Physician attitudes toward foot care education and foot examination and their correlation with patient practice

Foot Care Prioritization Among Health Care Providers Treating Diabetic Patients in Saudi Arabia: A Survey-Based Study

BACKGROUND

Diabetic foot disease (DFD) is a significant complication associated with diabetes, characterized by the potential for progressive amputation of specific foot segments or the entire lower limb in the absence of timely identification of infection and intervention. The aim of our research is to evaluate the degree of importance given to foot care by healthcare professionals who are responsible for treating individuals with diabetes in Riyadh, Saudi Arabia.

METHODS

This cross-sectional study utilized an online survey previously validated in Australia. The mean foot care prioritization score was used to identify the dummy variable for binary logistic regression analysis, which was used to identify predictors of foot care prioritization.

RESULTS

A total of 222 participants were involved in this study. Assessing for the risk of developing foot complications, visually inspecting feet for wounds, and providing or recommending footwear to prevent foot complications were the most commonly reported practices, accounting for 80.60% (n = 178), 76.10% (n = 169), and 75.20% (n = 167), respectively. The most commonly referred patients to a specialist tertiary multi-disciplinary foot care team were patients with ulcers in patients with absent foot pulses, ulcers with ascending cellulitis, and diabetic ulceration, accounting for 73.50% (n = 163), 71.60% (n = 159), and 66.70% (n = 148), respectively. The mean foot care prioritization score for the study participants was 54.1 (standard deviation: 11.7) out of 78 (69.4%), which demonstrates a moderately high level of foot care prioritization. Binary logistic regression analysis identified that healthcare professionals who are aged 35-44 years, those who have 5-10 years of experience, those who work at private hospitals, those who have a higher number of practice clinics per week, and those who have to manage a higher number of patients with diabetes in each clinic were more likely to prioritize foot care in their practices (p < 0.05).

CONCLUSION

Our study found that healthcare professionals in Saudi Arabia place a moderate degree of emphasis on foot care. Healthcare professionals falling within the age range of 35-44 years, possessing 5-10 years of experience, employed at private hospitals, overseeing a greater number of practice clinics weekly, and managing a greater number of patients with diabetes per clinic exhibited a greater propensity to prioritize foot care within their respective practices. Policymakers should consider the integration of continuous glucose monitoring technologies, the establishment of standardized foot screening protocols, and the implementation of targeted educational programs for healthcare professionals.

Challenges and Expectations of Diabetic Foot Care from the Patients' Point of Views

INTRODUCTION

Diabetic foot ulcer (DFU) as a common complication of diabetes needs a multi-disciplinary care approach in which the patient suffering from DFU is considered as a member of the care team. According to the effective role of patients in DFU prevention and management, this study was an attempt to explore patients' views and expectations regarding provision of DFU preventive and therapeutic care to facilitate the process of care and management.

METHODS

A qualitative research approach, using two focus group discussions, was conducted with patients suffering from diabetes and DFU. The questions designed to encourage the discussion were focused on the patients' experience of foot and DFU care. We continued the discussions until we reached data saturation. The participants' responses were recorded via a recorder and by taking notes. Afterwards, the discussions were transcribed and common themes were identified and categorized.

RESULTS

Initially, fifty-seven codes were extracted which were then summarized and classified. Afterward, three themes and six sub-themes were determined as follows: defective education and ineffective communication("a defect in the patient education system", "impaired communication"), multi-faceted challenges of wound healing ("out of pocket expenses, treatment compliance", "non-physical injury"), and full support ("empathy" and "patient-centeredness").

CONCLUSION

According to patients' views, patients' concerns, and their socioeconomic conditions should be taken into consideration in designing an effective DFU care plan. In this regard, a strong communication with the patients to prepare a holistic care intended for patients' full support would be essential.

Diabetic foot care course: a quasi-experimental study on E-learning versus interactive workshop

Background

Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment.

