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Van Netten JJ, Aan De Stegge WB, Dijkgraaf MGW, Bus SA. Cost-effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: A multicenter randomized controlled trial. Diabetes Metab Res Rev 2024; 40:e3805. [PMID: 38686868 DOI: 10.1002/dmrr.3805] [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: 04/24/2023] [Revised: 01/02/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
AIMS Diabetes-related foot ulcers are common, costly, and frequently recur. Multiple interventions help prevent these ulcers. However, none of these have been prospectively investigated for cost-effectiveness. Our aim was to evaluate the cost-effectiveness of at-home skin temperature monitoring to help prevent diabetes-related foot ulcer recurrence. MATERIALS AND METHODS Multicenter randomized controlled trial. We randomized 304 persons at high diabetes-related foot ulcer risk to either usual foot care plus daily at-home foot skin temperature monitoring (intervention) or usual care alone (control). Primary outcome was cost-effectiveness based on foot care costs and quality-adjusted life years (QALY) during 18 months follow-up. Foot care costs included costs for ulcer prevention (e.g., footwear, podiatry) and for ulcer treatment when required (e.g., consultation, hospitalisation, amputation). Incremental cost-effectiveness ratios were calculated for intervention versus usual care using probabilistic sensitivity analysis for willingness-to-pay/accept levels up to €100,000. RESULTS The intervention had a 45% probability of being cost-effective at a willingness-to-accept of €50,000 per QALY lost. This resulted from (non-significantly) lower foot care costs in the intervention group (€6067 vs. €7376; p = 0.45) because of (significantly) fewer participants with ulcer recurrence(s) in 18 months (36% vs. 47%; p = 0.045); however, QALYs were (non-significantly) lower in the intervention group (1.09 vs. 1.12; p = 0.35), especially in those without foot ulcer recurrence (1.09 vs. 1.17; p = 0.10). CONCLUSIONS At-home skin temperature monitoring for diabetes-related foot ulcer prevention compared with usual care is at best equally cost-effective. The intervention resulted in cost-savings due to preventing foot ulcer recurrence and related costs, but this came at the expense of QALY loss, potentially from self-monitoring burdens.
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Affiliation(s)
- Jaap J Van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, the Netherlands
| | - Wouter B Aan De Stegge
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Hospital Group Twente, Almelo, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, the Netherlands
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Eckert KA, Fife CE, Carter MJ. The Impact of Underlying Conditions on Quality-of-Life Measurement Among Patients with Chronic Wounds, as Measured by Utility Values: A Review with an Additional Study. Adv Wound Care (New Rochelle) 2023; 12:680-695. [PMID: 37815559 PMCID: PMC10615090 DOI: 10.1089/wound.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 10/11/2023] Open
Abstract
Significance: Quality of life (QoL) is important to patients with chronic wounds and is rarely formally evaluated. Understanding what comorbidities most affect the individual versus their wounds could be a key metric. Recent Advances: The last 20 years have seen substantial advances in QoL instruments and conversion of patient data to a single value known as the health utilities index (HUI). We review these advances, along with wound-related QoL, and analyze real-world comorbidities challenging wound care. Critical Issues: To understand the impact of underlying comorbidities in a real-world patient population, we examined a convenience sample of 382 patients seen at a hospital-based outpatient wound center. This quality reporting study falls outside the regulations that govern human subject research. Comorbid conditions were used to calculate HUIs using a variety of literature-reported approaches, while Wound-Quality-of-Life (W-QoL) questionnaire data were collected from patients during their first visit. The mean number of conditions per patient was 8; 229 patients (59.9%) had utility values for comorbidities/conditions, which were worse/lower than their wounds' values. Sixty-three (16.5%) patients had depression and/or anxiety, 64 (16.8%) had morbid obesity, and 204 (53.4%) had gait and mobility disorders, all of which could have affected W-QoL scoring. The mean minimum utility value (0.5) was within 0.05 units of an average of 13 studies reporting health utilities from wound care populations using the EuroQol 5 Dimension instrument. Future Directions: The comorbidity associated with the lowest utility value is what might most influence the QoL of patients with chronic wounds. This finding needs further investigation.
