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Highton P, Jeffers S, Butt A, O'Mahoney L, Jenkins S, Abdala R, Haddon L, Gillies C, Curtis F, Hadjiconstantinou M, Khunti K. Patient-reported outcomes in diabetes-related foot conditions: Is patient experience influenced by ethnicity? A mixed-methods systematic review. Diabet Med 2024:e15420. [PMID: 39102339 DOI: 10.1111/dme.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/07/2024]
Abstract
AIMS Research in diabetes-related foot conditions (DRFC) often focuses on ulcer-related care, whilst the patient experience and influence of sociodemographic factors are under-researched. This systematic review investigated patient-reported outcomes and experience in people with DRFC. METHODS Multiple databases were searched from inception to 16 August 2023. All original articles that assessed any patient-reported outcome or experience in DRFC and reported participant ethnicity were included. Data were synthesized using a sequential contingent approach. Study quality was assessed using study design-specific tools. RESULTS Twenty-three studies were included (11 qualitative, 11 quantitative and one mixed-methods). DRFC had a largely negative impact on various life dimensions, including social and daily life, work, emotional and psychological well-being, necessitating dependence on others in the form of emotional, social and/or religious support, which were experienced differently by different groups. Patient DRFC knowledge and self-care habits were typically suboptimal, and levels of hope and feeling of control over their condition varied between groups. Outcomes varied slightly between ethnicities across studies, with some ethnicity-specific themes identified such as beliefs about disease cause and footwear habits. Quantitative and qualitative findings were mostly congruent. CONCLUSIONS DRFC profoundly and negatively impacts patient-reported outcomes and experience, with limited evidence suggesting an influence of ethnicity.
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Affiliation(s)
- Patrick Highton
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Shavez Jeffers
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Ayesha Butt
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Lauren O'Mahoney
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Sian Jenkins
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ruksar Abdala
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Louise Haddon
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Ffion Curtis
- Liverpool Reviews & Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- National Institute for Health and Care Research Applied Research Collaboration East Midlands, Leicester, UK
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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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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Stolt M, Katajisto J, Peltonen J, Suhonen R, Leino-Kilpi H. Development and testing of a new electronic foot health promotion programme on nurses' foot self-care. BMC Nurs 2020; 19:29. [PMID: 32327936 PMCID: PMC7168980 DOI: 10.1186/s12912-020-00423-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Nurses form the largest professional group in health care, and they spend most of their working day on their feet. From the perspective of work well-being, healthy feet are important to tolerate the physical demands of nursing work. However, little is known about how nurses’ foot self-care practices can be promoted with computerised interventions. The aim of this study was two-fold: to explore the preliminary effects of the electronic Foot Health Promotion Programme (FHPP) on foot self-care in nurses and to examine the usability of the programme. Methods A single group pretest-posttest design was used. The FHPP was targeted at nurses working in the operating theatre. The FHPP lasted for 4 weeks and focused on improving nurses’ knowledge and awareness of foot self-care through self-directed learning tasks. The primary outcome was knowledge of foot self-care. The secondary outcomes were foot health and work ability. Thirty-seven participants completed the study. The outcomes were assessed at baseline (April–June 2017) and 4 weeks (August–September 2017) after the intervention ended. The data were analysed statistically. Results Participants’ knowledge of foot self-care and foot health improved; however, the changes were not statistically significant. The FHPP was considered to be usable and has potential as a tool to increase knowledge of foot self-care among nurses. Conclusions The FHPP developed in this study is a newly developed potential tool to increase nurses’ knowledge of foot self-care. Application of the FHPP as part of occupational health care may enhance nursing personnel’s foot self-care and lower extremity health. Trial registration ClinicalTrials.gov NCT03116451, 17.4.2017.
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Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, and Turku University Hospital, Turku, Finland
| | - Jouko Katajisto
- 2Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Johanna Peltonen
- 3Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, and Turku University Hospital, City of Turku, Welfare Division, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, and Turku University Hospital, Turku, Finland
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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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Subrata SA, Phuphaibul R. A nursing metaparadigm perspective of diabetic foot ulcer care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S38-S50. [PMID: 30925236 DOI: 10.12968/bjon.2019.28.6.s38] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.