Methods

This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A P value of <0.05 was considered as significant.

Results

The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups (P < 0.01).

Conclusions

The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.

Quality of Foot Care Among Patients With Diabetes: A Study Using a Polish Version of the Diabetes Foot Disease and Foot Care Questionnaire

Diabetic foot syndrome is a common, yet serious complication of diabetes, affecting 4% to 10% of patients with diabetes. Polish Diabetes Association guidelines emphasize the need for prevention among patients with diabetes; a key role is played by consistent education on foot care and ulceration prevention. The Diabetes Foot Disease and Foot Care Questionnaire (DFDFC-Q) is the only research instrument available for comprehensive assessment of foot self-care. The study purposes were to explore the quality of foot care among patients with diabetes and to evaluate the psychometric properties of the Polish version of the DFDFC-Q in adult patients with diabetes. The study included 180 patients (112 females and 68 males, mean age 62 ± 14.1 years) with clinically confirmed diabetes mellitus and was performed between January 2017 and May 2018. The questionnaire was translated into Polis, and evaluated by using Cronbach's α coefficient. Of the 180 patients, 39.7% demonstrated good quality of self-care, 44.7% demonstrated moderate quality, and 15.6% demonstrated low quality. Mean score in the group was 22 ± 4.18 points. Scale reliability as measured by Cronbach's α was 0.672. One hundred thirteen (62.78%) patients inspected their feet daily. Many patients wore improper footwear: flip-flops (69.44%) or sandals (58.89%). The aspect most commonly omitted in diabetes education was inspection of the soles of one's feet using a mirror (17.7%). We found that 16.1% of patients visited a podologist in the past year. Comparative analysis demonstrated that a good-quality foot self-care was associated with high school education (p = .008), not having a partner (p = .046), and adhering to dietary recommendations (p = .014). In the linear regression model, independent predictors of better foot self-care included high school and vocational education (β = 7.439, p = .001 and β = 5.539, p = .014, respectively), marital status (divorced and single: β = 3.496, p = .025, widowed: β = 3.466, p = .048), professional inactivity (retirees: β = 7.679, p = .001; disability pensioners: β = 3.522, p = .049; unemployed: β = 4.631, p = .017), and adhering to a diet (β = 5.065, p = .001). An independent negative predictor (i.e., one associated with lower scores in the questionnaire) was male sex (β = -2.853, p = .024). The Polish version of the DFDFC-Q has moderate psychometric properties, but because of the lack of other available instruments for foot self-care assessment, it can be used in the population of Polish diabetic patients. Better quality of foot self-care is determined by high school education, marital status (not having a partner), and adhering to dietary treatment recommendations.

Factors associated with awareness and practice about foot care among patients admitted with diabetes mellitus: A cross sectional research from a medical college hospital of southern India

Background

Diabetes Mellitus (DM) causes micro and macro vascular complications. One of the complications of DM is diabetic foot that results in amputations and decreased quality of life. The aim of this study was to assess the awareness and practice about foot care and associated factors among admitted patients in a teaching hospital of coastal Karnataka, India.

Material and Methods

A cross-sectional study was conducted in a medical college hospital after obtaining institutional ethics approval from 24th December 2016 to 21st January 2017. Adults with diabetes (N=317) admitted in the hospital were interviewed with a validated structured questionnaire for awareness and practice regarding foot care. The scores obtained were further graded into good and poor. Data was analyzed with SPSS version 22 for descriptive statistics. Bivariate logistic and linear regressions were used to determine the association between variables and awareness/practice scores.

Results

Mean age of the participants was 56.98 (±10.54) years with males constituting the majority (63.4%). Good awareness and practice scores were observed among 69.1% and 41.6% participants, respectively. Good awareness scores were associated with male patients (p=0.027), currently not married (p=0.044), below poverty line socioeconomic status (p=0.014) and presence of foot ulcer (p=0.021). Good practice scores was associated with secondary schooling (p=0.003) and receiving insulin (p=0.045). Moderate correlation with coefficient 0.493 (p<0.001) was observed between awareness and practice scores.

