Systematic Review of the Impact of Foot Care Education on Self Efficacy and Self Care in Patients With Diabetes. Eur J Vasc Endovasc Surg 2020; 60:282-292. [DOI: 10.1016/j.ejvs.2020.03.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/05/2020] [Accepted: 03/31/2020] [Indexed: 11/19/2022]
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Gökdeniz D, Akgün Şahin Z. Evaluation of Knowledge Levels About Diabetes Foot Care and Self-Care Activities in Diabetic Individuals. INT J LOW EXTR WOUND 2020; 21:65-74. [PMID: 32716226 DOI: 10.1177/1534734620926266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was conducted descriptively for the purpose of evaluating the knowledge levels concerning diabetic foot care and self-care activities in individuals with diabetes. The study was carried out with 120 patients who had applied to the internal medicine clinic and endocrine polyclinic in a public hospital in the city center of Turkey. It was determined that Diabetes Self-Care Scale (DSCS) score averages were significantly different between the patients in the age group of 56 to 65 years, who had been diagnosed diabetes for 21 years, and went to doctor every month (P < .05). It was found that the Diabetes Foot Knowledge Questionnaire score average was 2.3 ± 1.5 (minimum = 0; maximum = 5), the DSCS score average was 76.6 ± 15.5 (minimum = 46; maximum = 124), and the FSOG score average was 55.5 ± 10.8 (minimum = 30; maximum = 74). It should be stated to the patients that an appropriate foot care in diabetes is certainly important to prevent wound development.
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Fujii K, Stolt M. Intervention study of a foot-care programme enhancing knowledge and practice among nurses and care workers at in-home service providers. Nurs Open 2020; 7:1039-1051. [PMID: 32587723 PMCID: PMC7308698 DOI: 10.1002/nop2.479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Aim To evaluate the foot-care educational programme for nurses and care workers at in-home service providers. Design A non-randomized controlled study with random cluster sampling method. Methods Study participants were nurses and care workers of 21 in-home service providers, including home-visit nursing and care providers, 1-day care service centres or care centres with rehabilitation programme in Japan. Foot-care programme with foot-care tools as a package or standard care comprising 3-5 sessions over 2 months was provided to 110 participants (87 were on analysis). The outcomes were changes in foot-care knowledge and scores in pre-post interventions. Data were analysed with descriptive statistics, t test, logistic regression analysis and ANCOVA. Results Before adjusting for background, total scores of knowledge and practice categories were higher than the baseline in the intervention group (43 participants) compared with the control group (44 participants). After background correction due to potential bias of non-random cluster sampling, significant between group differences were observed in mean score changes in skin and consultation subscales of the practice category.
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Affiliation(s)
- Kashiko Fujii
- Graduate School of MedicineSchool of Health SciencesNagoya UniversityNagoya CityJapan
- University of Human EnvironmentsObuJapan
| | - Minna Stolt
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalTurkuFinland
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Association between Foot Care Knowledge and Practices among African Americans with Type 2 Diabetes: An Exploratory Pilot Study. J Natl Med Assoc 2019; 111:256-261. [DOI: 10.1016/j.jnma.2018.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 03/01/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022]
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Nguyen TPL, Edwards H, Do TND, Finlayson K. Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Res Clin Pract 2019; 152:29-38. [PMID: 31082445 DOI: 10.1016/j.diabres.2019.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/12/2019] [Accepted: 05/03/2019] [Indexed: 01/13/2023]
Abstract
AIMS To evaluate the effectiveness of a theory-based foot care education intervention program (3STEPFUN) for people with type 2 diabetes at low risk of developing a foot ulcer. METHODS A controlled, pre-test/ post-test quasi-experimental design was used. From 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received (1) a small group intensive education and hands-on skills session; (2) a foot care kit and documents; and (3) three regular booster follow-up phone calls over 6 months. Generalised Estimating Equations models were undertaken to examine the impact of the intervention on outcomes over time. RESULTS The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: improved preventive foot care behaviour (p = 0.001); and decreased prevalence of foot risk factors for ulceration (i.e. dry skin, corns/ callus) (OR: 0.04, 95% CI 0.01 - 0.13, p < 0.001). CONCLUSIONS The study's findings provide evidence of 3STEPFUN on improving foot self-care behaviour and preventing minor foot problems. Further study with formal RCT design and longer follow-up time to examine the effects on decreasing foot ulcer incidence is recommended.
