Effects of training podiatrists to use imagery‐based motivational interviewing when treating people with diabetes‐related foot disease: a mixed‐methods pilot study

Kaczmarek, Tracey; Netten, Jaap J. van; Lazzarini, Peter A; Kavanagh, David J.

doi:10.1186/s13047-021-00451-1

Cited by 10 publications

(17 citation statements)

References 68 publications

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“…Therefore, understanding what resonates is central to informing foot health policy and practice level strategies and addressing the associated signi cant healthcare burden, where prevention is preferable to cure (18). This would be consistent with contemporaneous policy that places health ownership on the individual, encouraging self-management (19)(20)(21).…”

Section: Introductionsupporting

confidence: 77%

Where do you stand? An exploration of perspectives toward feet, foot health, and footwear using innovative digital methods

Skidmore

Prior

Nester

et al. 2023

Preprint

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Background The cost of losing foot health is significant to the person, healthcare systems, and economy, with diabetes related foot health issues alone costing over £1 billion annually in the UK. Yet many foot health problems are preventable through alternative health behaviour. It is therefore important to understand how feet, foot health and footwear are conceptualised to gain understanding about how these might influence foot health behaviour and inform health messages that seek to protect or improve foot health through altered health behaviour. This research seeks to explore attitudes and beliefs and identify phenomena that may act as barriers or motivators to the proactive self-management of foot health, Methods Public conversations involving 2,699 expressions related to feet, footwear or foot health on Facebook, Twitter, and Instagram were extracted. Conversations on Facebook and Twitter were scraped with NVivo’s NCapture plugin whereby data is extracted and downloaded to NVivo. Extracted files were uploaded to the Big Content Machine (software developed at the University of Salford) which facilitated the search for keywords ‘foot’, ‘feet’, ‘footwear’, ‘shoe’, and ‘shoes’. Instagram was scraped by hand. Data was analysed using a Thematic Analysis approach. Results Three themes were identified; 1) connections and disconnections derived from social and cultural constructs, 2) phenomena beyond attitudes and beliefs that relate to symbolic representations and the impact when foot health is lost, and 3) phenomena relating to SoMe as a conduit for the exploration of attitudes and beliefs. Conclusions This novel research exemplifies complex and sometimes incongruous perspectives about feet including their value for what they facilitate, contrasted with negative feelings about the negative impact that can have aesthetically when feet work hard. Sometimes feet were devalued, with expressions of disgust, disconnection, and ridicule. The importance of contextual, social, and cultural phenomena with implications for optimising foot health messages. Knowledge gaps including factors related to children’s foot health and development, and how to treat foot health problems. The power of communities with shared experience to influence decisions, theories, and behaviour about foot health was also revealed. While people do talk about feet in some social contexts, it is not always in a way that promotes overt, positive foot health behaviour. Finally, this research demonstrates the benefit of exploring perspectives in uncontrived settings and illuminates the potential utility of SoMe as a vehicle to promote foot health self-management behaviour that is responsive to the social and demographic variances of engagers who inhabit those spaces.

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Section: Introductionsupporting

confidence: 77%

Where do you stand? An exploration of perspectives toward feet, foot health, and footwear using innovative digital methods

Skidmore

Prior

Nester

et al. 2023

Preprint

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“…Studies suggest that patient-centric education, along with motivational interviewing techniques, also show promise in improving low patient motivation to offloading adherence. These studies recommend using layman’s terms, such as “fragile foot” or “broken foot”, to educate patients that DFUs are in fact a severe condition and that their offloading treatments need to be used to protect their “fragile foot” against what seems like “trivial trauma” (from plantar tissue stress that they cannot feel due to DPN) to prevent “further damage” and allow their “fragile foot” to rest and heal [ 24 , 108 , 111 , 112 ]. Additionally, visually showing patients their plantar pressure maps and healing rates, before and after offloading treatment is used, have also shown promise in improving patient’s understanding of the severity and impact of high plantar pressure on DFUs, and in turn adherence to offloading treatments [ 20 , 24 , 108 , 109 , 111 , 113 ].…”