Conclusion

Seven and four out of 10 study participants had good awareness and practice scores about foot care, respectively. A tailor-made health education module addressing the lacunae identified in the awareness and practice domains needs to be provided to the patients with diabetes mellitus.

Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease

BACKGROUND

The evolving clinical burden of limb loss secondary to diabetes and peripheral artery disease remains poorly characterized. We sought to examine secular trends in the rate of lower-extremity amputations related to diabetes, peripheral artery disease or both.

METHODS

We included all individuals aged 40 years and older who underwent lower-extremity amputations related to diabetes or peripheral artery disease in Ontario, Canada (2005-2016). We identified patients and amputations through deterministic linkage of administrative health databases. Quarterly rates (per 100 000 individuals aged ≥ 40 yr) of any (major or minor) amputation and of major amputations alone were calculated. We used time-series analyses with exponential smoothing models to characterize secular trends and forecast 2 years forward in time.

RESULTS

A total of 20 062 patients underwent any lower-extremity amputation, of which 12 786 (63.7%) underwent a major (above ankle) amputation. Diabetes was present in 81.8%, peripheral artery disease in 93.8%, and both diabetes and peripheral artery disease in 75.6%. The rate of any amputation initially declined from 9.88 to 8.62 per 100 000 between Q2 of 2005 and Q4 of 2010, but increased again by Q1 of 2016 to 10.0 per 100 000 (p = 0.003). We observed a significant increase in the rate of any amputation among patients with diabetes, peripheral artery disease, and both diabetes and peripheral artery disease. Major amputations did not significantly change among patients with diabetes, peripheral artery disease or both.

INTERPRETATION

Lower-extremity amputations related to diabetes, peripheral artery disease or both have increased over the last decade. These data support renewed efforts to prevent and decrease the burden of limb loss.

Delay between Onset of Symptoms and Seeking Physician Intervention Increases Risk of Diabetic Foot Complications: Results of a Cross-Sectional Population-Based Survey

We present a post hoc analysis of 17,530 questionnaires collected as part of the 2012 screening for neuropathy using Norfolk Quality of Life tool in patients with diabetes in Romania, to assess the impact on foot complications of time between the onset of symptoms of diabetes/its complications and the physician visit. Odds ratios (ORs) for self-reporting neuropathy increased from 1.16 (95% CI: 1.07-1.25) in those who sought medical care in 1-6 months from symptoms of diabetes/its complications onset to 2.27 in those who sought medical care >2 years after symptoms onset. The ORs for having a history of foot ulcers were 1.43 (95% CI: 1.26-1.63) in those who sought medical care in 1-6 months and increased to 3.08 (95% CI: 2.59-3.66) in those who sought medical care after >2 years from symptoms of diabetes/its complications onset. The highest ORs for a history of gangrene (2.49 [95% CI: 1.90-3.26]) and amputations (2.18 [95% CI: 1.60-2.97]) were observed in those who sought medical care after >2 years following symptoms onset. In conclusion, we showed that waiting for >1 month after symptoms onset dramatically increases the risk of diabetic foot complications. These results show the need for accessible educational programs on diabetes and its chronic complications and the need to avoid delays in reporting.

Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor polyneuropathy: the KORA F4 study

OBJECTIVE

Distal sensorimotor polyneuropathy (DSPN) is a severe complication of type 2 diabetes. This study aimed to assess the prevalence of unawareness of DSPN in prediabetes and diabetes in a sample of the older population of Augsburg, Germany.

RESEARCH DESIGN AND METHODS

Glucose tolerance status was determined in 61- to 82-year-old participants of the population-based KORA F4 Study (2006-2008) (n = 1,100). Clinical DSPN was defined as the presence of bilaterally impaired foot-vibration perception and/or bilaterally impaired foot-pressure sensation. DSPN case subjects were considered unaware of their condition when answering "no" to the question, "Has a physician ever told you that you are suffering from nerve damage, neuropathy, polyneuropathy, or diabetic foot?"