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Affiliation(s)
- Thi Phuong Lan Nguyen
- School of Nursing, Faculty of Health, Queensland University of Technology, Australia; Ho Chi Minh City University of Medicine and Pharmacy, Viet Nam.
| | - Helen Edwards
- Faculty of Health, Queensland University of Technology, Australia
| | | | - Kathleen Finlayson
- School of Nursing, Faculty of Health, Queensland University of Technology, Australia
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Differences Between Patient-Reported Versus Clinician-Observed Nonulcerative Signs and Symptoms of the Foot in Patients With Diabetes Mellitus. J Wound Ostomy Continence Nurs 2019; 46:113-116. [PMID: 30747799 DOI: 10.1097/won.0000000000000504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The primary aim of this study was to compare patient reported versus clinician-observed nonulcerative foot conditions in patients attending a diabetic foot clinic and deemed at risk for diabetic foot ulcers. DESIGN Retrospective review of medical records. SUBJECTS AND SETTING The medical records of 126 patients with diabetes mellitus and deemed at risk for developing diabetic foot ulcers were reviewed. All patients received care from a diabetic foot outpatient clinic in a university-based hospital in Tokyo, Japan, between November 2008 and October 2009. METHODS We compared patients' self-identified foot complaints with clinically observable conditions affecting the feet of these individuals with diabetes mellitus. Patients' medical records were retrieved, and patient complaints and identified preulcerative signs of the foot were documented. All clinical observations were made by nurse specialists with knowledge of diabetic foot conditions. Nonulcerative diabetic foot conditions we observed included calluses, corns, abnormal nails, fissures, tinea pedis, and tinea unguium. Patient sensitivity to correctly identify these signs was calculated using the following formula: patient-reported foot signs divided by clinically identified preulcerative signs. RESULTS Patient sensitivity for identifying nonulcerative signs varied based on the foot condition was 51.4% for calluses, 47.8% for pincer nails, 44.4% for corns, 33.3% for fissures, 19.4% for nail abnormalities, 3.9% for scales/maceration between the toes, 2.6% for interdigital tinea pedis, and 18.2% for tinea unguium. CONCLUSION These findings suggest that persons with diabetes vary in their awareness of conditions affecting their feet and enhancing their risk for the development of diabetic foot ulcers. We recommend additional education on foot-related self-care including how often to observe their feet and how to recognize symptoms that may elevate their risk for diabetic foot ulcers.
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Miikkola M, Lantta T, Suhonen R, Stolt M. Challenges of foot self-care in older people: a qualitative focus-group study. J Foot Ankle Res 2019; 12:5. [PMID: 30675187 PMCID: PMC6339366 DOI: 10.1186/s13047-019-0315-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Foot health is an important aspect of general health, and it can be maintained and promoted through foot self-care. However, little is known about older people’s experiences of caring for their feet. The aim of this study was to gather knowledge about experiences of foot self-care from the perspective of healthy older people in order to improve their welfare and their management of foot health. Methods A qualitative descriptive design with focus groups was used. Seventeen older people recruited from daytime activity centres participated in the focus groups (n = 4). The data were analysed using inductive content analysis. Results The participants described their foot self-care as including various activities, but they were hindered by the following factors: physical (e.g. changes in nail structure), external (e.g. seeking help from multi-level professionals) and internal (e.g. related to ageing). Foot self-care was considered to be important, but it was not systematically carried out. The participants thought that health-care professionals neglected patients’ feet. Conclusions Older people use a variety of methods to care for their feet. However, several factors hinder their ability to do so. Older people need advice, education and support to maintain their foot health. Future research is needed to identify effective ways to support older people in foot self-care and improve their welfare as active citizens.
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Affiliation(s)
- Maija Miikkola
- 1Department of Nursing Science, University of Turku, Turku, Finland
| | - Tella Lantta
- 1Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Suhonen
- 1Department of Nursing Science, University of Turku, Turku, Finland.,2Turku University Hospital, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
| | - Minna Stolt
- 1Department of Nursing Science, University of Turku, Turku, Finland.,2Turku University Hospital, Turku, Finland
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Yokota K, Hayashi Y, Kurata J, Fujita A. Effectiveness of a Self-Foot-Care Educational Program for Prevention of Diabetic Foot Disease. Health (London) 2019. [DOI: 10.4236/health.2019.111002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Osypchuk DV, Chernyshov VP, Chernysheva LI, Kissel NP, Dons'koi BV, Matvienko IM, Rodionov VP, Makovs'ka YU. [REDUCED RESPONSE OF NATURAL KILLER LYMPHOCYTES TO TOLL-LIKE RECEPTOR 3 STIMULATION IN CHILDREN WITH RECURRENT INFECTIONS.]. ACTA ACUST UNITED AC 2018; 62:12-17. [PMID: 29975469 DOI: 10.15407/fz62.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we examined the activation of natural killer(NK)-lymphocytes mediated by Toll-like receptor 3(TLR3), in the group of children with recurrent infections and the group of children with invasive bacterial infections. We examined level of CD69 (marker, of activation) expression on NK - lymphocytes after incubation with TLR3 ligand. There was a significant decrease in the level of an activation marker - 36,3±4,4% in the group of children with recurrent infections, compared with a control group of healthy children (56,5±4,9%) and the group of children with invasive bacterial infections (55,9±4,4%). Also, decreased was an activation potential of NK-lymphocytes - 24,9±L4,5% which was calculated as the difference between the percentage of CD69+ NK - lymphocytes after incubation and spontaneous value (without the addition of activator). There were no correlations between markers of TLR3 mediated activation of NK-cells and the age. Thus, the ability to activate NK - lymphocyte mediated by TLR3, independent of age and reduced in the group of children with recurrent infections. Reduced activation of NK-lymphocytes may contribute to increased susceptibility to viral infections and bacterial complications.