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Affiliation(s)
- Sumarno Adi Subrata
- PhD Candidate, Doctor of Philosophy Program in Nursing, International and Collaborative with Foreign University Program, Mahidol University, Thailand; and Nursing Lecturer, Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
| | - Rutja Phuphaibul
- Professor of Nursing, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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Khunkaew S, Fernandez R, Sim J. Health-Related Quality of Life and Self-Care Management Among People With Diabetic Foot Ulcers in Northern Thailand. SAGE Open Nurs 2019; 5:2377960819825751. [PMID: 33415216 PMCID: PMC7774360 DOI: 10.1177/2377960819825751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/13/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are a common complication of diabetes that impacts on the health-related quality of life (HRQOL). Foot care is an important factor in the self-care management of patients with DFUs. The objective of this study was to investigate the HRQOL and foot care management of people with DFUs. A cross-sectional study involving 41 people with DFUs was conducted at a large tertiary hospital in Northern Thailand. The Diabetic Foot Ulcer Scale-Short Form and the VA-Diabetes Foot Care Survey were used to assess the HRQOL and foot care management among people with DFUs. The majority of the participants were female (n = 24, 58.5%), and the mean age was 62.13 years. The scores for HRQOL in the six domains were as follows: leisure (66.95 ± 28.03), physical health (68.93 ± 28.51), dependence or daily life (80.08 ± 25.23), negative emotions (71.23 ± 29.48), worried about ulcers (62.20 ± 31.97), and bothered by ulcer care (69.36 ± 25.20). High scores indicate a high (good) HRQOL. Less than a third of the participants reported that they had received education about foot care management. Almost all participants reported that they washed their feet daily; however, a large proportion did not test the water temperature or use lubricants on their feet. Most of the participants did not have a mirror for checking under their feet (48.8%), and there was a lack of knowledge about how to use a mirror for foot inspections (51.2%). This study provides guidance for clinicians on the content and delivery of diabetes education programs for people with diabetes (and DFUs) in Northern Thailand. The findings provide guidance on existing knowledge and the need for programs to address barriers to foot self-care management both in terms of skills and attitudes.
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Affiliation(s)
- Saneh Khunkaew
- School of Nursing, University of Wollongong,
New South Wales, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong,
New South Wales, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong,
New South Wales, Australia
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Stevens K, Bruneau J, Moralejo D. Foot self-management for adults with diabetes in western countries: a scoping review protocol. ACTA ACUST UNITED AC 2018; 15:2249-2256. [PMID: 28902691 DOI: 10.11124/jbisrir-2016-003269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SCOPING REVIEW OBJECTIVE/QUESTION The objective of this scoping review is to examine and map the range of issues related to self-management of feet in adults with diabetes with similar lifestyles, risks and health care in western countries.
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Affiliation(s)
- Kathleen Stevens
- Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: a Joanna Briggs Institute Affiliated Group, School of Nursing, Memorial University of Newfoundland, St. John's, Canada
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Ahmad Sharoni SK, Mohd Razi MN, Abdul Rashid NF, Mahmood YE. Self-efficacy of foot care behaviour of elderly patients with diabetes. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2017; 12:2-8. [PMID: 29423123 PMCID: PMC5791827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Elderly patients with diabetes are at a high risk of contracting diabetic foot problems. Self-efficacy is essential to help improve foot care behaviour. AIM To identify levels of self-efficacy and foot care behaviour and their relationship with demographic characteristics in elderly patients with diabetes. METHODS A cross-sectional study was conducted in two general hospitals in Malaysia from May to June 2015. Diabetes patients aged 60 years with specific inclusion criteria were invited to participate in this study. The respondents were interviewed using a set of validated questionnaires. Data were analysed with descriptive and inferential statistics (multiple linear regression) using Statistical Package for the Social Sciences version 20.0. RESULTS Levels of foot self-efficacy (mean+31.39; standard deviation=7.76) and foot care behaviour (mean=25.37; SD=5.88) were high. There was a positive significant relationship between foot self-efficacy (β = 0.41, p < 0.001) and gender (β = 0.30, p < 0.001) with foot care behaviour. CONCLUSION Self-efficacy can be incorporated in diabetes education to improve foot care behaviour. High-risk patients should be taught proper foot inspection and protection as well as the merits of skin care to prevent the occurrence of diabetic foot problems.
