Clinician Assessment Tools for Patients with Diabetic Foot Disease: A Systematic Review

Abstract

The amputation rate in patients with diabetes is 15 to 40 times higher than in patients without diabetes. To avoid major complications, the identification of high-risk in patients with diabetes through early assessment highlights as a crucial action. Clinician assessment tools are scales in which clinical examiners are specifically trained to make a correct judgment based on patient outcomes that helps to identify at-risk patients and monitor the intervention. The aim of this study is to carry out a systematic review of valid and reliable Clinician assessment tools for measuring diabetic foot disease-related variables and analysing their psychometric properties. The databases used were PubMed, Scopus, SciELO, CINAHL, Cochrane, PEDro, and EMBASE. The search terms used were foot, ankle, diabetes, diabetic foot, assessment, tools, instruments, score, scale, validity, and reliability. The results showed 29 validated studies with 39 Clinician assessment tools and six variables. There is limited evidence on all of the psychometric characteristics of the Clinician assessment tools included in this review, although some instruments have been shown to be valid and reliable for the assessment of diabetic neuropathy (Utah Early Neuropathy Scale or UENS); ulceration risk (Queensland High Risk Foot Form or QHRFF); diabetic foot ulcer assessment, scoring, and amputation risk (Perfusion, extent, depth, infection and sensation scale or PEDIS and Site, Ischemia, Neuropathy, Bacterial Infection, and Depth score or SINBAD); and diabetic foot ulcer measurement (Leg Ulcer Measurement Tool LUMT).

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

“…Patients usually need to be hospitalised for a long time or repeatedly in a specific period of time because of the symptom exacerbations; additionally, they need to take long-term medications for diabetes and complications. The treatment of infections in DFU should be done after identification of the pathogen and analysing the susceptibility to antibiotics, and a correct diagnostic is established [51,52]. Costs related to microbiological testing are variable with the method used, confirmation of a strain with a resistance phenotype, therapeutic options, etc.…”

Software Validation: Sisped (Diabetic Foot System) As A Diagnostic Support

“…In Brazil, prevention performed in the context of PHC by the physician or nurse contributes to the reduction of complications by identifying patients at higher risk for foot ulceration, in addition to implementing prophylactic interventions, including the stimulation of self-care [22]. Comprehensive educational programs, which include the encouragement of self-care, regular foot examination, risk classi cation, and therapeutic education, can reduce the occurrence of foot injuries by up to 50% [6,23].…”

Validities and Reliabilities of Screening for Diabetic Foot Ulcer (DFU) among Diabetes Mellitus Patients with and without DFU

“…The tools for assessment are important as part of the nursing process in the assessment phase before diagnosing the main problem, as are planning and intervention in patients. The function of the assessment tool is to make a framework that helps nurses in decision making as well as in the comprehensive care of specific components (Fernández-Torres et al, 2020). Based on (Alfaqih et al, 2019) the early identification of high risk DFU is crucial in decreasing the numbers of morbidity and mortality cases.…”