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MESH Headings
- Adolescent
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, Differentiation, T-Lymphocyte/genetics
- Antigens, Differentiation, T-Lymphocyte/immunology
- Bacterial Infections/genetics
- Bacterial Infections/immunology
- Bacterial Infections/microbiology
- Case-Control Studies
- Child
- Child, Preschool
- Female
- Gene Expression Regulation
- Humans
- Infant
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/microbiology
- Lectins, C-Type/genetics
- Lectins, C-Type/immunology
- Lymphocyte Activation
- Male
- Poly I-C/pharmacology
- Primary Cell Culture
- Recurrence
- Respiratory Tract Infections/genetics
- Respiratory Tract Infections/immunology
- Respiratory Tract Infections/microbiology
- Toll-Like Receptor 3/genetics
- Toll-Like Receptor 3/immunology
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Yuncken J, Williams CM, Stolwyk R, Haines TP. People with diabetes foot complications do not recall their foot education: a cohort study. J Foot Ankle Res 2018; 11:12. [PMID: 29636823 PMCID: PMC5889603 DOI: 10.1186/s13047-018-0255-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study is to document what and how diabetes specific foot health information was provided during a podiatry consultation, and what information was retained at 1 month post consultation. Methods This project was embedded within a prospective cohort study with two groups, podiatrists and people with diabetes. Data collection included the Problem Areas in Diabetes Questionnaire (PAID), Montreal Cognitive Assessment (MoCA), information covered during the consultation, method of delivery and perceived key educational message from both participant perspectives at the time of the appointment and 1 month post appointment. Results There were three podiatrists and 24 people with diabetes who provided information at the two time points. Diabetes education provided by the podiatrists was mostly verbal. The key educational message recalled by both groups differed at the time of the appointment (14 out of 24 of responses) and at 1 month post the appointment time (11 out of 24 of responses). Conclusions Education is a vital component to the treatment regime of people with diabetes. It appears current approaches are ineffective in enhancing understanding of diabetes impact on foot health. This study highlights the need for research investigating better ways to deliver key pieces of information to this population. Electronic supplementary material The online version of this article (10.1186/s13047-018-0255-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Yuncken
- 1Peninsula Health, Community Health, PO Box 52, Frankston, VIC 3199 Australia
| | - Cylie M Williams
- 1Peninsula Health, Community Health, PO Box 52, Frankston, VIC 3199 Australia.,2Department of Physiotherapy, Monash University, McMahon's Rd, Frankston, VIC 3199 Australia
| | - Rene Stolwyk
- 3School of Psychological Sciences, Monash University, Frankston, Australia.,Monash Institute of Cognitive and Clinical Neurosciences, Frankston, Australia.,Monash-Epworth Rehabilitation Research Centre, Frankston, Australia
| | - Terry P Haines
- 6Monash Health, Allied Health Research Unit, Kingston Centre, Warrigal Rd, Cheltenham, VIC 3192 Australia.,7Monash University Department of School of Primary and Allied Health Care, McMahon's Rd, Frankston, VIC 3199 Australia
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The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PLoS One 2018. [PMID: 29534070 PMCID: PMC5849313 DOI: 10.1371/journal.pone.0192417] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. METHODS A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. RESULTS 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). CONCLUSION The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12616000210471.