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Affiliation(s)
- S K Ahmad Sharoni
- (Corresponding author) MscNurs (UM), RN (USM) Universiti teknologi MARA, Puncak Alam Campus, 42300 Puncak Alam, Selangor, Malaysia.
| | - M N Mohd Razi
- Bachelor of Nursing (hons) (UiTM) Universiti teknologi MARA, Selangor, Malaysia
| | - N F Abdul Rashid
- Bachelor of Nursing (hons) (UiTM) Universiti teknologi MARA, Selangor, Malaysia
| | - Y E Mahmood
- Bachelor of Nursing (hons) (UiTM) Universiti teknologi MARA, Selangor, Malaysia
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Daley CM, Hale JW, Berryhill K, Bointy S, Clark L, Chase B, LeMaster J, He J. Diabetes Self-Management Behaviors among American Indians in the Midwestern United States. ACTA ACUST UNITED AC 2017; 3:34-41. [PMID: 30637353 PMCID: PMC6329453 DOI: 10.20431/2455-5983.0301005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to understand if American Indian adults with diabetes in the Midwest are similar to American Indian adults nationally in their self-management behaviors. This cross-sectional survey was conducted from May 2009 to April 2010 at powwows, health fairs, and other community events. The convenience sample self-selected into the study and answered questions via touch screen computer about diabetes self-management. Participants were significantly below the national average for American Indians in their adherence to self-management recommendations in daily foot checks (p=0.0035) and having had a dilated eye exam in the previous year (p=0.0002), despite being significantly more likely to have taken a diabetes self-management class (p<0.0001). They were similar to the national average for daily glucose checks and having had one or more hemoglobin A1C tests in the previous year. Participants were less likely to eat 5 or more servings of fruits or vegetables per day (p=0.0001), but more likely to achieve 150 minutes or more of physical activity per week (p=0.0001). Programs addressing self-care issues should be developed to help improve the self-management habits of American Indian adults with diabetes, with particular attention to activities outside of monitoring blood glucose and hemoglobin A1C levels.
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Affiliation(s)
- Christine M Daley
- Professor of Family Medicine and Preventive Medicine & Public Health Director, Center for American Indian Community Health, USA
| | - Jason W Hale
- Research Instructor of Family Medicine, Assistant Director, Center for American Indian Community Health, USA
| | - Kelly Berryhill
- Research Associate, Center for American Indian Community Health, USA
| | - Shelley Bointy
- Project Director, Center for American Indian Community Health, USA
| | - Lauren Clark
- Graduate Research Associate, Department of Biostatistics Member, Center for American Indian Community Health, USA
| | - Brian Chase
- Graduate Research Associate, Department of Biostatistics Member, Center for American Indian Community Health, USA
| | - Joseph LeMaster
- Associate Professor of Family Medicine Member, Center for American Indian Community Health, USA
| | - Jianghua He
- Associate Professor of Biostatistics Member, Center for American Indian Community Health, USA
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Sharath S, Henson H, Flynn S, Pisimisis G, Kougias P, Barshes NR. Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss. ACTA ACUST UNITED AC 2016; 52:851-8. [PMID: 26745753 DOI: 10.1682/jrrd.2014.07.0176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 06/17/2015] [Indexed: 11/05/2022]
Abstract
In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were </=65 yr, those between 66 and 79 yr were 18% less likely to ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.
