Charcot neuroarthropathy patient education among podiatrists in Scotland: a modified Delphi approach

Abstract

BackgroundThis evaluation sought to determine current Charcot neuroarthropathy (CN) diabetes patient education practices among Scottish National Health Service (NHS) and academic podiatrists and evaluate novel visual tools and develop expert consensus for future practice.MethodsQuestionnaires collected mixed qualitative and quantitative responses, analysed concurrently within a convergence coding matrix. Delphi methodology permitted member-checking and agreement of consensus over two rounds.ResultsFourteen participants (16.28%) completed a Round One questionnaire, leading to the generation of four themes; Experience; Person-Centred Care and the Content and Context of CN patient education. Seven consensus statements were subsequently developed and six achieved over 80% agreement among 16 participants (18.60%) with a Round Two questionnaire. Respondents agreed CN patient education should be considered for all ‘At-risk’ individuals with diabetic peripheral neuropathy (DPN). Verbal metaphors, including the ‘rocker-bottom’ foot, soft or brittle bones, collapsing, walking on honeycomb and a shattering lightbulb were frequently employed. Visual tools, including visual metaphors and The Charcot Foot Thermometer, were positively evaluated and made available online.ConclusionsKey findings included respondent’s belief that CN education should be considered for all individuals with DPN and the frequent use of simile, analogy and metaphor in CN education. The concept of ‘remission’ proved controversial due to its potential for misinterpretation.Electronic supplementary materialThe online version of this article (10.1186/s13047-018-0296-8) contains supplementary material, which is available to authorized users.

Factors impacting the evidence‐based assessment, diagnosis and management of Acute Charcot Neuroarthropathy: a systematic review

“…Resource limitation leads to more use of x-ray Health professional knowledge to utilise and apply the appropriate form of offloading Bullen et al,. 2018 [ 15 ]. Delphi/ Scotland EO Individual Health Professional Health professional knowledge to appropriately prepare individuals for the potential onset of CN Nil Health professional capacity to educate the patient to understand importance of offloading.…”

“…A delay in diagnosis and treatment was often due to the patient’s inability to identify the imminent onset of the condition, which could be as a result of an inability to identity a precipitating traumatic episode, their disregard of painful symptoms (e.g. dull ache) and a general lack of awareness of their foot-health [ 7 , 15 , 17 , 18 , 20 , 24 , 35 ].…”

“…A fundamental factor impacting best practice that cut across all themes was a delay in timely assessment, diagnosis and management. This delay could be related to a patient's lack of awareness of the condition resulting in delayed presentation to an appropriate service, lack of health professional knowledge of CN and applied management skills, lack of patient proximity to services and access, and health service protocol on the management of CN [1, 3–7, 14–38, 40–43].…”

Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study

“…Charcot misdiagnosis occurred in 63.0% of participants prior to attending the HRFS, most commonly confused with cellulitis (47.1%). Despite increased awareness, the acknowledged importance of Charcot-related patient education [ 49 ], and the publication of an evidence-based pathway [ 3 ], disparity still remains for early diagnosis [ 31 ]. Our findings support close monitoring for signs of Charcot foot in those with ulceration or reported traumatic injury to the foot.…”