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Rahaman HS, Jyotsna VP, Sreenivas V, Krishnan A, Tandon N. Effectiveness of a Patient Education Module on Diabetic Foot Care in Outpatient Setting: An Open-label Randomized Controlled Study. Indian J Endocrinol Metab 2018; 22:74-78. [PMID: 29535941 PMCID: PMC5838916 DOI: 10.4103/ijem.ijem_148_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A large number of patients with diabetes mellitus are unaware of foot care and are at risk of developing foot ulcer and amputation. This increases healthcare burden due to preventable complication of diabetes. AIMS We conducted this study to assess the effectiveness of a foot care education module for diabetes developed by us. MATERIALS AND METHODS One hundred and twenty-seven patients with diabetes mellitus attending our outpatient were randomized into intervention (n = 63) and control groups (n = 64). At first visit, 1 and 3 months later, both groups filled a questionnaire regarding foot care knowledge and practice. The intervention group was administered foot care education module and the control group received routine care at baseline and 1 month. Patient education module consisted of an audio-visual display and a pamphlet on diabetes foot care. Change in score at 3 months was assessed by Student's t-test. RESULTS Knowledge scores in the intervention group at first, second, and third visits were 9.8 ± 1.8, 10.2 ± 1.6, and 11.0 ± 1.7, respectively. The knowledge scores in the control group at first, second, and third visits were 9.9 ± 1.7, 9.8 ± 1.6, and 10.0 ± 1.8, respectively. The change in knowledge score was statistically significant (P < 0.001) at third visit compared to first in the intervention group but not in the control group (P = 0.62). Practice score also improved significantly (P < 0.001) in the intervention group in the second visit but not in the control group. CONCLUSION Audio-visual foot care patient education module in outpatient setting is an effective means to improve foot care knowledge and practice in patients with diabetes.
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Affiliation(s)
- Hammadur Sk Rahaman
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - V. Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Sharoni SKA, Abdul Rahman H, Minhat HS, Shariff Ghazali S, Azman Ong MH. A self-efficacy education programme on foot self-care behaviour among older patients with diabetes in a public long-term care institution, Malaysia: a Quasi-experimental Pilot Study. BMJ Open 2017; 7:e014393. [PMID: 28600363 PMCID: PMC5623401 DOI: 10.1136/bmjopen-2016-014393] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE A pilot self-efficacy education programme was conducted to assess the feasibility, acceptability and potential impact of the self-efficacy education programme on improving foot self-care behaviour among older patients with diabetes in a public long-term care institution. METHOD A prequasi-experimental and postquasi-experimental study was conducted in a public long-term care institution in Selangor, Malaysia. Patients with diabetes aged 60 years and above who fulfilled the selection criteria were invited to participate in this programme. Four self-efficacy information sources; performance accomplishments, vicarious experience, verbal persuasion and physiological information were translated into programme interventions. The programme consisted of four visits over a 12-week period. The first visit included screening and baseline assessment and the second visit involved 30 min of group seminar presentation. The third and fourth visits entailed a 20-min one-to-one follow-up discussion and evaluation. A series of visits to the respondents was conducted throughout the programme. The primary outcome was foot self-care behaviour. Foot self-efficacy (efficacy-expectation), foot care outcome expectation, knowledge of foot care, quality of life, fasting blood glucose and foot condition were secondary outcomes. Data were analysed with descriptive and inferential statistics (McNemar's test and Wilcoxon signed-rank test) using the Statistical Package for the Social Sciences V.20.0. RESULTS Fifty-two residents were recruited but only 31 met the inclusion criteria and were included in the analysis at baseline and at 12 weeks postintervention. The acceptability rate was moderately high. At postintervention, foot self-care behaviour (p<0.001), foot self-efficacy (efficacy-expectation), (p<0.001), foot care outcome expectation (p<0.001), knowledge of foot care (p<0.001), quality of life (physical symptoms) (p=0.003), fasting blood glucose (p=0.010), foot hygiene (p=0.030) and anhydrosis (p=0.020) showed significant improvements. CONCLUSION Findings from this pilot study would facilitate the planning of a larger study among the older population with diabetes living in long-term care institutions. TRIAL REGISTRATION NUMBER ACTRN12616000210471; Pre-results.