RESULTS

Clinical DSPN was prevalent in 154 (14%) participants, 140 of whom were unaware of their disorder. At a prevalence of 23.9% (95% CI 12.6-38.8), participants with combined impaired fasting glucose and impaired glucose tolerance had the highest prevalence of DSPN. Of these, 10 of 11 (91%) were unaware of having clinical DSPN. Participants with known diabetes had an equally high prevalence of DSPN [22.0% (16.2-28.9)], with 30 of the 39 (77%) DSPN case subjects unaware of having the disorder. Among subjects with known diabetes who reported to have had their feet examined by a physician, 18 of 25 (72%) clinical DSPN case subjects emerged unaware of having DSPN.

CONCLUSIONS

Our findings showed a high prevalence of unawareness of having clinical DSPN among the prediabetic and diabetic groups and an insufficient frequency of professional foot examinations, suggesting inadequate attention to diabetic foot prevention practice.

Impact of action cues, self-efficacy and perceived barriers on daily foot exam practice in type 2 diabetes mellitus patients with peripheral neuropathy

AIMS AND OBJECTIVES

To identify the effects of health belief model factors on daily foot-exam practice among diabetes mellitus patients with peripheral neuropathy.

BACKGROUND

Daily foot exams are one of the most important self-care behaviours that prevent the occurrence of diabetic foot ulcers and subsequent amputation. Although daily foot exams were under-practiced in patients with peripheral neuropathy, few studies have explored modifiable social-psychological factors related to daily foot exams.

DESIGN

A cross-sectional survey was used to collect the data.

METHODS

A total of 277 patients with diabetes and peripheral neuropathy were recruited from two hospitals in northern Taiwan. The Family APGAR and Diabetic Foot Ulcer Health Belief Scale (DFUHBS) were used to measure family support and health belief factors respectively. Data on foot-exam practice, perceived self-efficacy and action cues were collected through the use of structured questionnaires. The data were analysed using logistic regression.

RESULT

The regression model revealed that select action cues (recommendations from family, friends, or health professionals), perceived self-efficacy and perceived barriers interactively influenced the participants' daily foot-exam practice.

CONCLUSION

Factors related to daily foot-exam practice were identified. Specifically, action cues played a significant role in motivating daily foot-exam practice in this group.

RELEVANCE TO CLINICAL PRACTICE

This study recognises modifiable factors that influence the daily foot-exam practice of patients with diabetes and peripheral neuropathy. Using the findings of this study, health professionals can design interventions that aim to modify the above factors as a means to promote daily foot-exam practice.

Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica

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.

Attitudes arid Self-care Behavior of Patients with Type 2 Diabetes attending the Emergency Department at Hamad General Hospital

Diabetes is a public health problem and optimal glycemic control requires diligent daily self-management to reduce morbidity and mortality associated with diabetes and its complications. By means of a carefully designed questionnaire, 215 patients with Type 2 diabetes who were admitted to the Emergency Department at Hamad General Hospital during the period from 1 May 2008 to 31 August 2008 were selected randomly and interviewed to determine their attitudes and behaviors influencing effective glycemic control and the extent to which they were helped by education and advice from care providers. The mean ± SD of both the total diabetes attitudes with subscales, and the self-care behaviors were measured in addition to the mean ± SD of both hemoglobin A1 c, and the number of admissions to the emergency department over the preceding six months. Participants reported the highest performance following a specific diet which had the highest significant negative correlation (r = -0.181, p = 0.009) with hemoglobin A1c as compared with the other self-care behaviors. The study emphasized the importance of improving the attitude of Type∼2 diabetics and their self-care behaviors because of the association with Emergency Department Admission and Glycemic Control. An appropriate educational approach and follow-up taking into account individual patient characteristics, needs to be implemented.