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Affiliation(s)
| | - Caroline E. Fife
- Intellicure, LLC, The Woodlands, Texas, USA
- U.S. Wound Registry (501 3C Nonprofit), The Woodlands, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
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Lo ZJ, Chong B, Tan E, Ooi D, Liew H, Hoi WH, Cho YT, Wu K, Surendra NK, Mammadova M, Nah A, Goh V, Car J. Patients, carers and healthcare providers' perspectives on a patient-owned surveillance system for diabetic foot ulcer care: A qualitative study. Digit Health 2023; 9:20552076231183544. [PMID: 37377563 PMCID: PMC10291864 DOI: 10.1177/20552076231183544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Objective Digital health has recently gained a foothold in monitoring and improving diabetes care. We aim to explore the views of patients, carers and healthcare providers (HCPs) regarding the use of a novel patient-owned wound surveillance application as part of outpatient management of patients with diabetic foot ulcers (DFUs). Methods Semi-structured online interviews were conducted with patients, carers and HCPs in wound care for DFUs. The participants were recruited from a primary care polyclinic network and two tertiary hospitals in Singapore, within the same healthcare cluster. Purposive maximum variation sampling was used to select participants with differing attributes to ensure heterogeneity. Common themes relating to the wound imaging app were captured. Results A total of 20 patients, 5 carers and 20 HCPs participated in the qualitative study. None of the participants have used a wound imaging app before. Regarding a patient-owned wound surveillance app, all were open and receptive to the system and workflow for use in DFU care. Four major themes emerged from patients and carers: (1) technology, (2) application features and usability, (3) feasibility of using the wound imaging application and (4) logistics of care. Four major themes were identified from HCPs: (1) attitudes towards wound imaging app, (2) preferences regarding functionality, (3) perceived challenges for patients/carers and (4) perceived barriers for HCPs. Conclusion Our study highlighted several barriers and facilitators from patients, carers and HCPs regarding the use of a patient-owned wound surveillance app. These findings demonstrate the potential of digital health and areas to improve and tailor a DFU wound app suitable for implementation in the local population.
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Affiliation(s)
- Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elaine Tan
- National Healthcare Group Polyclinics, Singapore
| | - Desmond Ooi
- Vascular Surgery Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Wai Han Hoi
- Department of Endocrinology, Woodlands Health, Singapore
| | - Yuan Teng Cho
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
| | | | - Naren Kumar Surendra
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Maleyka Mammadova
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Audrey Nah
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Victor Goh
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
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Bahaadinbeigy K, Sheikhtaheri A, Fatehi F, Moulaei K. Development and Usability Evaluation of a Telemedicine System for Management and Monitoring of Patients with Diabetic Foot. Healthc Inform Res 2022; 28:77-88. [PMID: 35172093 PMCID: PMC8850172 DOI: 10.4258/hir.2022.28.1.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: The aim of the present study was to develop and evaluate the usability of a telemedicine system for management and monitoring of patients with diabetic foot.Methods: This study was conducted in four phases. In the first phase, the information needs and characteristics required to design the telemedicine system were identified based on a literature review. Then, in a two-stage Delphi survey, 15 experts approved the identified information needs and characteristics. The prototype telemedicine system was then designed. In the third phase, system usability was evaluated through a semi-structured interview. In the fourth phase, users’ satisfaction with the designed system was analyzed.Results: Out of 115 information needs and required characteristics, 95 were considered in the system design. Eight main pages for enabling patient-physician interactions and physician-physician interactions, monitoring the patient and controlling the disease process, providing medical consultation, and prescribing medications were considered. In the third phase, 26 distinct problems were identified. However, 75% of the participants were very satisfied with the system.Conclusions: This study presents an attempt to design and evaluate a telemedicine system for the management and monitoring of patients with diabetic foot. In this system, patients receiving medical services or physicians who encounter rare cases can send the complete medical history, clinical test results, and videos and images related to the foot to specialist physicians. After examining the medical history or images and videos, the physician can provide the necessary medication prescriptions and laboratory tests or other recommendations.