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Affiliation(s)
- Siti Khuzaimah Ahmad Sharoni
- Department of Nursing, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hejar Abdul Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hanafi Azman Ong
- Department of Statistics, Faculty of Computer Science and Mathematics, Universiti Teknologi MARA, Segamat, Johor, Malaysia
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Hypoglycaemia and brief interventions in the emergency department - A systematic review. Int Emerg Nurs 2017; 34:43-50. [PMID: 28442225 DOI: 10.1016/j.ienj.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE For people with diabetes, severe hypoglycaemia is the most common reason for emergency service usage and emergency department (ED) presentations. Brief interventions (BI) are a recognised intervention strategy in the ED for other conditions but to date, they have not been applied to those with hypoglycemia. This review aims to identify components and outcomes of BI for people with diabetes mellitus to inform the development of BI in the ED. METHOD A systematic review of randomized controlled trials was undertaken in MEDLINE, CINAHL, PsychINFO and EMBASE. Studies that examined brief interventions for people with diabetes were considered. Eligible studies were critically appraised and included in a narrative synthesis. RESULTS A total of 2475 citations were identified, 171 full papers were reviewed and four articles were included for review. The components 'advice' and 'assistance' from the five A Framework were the most frequently used BI components. Statistically significant improvements were achieved in psychological, functional, and satisfaction outcomes. However, clinical outcomes were not improved and economic outcomes like costs of BI were not evaluated. CONCLUSIONS The literature review demonstrated a lack of evidence related to BI in diabetes within the emergency setting despite the ED being an ideal environment. Future research needs to be conducted to investigate the effectiveness of BI for patients with diabetes.
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Ahmad Sharoni SK, Minhat HS, Mohd Zulkefli NA, Baharom A. Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review. Int J Older People Nurs 2016; 11:214-39. [PMID: 26916809 DOI: 10.1111/opn.12112] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of health education programmes to improve foot self-care practices and foot problems among older people with diabetes. BACKGROUND The complications of diabetes among older people are a major health concern. Foot problems such as neuropathy, ulcer and ultimately amputation are a great burden on older people with diabetes. Diabetes foot education programmes can influence the behaviour of older people in practising foot self-care and controlling the foot problems. However, the educational approaches used by the educators are different. Therefore, it is important to assess the education programmes from various evidence-based practices. DESIGN Six databases, EBSCOhost medical collections (MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection), SAGE, Wiley Online Library, ScienceDirect, SpringerLink and Web of Science, were used to search for articles published from January 2000 to March 2015. The search was based on the inclusion criteria and keywords including 'foot', 'care' and 'diabetes'. Fourteen studies were assessed and reviewed in the final stage. CONCLUSIONS Health education programmes varied according to their design, setting, approach, outcome measured and results. Foot assessment, verbal and written instructions and discussion were proved to improve the foot self-care and foot problems. Subsequent follow-ups and evaluations had a significant effect. An improvement was observed in foot self-care scores and foot problems (such as neuropathy, foot disability, lesion, ulcer, tinea pedis and callus grade) after implementation of the health education programme. IMPLICATIONS FOR PRACTICE The findings of this study support the claim that a health education programme increases the foot self-care scores and reduces the foot problems. However, there were certain methodological concerns in the reviewed articles, indicating the need for further evaluation. In future, researchers and practitioners must implement a vigorous education programme focusing on diabetes foot self-care among the older population.
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Affiliation(s)
- Siti Khuzaimah Ahmad Sharoni
- Nursing Department, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Anisah Baharom
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Bonner T, Foster M, Spears-Lanoix E. Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature. Diabet Foot Ankle 2016; 7:29758. [PMID: 26899439 PMCID: PMC4761684 DOI: 10.3402/dfa.v7.29758] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/27/2015] [Accepted: 11/28/2015] [Indexed: 12/01/2022]
Abstract
Introduction The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Methods Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Results Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Conclusion Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations.
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Affiliation(s)
- Timethia Bonner
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA;
| | - Margaret Foster
- Health Sciences Center, Texas A&M University, College Station, TX, USA
| | - Erica Spears-Lanoix