Foot care education in patients with diabetes at low risk of complications: a consensus statement

AIMS

To define and agree a practical educational framework for delivery by all healthcare professionals managing patients with diabetes, particularly those at low risk of developing foot complications.

METHODS

A consensus meeting of a multidisciplinary expert panel. Prior to the meeting, relevant clinical papers were disseminated to the panel for review. The consensus was largely based upon the experts' clinical experience and judgement.

RESULTS

Four main health behaviours were identified for those at low risk of developing foot complications, namely: control of blood glucose levels; attendance at annual foot screening examination; reporting of any changes in foot health immediately; and the engagement in a simple daily foot care routine.

CONCLUSION

There is currently little evidence-based literature to support specific foot care practices. Patients with diabetes at low risk of developing complications should be encouraged to undertake a basic foot care regimen to reduce their likelihood of developing complications.

Regularity of preventive foot care in persons with diabetes: results from the Nord-Trøndelag Health Study

The purpose of the present study was to examine the regularity of preventive care for persons with diabetes in the Nord-Trøndelag Health Study to identify associated demographic, lifestyle, and disease-related factors. Among 1,972 persons with diabetes, 1,459 (74%) answered questions related to preventive foot care. The final sample included 1,312 persons with known diabetes, but without a self-reported history of foot ulcer. Almost 85% reported receiving regular clinical diabetes examinations, 31.7% reported regular foot inspection by health care personnel, and 66.3% reported foot self-inspection. Only 58.8% reported regular clinical diabetes examination combined with foot inspection. Males, patients not using insulin, and those with shorter diabetes duration or macrovascular complications were more likely to report less regular preventive care.

Psychosocial and behavioral aspects of diabetic foot lesions

This article reviews key findings from recently conducted and ongoing studies into how patients adapt to diabetic foot complications by focusing on two areas. These areas include the role of psychological factors in guiding preventive foot self-care and the impact of diabetic foot ulceration and amputations on an individual's emotional state and quality of life.

The effect of commitment to the organization on physicians' familiarity with guidelines for diabetes in managed care organizations

Despite continuous efforts, healthcare organizations still find it difficult to influence physicians to follow clinical guidelines. Previous studies have not taken into account the organizational context of the physicians' practice. We conducted a survey of a representative sample of 743 primary care physicians employed in Israel's 2 largest managed care health plans. The findings indicated that "commitment to the health plan" and "perceived monitoring by the health plan" had an independent positive effect on familiarity with guidelines for treating diabetes. We propose that managers of healthcare organizations consider enhancing physicians' commitment to the organization as a means for increasing their adherence with clinical guidelines, thereby improving the quality of care provided to diabetic patients.

Diabetes foot self-care practices in a rural triethnic population

PURPOSE

The purposes of this study were to assess the level of foot self-care performed in a rural, multiethnic population of older adults and to identify factors associated with foot self-care.

METHODS

The Evaluating Long-term Diabetes Self-management Among Elder Rural Adults study included a random sample of 701 African American, Native American, and white adults from 2 rural North Carolina counties. Participants completed in-home interviews, 5 foot self-care practices from the Summary of Diabetes Self-Care Activities (SDSCA), functional status measures, and measures of education and support for foot care.

RESULTS

Foot care practices/behaviors reported at least 6 days/week ranged from 35.6% for inspecting shoes to 79.2% for not soaking feet. Four independent predictors of the SDSCA summary foot care index score were observed: having been shown how to care for feet (P < .0001), female gender (P = .03), having had a doctor check nerves in feet in past year (P = .02), and not receiving support caring for feet (P = .0425).

CONCLUSIONS

These findings indicate that educating patients about foot self-care may encourage routine foot care but that those dependent on either formal or informal support to perform foot care do so less frequently than those who perform it independently.