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Affiliation(s)
- Sherene Sharath
- Health Services & Research Development, Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston, TX
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Matricciani L, Jones S. Who cares about foot care? Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: an integrative review. DIABETES EDUCATOR 2014; 41:106-17. [PMID: 25480398 DOI: 10.1177/0145721714560441] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Appropriate and timely foot self-care practices may prevent diabetes-related foot complications. However, self-care practices are often neglected, particularly by older adults. The purpose of this study was to conduct an integrative, systematic literature review of the psychosocial barriers and enablers of foot self-care practices among older adults diagnosed with diabetes. METHODS An integrative, systematic literature review and a deductive thematic analysis was conducted to determine psychosocial barriers and enablers of foot self-care practices among older adults. RESULTS A total of 130 different studies were retrieved from the search strategy. From these, 9 studies were identified and included for review. Physical ability, perceived importance, patient knowledge, provision of education, social integration, risk status, and patient-provider communication were identified as key barriers and enablers of foot self-care. Participants at high risk of foot complications were found to perceive themselves at greater risk of complications, receive more education, and engage in better overall foot self-care practices compared to those at low risk of foot complications. CONCLUSION Foot self-care practices appear underutilized as primary prevention measures by older adults and are instead adopted only once complications have already occurred. Likewise, facilitators of foot self-care practices, such as education, appear to be reserved for individuals who have already developed foot complications. Health care professionals such as diabetes educators, podiatrists, and general practitioners may play an important role in the prevention of foot complications among older adults by recognizing, referring, and providing early education to older adults.
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Affiliation(s)
- Lisa Matricciani
- Sansom Institute, Division of Health Sciences, University of South Australia, Adelaide, Australia (Ms Matricciani, Dr Jones)
| | - Sara Jones
- Sansom Institute, Division of Health Sciences, University of South Australia, Adelaide, Australia (Ms Matricciani, Dr Jones)
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Dikeukwu RA, Omole OB. Awareness and practices of foot self-care in patients with diabetes at Dr Yusuf Dadoo district hospital, Johannesburg. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2013.10872314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RA Dikeukwu
- Department of Family Medicine, University of the Witwatersrand, Johannesburg
| | - OB Omole
- Clinical Unit (Family Medicine), Sedibeng District Department of Family Medicine, University of the Witwatersrand, Johannesburg
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Margolis DJ, Hoffstad O, Weibe DJ. Lower-extremity amputation risk is associated with variation in behavioral risk factor surveillance system responses. Diabetes Care 2014; 37:2296-301. [PMID: 24879843 DOI: 10.2337/dc14-0788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether regional variation in the rate of lower-extremity amputation (LEA) is associated with health behaviors. RESEARCH DESIGN AND METHODS This was a cross-sectional prevalence study of merged data from the U.S. Census, Medicare parts A and B, and the Behavioral Risk Factor Surveillance System. We used regression models to determine whether previously described regional variation in LEA incidence was associated with responses to the Behavioral Risk Factor Surveillance System. Regions were created using Dartmouth Atlas Health Referral Regions. RESULTS The mean and median incidence of LEA was 4.5 per 1,000 persons with diabetes; the rate varied from 2.4 to 7.9 LEA per 1,000 persons by health referral region. Statistically significant inverse associations were found between LEA and the rate of patients reporting colorectal screening (P < 0.0001) or the participation in diabetes management classes (P = 0.018). Most other factors, including daily foot evaluations, were not associated with a decreased risk of LEA. These findings were also found to be associated with geographically clustered regions known for increased risk of LEA. CONCLUSIONS LEA is known to vary by region in the U.S., and regions with higher rates of LEA tend to be clustered together. Some of this variation may be explained by health behaviors in those regions, such as attending diabetes education classes or better health prevention habits (e.g., colon cancer screening). It should be possible to prevent unwanted LEAs by educating individuals with diabetes and foot ulcers about the need for participation in foot ulcer treatment.