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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Evaluation of foot care and self-efficacy in patients with diabetes in Turkey: an interventional study. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0464-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hoogeveen RC, Dorresteijn JAN, Kriegsman DMW, Valk GD. Complex interventions for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2015; 2015:CD007610. [PMID: 26299991 PMCID: PMC8504983 DOI: 10.1002/14651858.cd007610.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ulceration of the feet, which can lead to the amputation of feet and legs, is a major problem for people with diabetes mellitus, and can cause substantial economic burden. Single preventive strategies have not been shown to reduce the incidence of foot ulceration to a significant extent. Therefore, in clinical practice, preventive interventions directed at patients, healthcare providers and/or the structure of health care are often combined (complex interventions). OBJECTIVES To assess the effectiveness of complex interventions in the prevention of foot ulcers in people with diabetes mellitus compared with single interventions, usual care or alternative complex interventions. A complex intervention is defined as an integrated care approach, combining two or more prevention strategies on at least two different levels of care: the patient, the healthcare provider and/or the structure of health care. SEARCH METHODS For the second update we searched the Cochrane Wounds Group Specialised Register (searched 22 May 2015), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 4), The Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library 2015, Issue 4), The Health Technology Assessment Database (HTA) (The Cochrane Library 2015, Issue 4), The NHS Economic Evaluation Database (NHS EED) (The Cochrane Library 2015, Issue 4), Ovid MEDLINE (1946 to 22 May 2015), Ovid MEDLINE (In-Process & Other Non-Indexed Citations 21 May, 2015), Ovid EMBASE (1974 to 21 May, 2015) and EBSCO CINAHL (1982 to 22 May, 2015). SELECTION CRITERIA Prospective randomised controlled trials (RCTs) which compared the effectiveness of combinations of preventive strategies, not solely patient education, for the prevention of foot ulcers in people with diabetes mellitus, with single interventions, usual care or alternative complex interventions. DATA COLLECTION AND ANALYSIS Two review authors were assigned to independently select studies, to extract study data and to assess risk of bias of included studies, using predefined criteria. MAIN RESULTS Only six RCTs met the criteria for inclusion. The study characteristics differed substantially in terms of healthcare settings, the nature of the interventions studied and outcome measures reported. In three studies that compared the effect of an education-centred complex intervention with usual care or written instructions, only little evidence of benefit was found. Three studies compared the effect of more intensive and comprehensive complex interventions with usual care. One study found a significant and cost-effective reduction, one of lower extremity amputations (RR 0.30, 95% CI 0.31 to 0.71). One other study found a significant reduction of both amputation and foot ulcers. The last study reported improvement of patients' self care behaviour. All six included RCTs were at high risk of bias, with hardly any of the predefined quality assessment criteria met. AUTHORS' CONCLUSIONS There is no high-quality research evidence evaluating complex interventions for preventing diabetic foot ulceration and insufficient evidence of benefit.
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Affiliation(s)
- Ruben C Hoogeveen
- Diakonessenhuis hospitalDepartment of Internal MedicineBosboomstraat 1UtrechtNetherlands3582 KE
| | - Johannes AN Dorresteijn
- University Medical Center UtrechtDepartment of Internal MedicineHeidelberglaan 100UMCU postbox F02.1263508 GA UtrechtNetherlands
| | - Didi MW Kriegsman
- Zonnehuisgroep Amstelland (KBO)Laan van de Helende Meesters 12AmstelveenNetherlands1186 AM
| | - Gerlof D Valk
- University Medical Center UtrechtDepartment of Internal MedicineHeidelberglaan 100UMCU postbox F02.1263508 GA UtrechtNetherlands
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Monami M, Zannoni S, Gaias M, Nreu B, Marchionni N, Mannucci E. Effects of a Short Educational Program for the Prevention of Foot Ulcers in High-Risk Patients: A Randomized Controlled Trial. Int J Endocrinol 2015; 2015:615680. [PMID: 26448748 PMCID: PMC4581554 DOI: 10.1155/2015/615680] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/26/2015] [Accepted: 08/10/2015] [Indexed: 12/28/2022] Open
Abstract
Background. Patient education is capable of reducing the risk for diabetic foot ulcers. However, specific education on foot ulcer prevention was either included in broader programs addressing different parts of diabetes care or provided with time- and resource-consuming curricula. The aim of the study is to assess the feasibility and efficacy of a brief educational program for the prevention of diabetic foot ulcers in high-risk patients. Methods. The study was performed on type 2 diabetic patients, randomized in a 1 : 1 ratio either to intervention or to control group. The principal endpoint was the incidence of foot ulcers. The intervention was a two-hour program provided to groups of 5-7 patients, including a 30-minute face-to-face lesson on risk factors for foot ulcers, and a 90-minute interactive session with practical exercises on behaviors for reducing risk. Results. The study was prematurely terminated due to a highly significant difference in outcome between the two treatment groups. The final sample was therefore composed of 121 patients. Six patients, all in the control group, developed ulcers during the 6-month follow-up (10% versus 0%, p = 0.012). Conclusions. A brief, 2-hour, focused educational program is effective in preventing diabetic foot ulcers in high-risk patients.