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Affiliation(s)
- Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Fatehi
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Khadijeh Moulaei
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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Sutton E, Ganie S, Chan C, Kaur A, Nussbaum E. Photobiomodulation and diabetic foot and lower leg ulcer healing: A narrative synthesis. Foot (Edinb) 2021; 48:101847. [PMID: 34390946 DOI: 10.1016/j.foot.2021.101847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To provide a comprehensive narrative review and critical appraisal of research investigating photobiomodulation (PBM), formerly known as low level laser therapy which includes lasers and light emitting diodes (LEDs), as a treatment to promote diabetic foot and lower leg ulcer (DFU) healing for humans. MATERIALS AND METHODS Pubmed, CINAHL, Scopus, and OVID Medline databases were used to find relevant studies published between January 2000 and January 2020. Reference lists of identified articles were scanned for additional studies that might have been missed in the database searches. RESULTS A total of 13 studies, with a total of 417 participants, were included in this review. DISCUSSION The studies were critically appraised using the PEDro scale, which revealed weaknesses in study designs such as small sample sizes and problems with reproducibility with respect to the laser protocols. Characteristics of PBM that improved wound healing were wavelengths of 630 nm-660 nm and infrared wavelengths of 850 or 890 nm, and radiant exposure levels of 3 J/cm2-7 J/cm2. PBM was beneficial for superficial and deep DFUs. Controlled blood glucose levels and adherence to best practices (pressure off-loading, optimized wound dressing changes, appropriate debridement, etc.) could have been a factor in the beneficial outcomes. CONCLUSION Regardless of the laser characteristics chosen, in the majority of studies PBM as a treatment for DFUs improved healing rate when compared with standard wound care alone. However, weaknesses across the studies indicate that further research is required.
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Affiliation(s)
- Eliana Sutton
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Sharifah Ganie
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Charlene Chan
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Anureet Kaur
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Ethne Nussbaum
- Department of Physical Therapy, MClSc Program in Wound Healing, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada; KITE, Toronto Rehab Institute, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada.
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Economic Evaluation of Sucrose Octasulfate Dressing for the Treatment of Diabetic Foot Ulcers for Type 2 Diabetes Patients. Can J Diabetes 2021; 46:126-133. [DOI: 10.1016/j.jcjd.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/05/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW Diabetic peripheral neuropathy eventually affects nearly 50% of adults with diabetes during their lifetime and is associated with substantial morbidity including pain, foot ulcers, and lower limb amputation. This review summarizes the epidemiology, risk factors, and management of diabetic peripheral neuropathy and related lower extremity complications. RECENT FINDINGS The prevalence of peripheral neuropathy is estimated to be between 6 and 51% among adults with diabetes depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes. The clinical manifestations are variable, ranging from asymptomatic to painful neuropathic symptoms. Because of the risk of foot ulcer (25%) and amputation associated with diabetic peripheral neuropathy, aggressive screening and treatment in the form of glycemic control, regular foot exams, and pain management are important. There is an emerging focus on lifestyle interventions including weight loss and physical activity as well. The American Diabetes Association has issued multiple recommendation statements pertaining to diabetic neuropathies and the care of the diabetic foot. Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Halsted 668, Baltimore, MD, 21287, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA.
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Wallace D, Perry J, Yu J, Mehta J, Hunter P, Cross KM. Assessing the Need for Mobile Health (mHealth) in Monitoring the Diabetic Lower Extremity. JMIR Mhealth Uhealth 2019; 7:e11879. [PMID: 30990455 PMCID: PMC6488952 DOI: 10.2196/11879] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/10/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background Complications of the diabetic lower extremity (such as diabetic foot ulcers, DFUs) occur when monitoring is infrequent, and often result in serious sequelae like amputation or even death. Objective To evaluate the potential application of mobile health (mHealth) to diabetic foot monitoring. We surveyed the self-management routines of a group of diabetic patients, as well as patient and clinician opinions on the use of mHealth in this context. Methods Patients with DFUs in Toronto, Ontario, Canada completed a 25-item questionnaire addressing their foot care practices, mobile phone use, and views on mHealth. Wound care clinicians across Canada were also surveyed using a 9-item questionnaire. Results Of the patients surveyed, 59/115 (51.3%) spend less than a minute checking their feet, and 17/115 (15%) of patients find it difficult to see their doctor or get to the hospital regularly. Mobile phone use was widespread in our patient cohort (93/115, 80.9%). Of mobile phone users, 68/93 (73.1%) would use a device on their mobile phone to help them check their feet. Of the clinicians who completed the questionnaire, only 7/202 (3.5%) were familiar with mHealth; however, 181/202 (92%) of clinicians expressed interest in using mHealth to monitor their patients between visits. Conclusions Patient education or motivation and clinician training were identified as the major barriers to mHealth use in the diabetic lower extremity, which may be a viable mechanism to improve DFU monitoring practices.
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Affiliation(s)
- David Wallace
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Perry
- Division of Plastic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Janelle Yu
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joshua Mehta
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Hunter
- Division of Plastic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Karen Michelle Cross
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.,Division of Plastic Surgery, St. Michael's Hospital, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, Toronto, ON, Canada
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