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Affiliation(s)
- David J Margolis
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PADepartment of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ole Hoffstad
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Douglas J Weibe
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Abu-Qamar MZ. Knowledge and practice of foot self-care among Jordanians with diabetes: An interview-based survey study. J Wound Care 2014; 23:247-50, 252-4. [DOI: 10.12968/jowc.2014.23.5.247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Z. Abu-Qamar
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia
- Department of Adult Health Nursing, Faculty of Nursing, Mu'tah University, Mu'tah, Jordan
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Guihan M, Bombardier CH, Ehde DM, Rapacki LM, Rogers TJ, Bates-Jensen B, Thomas FP, Parachuri R, Holmes SA. Comparing multicomponent interventions to improve skin care behaviors and prevent recurrence in veterans hospitalized for severe pressure ulcers. Arch Phys Med Rehabil 2014; 95:1246-1253.e3. [PMID: 24486242 DOI: 10.1016/j.apmr.2014.01.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/03/2014] [Accepted: 01/05/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare a multicomponent motivational interviewing (MI)/self-management (SM) intervention with a multicomponent education intervention to improve skin-protective behaviors and prevent skin worsening in veterans with spinal cord injury (SCI) hospitalized for severe pressure ulcers (PrUs). DESIGN Single-blinded, prospective, randomized controlled trial. SETTING Six Veterans Affairs SCI centers. PARTICIPANTS Veterans admitted for a severe (stage III/IV) PrU were followed up to 6 months postdischarge. INTERVENTION Telephone-based individual MI counseling plus SM skills group (SM+MI; n=71) versus an active control group of telephone-based individual educational counseling plus group education (n=72). MAIN OUTCOME MEASURES Self-reported skin-protective behaviors, objective skin worsening. RESULTS Intention-to-treat analyses found nonsignificant increases in skin behaviors in the SM+MI versus education control intervention arms at 3 and 6 months. The difference in behaviors used between SM+MI and education control intervention participants was 4.6% (95% confidence interval [CI], -11.3 to 2.7) (0-3mo) and 3.0% (95% CI, -8.7 to 3.9) (0-6mo). High rates of skin worsening were observed (n=74, 51.7%), usually within 3 months postdischarge and most frequently within the month postdischarge. Skin worsening, skin-related visits, and readmissions did not differ by study arm. Study limitations are presented. CONCLUSIONS For persons with chronic SCI and severe PrUs, complicated by multiple comorbidities, a primary focus on improving patient behavior is likely insufficient to address the complex problem of PrUs in SCI. More health care systems-level changes such as collaborative care may be needed to reduce PrU recurrence, especially in this era in which many people are discharged from the hospital unhealed or with little sitting tolerance.
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Affiliation(s)
- Marylou Guihan
- Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Jr. VA Hospital, Hines, IL; Edward Hines, Jr. VA Hospital, Hines, IL; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | | | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | | | | | | | | | - Sally A Holmes
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
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Barshes NR, Sigireddi M, Wrobel JS, Mahankali A, Robbins JM, Kougias P, Armstrong DG. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diabet Foot Ankle 2013; 4:21847. [PMID: 24130936 PMCID: PMC3796020 DOI: 10.3402/dfa.v4i0.21847] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 01/13/2023]
Abstract
Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging. Barriers to implementation include poor access to primary medical care; patient beliefs and lack of adherence to medical advice; delays in DFU recognition; limited healthcare resources and practice heterogeneity of specialists. Herein, we review the contemporary outcomes of DFU prevention and management to provide a framework for prioritizing quality improvement efforts within a resource-limited healthcare environment.
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Affiliation(s)
- Neal R Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Gayle KAT, Tulloch Reid MK, Younger NO, Francis DK, McFarlane SR, Wright-Pascoe RA, Boyne MS, Wilks RJ, Ferguson TS. Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica. Clin Pract 2012; 2:e85. [PMID: 24765484 PMCID: PMC3981191 DOI: 10.4081/cp.2012.e85] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/16/2012] [Accepted: 08/30/2012] [Indexed: 12/30/2022] Open
Abstract
This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. Approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82%) or leather shoes (64%), fairly high proportions reported wearing pointed toe shoes (39%), and 43% of women wore high heel shoes. In conclusion, approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided.
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