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Affiliation(s)
- Matteo Monami
- Division of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, 50141 Florence, Italy
- *Matteo Monami:
| | - Stefania Zannoni
- Division of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, 50141 Florence, Italy
| | - Marianna Gaias
- Division of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, 50141 Florence, Italy
| | - Besmir Nreu
- Division of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, 50141 Florence, Italy
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, 50141 Florence, Italy
| | - Edoardo Mannucci
- Division of Diabetes Agency, Careggi Teaching Hospital, 50141 Florence, Italy
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Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2014; 2014:CD001488. [PMID: 25514250 PMCID: PMC7057029 DOI: 10.1002/14651858.cd001488.pub5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES To assess the effects of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH METHODS We searched The Cochrane Wounds Group Specialised Register (searched 03 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8). SELECTION CRITERIA Prospective randomised controlled trials (RCTs) that evaluated educational programmes for preventing foot ulcers in people with diabetes mellitus. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data extraction and assessment of risk of bias. Primary end points were foot ulceration or ulcer recurrence and amputation. MAIN RESULTS Of the 12 RCTs included, the effect of patient education on primary end points was reported in only five. Pooling of outcome data was precluded by marked, mainly clinical, heterogeneity. One of the RCTs showed reduced incidence of foot ulceration (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.14 to 0.66) and amputation (RR 0.33, 95% CI 0.15 to 0.76) during one-year follow-up of diabetes patients at high risk of foot ulceration after a one-hour group education session. However, one similar study, with lower risk of bias, did not confirm this finding (RR amputation 0.98, 95% CI 0.41 to 2.34; RR ulceration 1.00, 95% CI 0.70 to 1.44). Three other studies, also did not demonstrate any effect of education on the primary end points, but were most likely underpowered. Patients' foot care knowledge was improved in the short term in five of eight RCTs in which this outcome was assessed, as was patients' self-reported self-care behaviour in the short term in seven of nine RCTs. Callus, nail problems and fungal infections improved in only one of five RCTs. Only one of the included RCTs was at low risk of bias. AUTHORS' CONCLUSIONS In some trials, foot care knowledge and self reported patient behaviour seem to be positively influenced by education in the short term. Yet, based on the only two sufficiently powered studies reporting the effect of patient education on primary end points, we conclude that there is insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation incidence.
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Affiliation(s)
- Johannes AN Dorresteijn
- University Medical Center UtrechtDepartment of Internal MedicineHeidelberglaan 100UMCU postbox F02.1263508 GA UtrechtNetherlands
| | - Didi MW Kriegsman
- Zonnehuisgroep Amstelland (KBO)Laan van de Helende Meesters 12AmstelveenNetherlands1186 AM
| | - Willem JJ Assendelft
- Radboud University Nijmegen Medical CenterDepartment of Primary and Community Care, 117 ELGPO Box 9101route 117NijmegenNetherlands6500 HB
| | - Gerlof D Valk
- University Medical Center UtrechtDepartment of Internal MedicineHeidelberglaan 100UMCU postbox F02.1263508 GA UtrechtNetherlands
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Attridge M, Creamer J, Ramsden M, Cannings‐John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev 2014; 2014:CD006424. [PMID: 25188210 PMCID: PMC10680058 DOI: 10.1002/14651858.cd006424.pub3] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. SEARCH METHODS A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification. MAIN RESULTS A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment. AUTHORS' CONCLUSIONS Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.
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Affiliation(s)
- Madeleine Attridge
- 3rd Floor Neuadd Meirionnydd, Cardiff UniversityCochrane Institute of Primary Care and Public HealthHeath ParkCardiffUKCF14 4YS
| | | | - Michael Ramsden
- 8th Floor, Neuadd Meirionnydd, Cardiff UniversityWales DeaneryHeath ParkCardiffUKCF14 4YS
| | - Rebecca Cannings‐John
- 4th Floor, Neuadd Meirionnydd, Cardiff UniversitySouth East Wales Trials UnitHealth ParkCardiffUKCF14 4XN
| | - Kamila Hawthorne
- 5th Floor, Cochrane Building, School of Medicine, Cardiff UniversityInstitute of Medical EducationHeath ParkCardiffUKCF14 4XN
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Ricci-Cabello I, Ruiz-Pérez I, Rojas-García A, Pastor G, Rodríguez-Barranco M, Gonçalves DC. Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression. BMC Endocr Disord 2014; 14:60. [PMID: 25037577 PMCID: PMC4107728 DOI: 10.1186/1472-6823-14-60] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/15/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs' characteristics associated with greater success. METHODS We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies. RESULTS We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated. CONCLUSIONS Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, 2nd floor, Walton Street, Jericho OX2 6NW, UK
- CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isabel Ruiz-Pérez
- CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Andalusian School of Public Health, Granada, Spain
| | - Antonio Rojas-García
- CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Andalusian School of Public Health, Granada, Spain
| | | | | | - Daniela C Gonçalves
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, 2nd floor, Walton Street, Jericho OX2 6NW, UK
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Newlin Lew K, Nowlin S, Chyun D, Melkus GD. State of the science: diabetes self-management interventions led by nurse principal investigators. West J Nurs Res 2014; 36:1111-57. [PMID: 24807891 DOI: 10.1177/0193945914532033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Over the past decade, diabetes self-management (DSM) interventions have become increasingly heterogeneous to address the needs of diverse populations. The purpose of this integrative review is to summarize the state of the science regarding DSM interventions led by nurse principal investigators. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses framework informed identification, selection, and appraisal of the literature. A total of 44 national and international studies (RCTs [randomized controlled trial] and quasi-experimental studies) were identified for inclusion. Across national studies, diverse ethnic groups (Latinos, African Americans, Asians, and Native Americans) were most frequently sampled (67%). Review findings identified (a) DSM intervention typologies (primary DSM intervention, DSM reinforcement intervention, and primary DSM intervention plus reinforcement intervention) and selection of blended or bundled intervention components; (b) DSM intervention translation to community-based, electronic, and home settings; and (c) DSM intervention delivery (interventionists, dosages, and fidelity).
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Abstract
Increasing cultural diversity in the United States and significant health disparities among immigrant populations make acculturation an important concept to measure in health research. The purpose of this cross-sectional, descriptive study was to examine acculturation and health of Korean American adults. A convenience sample of 517 Korean American adults in a Midwestern city completed a survey in either English or Korean. All four groups of Berry's acculturation model were identified using cluster analysis with Lee's Acculturation Scale. Assimilation, integration, and separation were found in the English survey sample, whereas integration, separation, and marginalization were found in the Korean survey sample. Moreover, the findings revealed that acculturation is a bidimensional process, and the unique nature of samples may determine acculturation groups. Physical health and mental health were significantly related to acculturation in the English survey sample. However, there was not a significant relationship between health and acculturation in the Korean survey sample.
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Jones H, Berard LD, MacNeill G, Whitham D, Yu C. Éducation sur l’autogestion. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fan L, Sidani S, Cooper-Brathwaite A, Metcalfe K. Improving foot self-care knowledge, self-efficacy, and behaviors in patients with type 2 diabetes at low risk for foot ulceration: a pilot study. Clin Nurs Res 2013; 23:627-43. [PMID: 23823459 DOI: 10.1177/1054773813491282] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pilot study aimed to explore the effects of an educational intervention on patients' foot self-care knowledge, self-efficacy, and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The intervention consisted of three sessions and was given over a 3-week period. A total of 70 eligible consenting participants were recruited for this pilot study. Fifty-six participants completed the study. The outcomes were assessed at pretest, following the first two sessions, and 3-month follow-up. The findings indicated that the foot self-care educational intervention was effective in improving foot self-care knowledge, self-efficacy and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with type 2 diabetes at low risk for foot ulcerations.
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Affiliation(s)
- Lifeng Fan
- University of Toronto, Toronto, Ontario, Canada
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Fan L, Sidani S, Cooper-Brathwaite A, Metcalfe K. Feasibility, acceptability and effects of a foot self-care educational intervention on minor foot problems in adult patients with diabetes at low risk for foot ulceration: a pilot study. Can J Diabetes 2013; 37:195-201. [PMID: 24070843 DOI: 10.1016/j.jcjd.2013.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/01/2013] [Accepted: 03/03/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives of the pilot study were to examine the feasibility and acceptability of the foot self-care educational intervention, and to explore its preliminary effects on reducing the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration. METHODS A one-group-repeated-measures design was used. The intervention given over 3 weeks consisted of a 1 hour 1-on-1 provider-patient interaction to discuss foot self-care strategies, 1 hour hands-on practice of strategies and 2 10-minute telephone contact booster sessions. Of the 70 eligible consenting participants, 56 completed the study. The outcomes were assessed at pretest and at 3-month follow-up. Chi-square and Fisher's exact test were used to examine changes in outcomes over time. RESULTS The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes mellitus. It was effective in reducing the occurrence of minor foot skin and toenails problems (all p<0.05) at 3-month follow up. CONCLUSIONS The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.
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Affiliation(s)
- Lifeng Fan
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Kent D, D'Eramo Melkus G, Stuart P“MW, McKoy JM, Urbanski P, Boren SA, Coke L, Winters JE, Horsley NL, Sherr D, Lipman R. Reducing the Risks of Diabetes Complications Through Diabetes Self-Management Education and Support. Popul Health Manag 2013; 16:74-81. [DOI: 10.1089/pop.2012.0020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Dan Kent
- Group Health Cooperative, University of Washington, Seattle, Washington
| | | | | | - June M. McKoy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Lola Coke
- Rush University College of Nursing, Chicago, Illinois
| | | | - Neil L. Horsley
- Dr. Wm. M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Dawn Sherr
- American Association of Diabetes Educators, Chicago, Illinois
| | - Ruth Lipman
- American Association of Diabetes Educators, Chicago, Illinois
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