Section: Common Barriers and Solutions To Using Best Offloading Treatmentsmentioning

confidence: 99%

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Lazzarini

Jarl

2021

Medicina

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Diabetic foot ulcers (DFU) are a leading cause of the global disease burden. Most DFUs are caused, and prolonged, by high plantar tissue stress under the insensate foot of a person with peripheral neuropathy. Multiple different offloading treatments have been used to try to reduce high plantar tissue stress and heal DFUs, including bedrest, casting, offloading devices, footwear, and surgical procedures. The best offloading treatments are those that balance the benefits of maximizing reductions in high plantar tissue stress, whilst reducing the risks of poor satisfaction, high costs and potential adverse events outcomes. This review aimed to summarize the best available evidence on the effects of offloading treatments to heal people with DFUs, plus review their use in clinical practice, the common barriers and solutions to using these treatments, and discuss promising emerging solutions that may improve offloading treatments in future. Findings demonstrate that knee-high offloading devices, non-removable or removable knee-high devices worn for all weight-bearing activities, are the gold standard offloading treatments to heal most patients with DFU, as they are much more effective, and typically safer, quicker, and cheaper to use compared with other offloading treatments. The effectiveness of offloading treatments also seems to increase when increased offloading mechanical features are incorporated within treatments, including customized insoles, rocker-bottom soles, controlled ankle motion, and higher cast walls. However, in clinical practice these gold standard knee-high offloading devices have low rates of prescription by clinicians and low rates of acceptance or adherence by patients. The common barriers resulting in this low use seem to surround historical misperceptions that are mostly dispelled by contemporary evidence. Further, research is now urgently required to close the implementation gap between the high-quality of supporting evidence and the low use of knee-high devices in clinical practice to reduce the high global disease burden of DFU in future.

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“…Motivational interviewing is a counselling method that has been used in a variety of populations to support healthy behaviours, such as physical activity. 22 Such counselling methods might be a valuable means to improve adherence to athome foot temperature monitoring. It is also likely that easy-touse devices would optimise monitoring adherence.…”

Section: Discussionmentioning

confidence: 99%

“…There is already a great burden of self‐monitoring placed on people with diabetes and thus a variety of forms of support may be needed for effective implementation of at‐home foot temperature monitoring. Motivational interviewing is a counselling method that has been used in a variety of populations to support healthy behaviours, such as physical activity 22 . Such counselling methods might be a valuable means to improve adherence to at‐home foot temperature monitoring.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of at home monitoring of foot temperature for risk reduction of diabetes‐related foot ulcer: A meta‐analysis

Golledge

Fernando

Alahakoon

et al. 2022

Diabetes Metabolism Res

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Aims To perform an updated systematic review of randomised controlled trials examining the efficacy of at‐home foot temperature monitoring in reducing the risk of a diabetes‐related foot ulcer (DFU). Methods Systematic review performed according to Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Risk‐of‐bias was assessed using version 2 of the Cochrane risk‐of‐bias tool. Meta‐analyses were performed using random effect models. Leave‐one‐out sensitivity analyses and a sub‐analysis excluding trials considered at high risk‐of‐bias assessed the consistency of the findings. The certainty of the evidence was assessed with GRADE. Results Five randomised controlled trials involving 772 participants meeting the International Working Group on the Diabetic Foot (IWGDF) risk category 2 or 3 were included. All trials reported instructing participants to measure skin temperature at‐home at six or more sites on each foot using a hand‐held infra‐red thermometer at least daily and reduce ambulatory activity in response to hotspots (temperature differences >2.2°C on two consecutive days between similar locations in both feet). One, one, and three trials were considered at low, moderate and high risk‐of‐bias, respectively. Participants allocated to at‐home foot temperature monitoring had a reduced risk of developing a DFU (relative risk 0.51, 95% CI 0.31–0.84) compared to controls. Sensitivity and sub‐analyses suggested that the significance of this finding was consistent. The GRADE assessment suggested a low degree of certainty in the finding. Conclusions At‐home daily foot temperature monitoring and reduction of ambulatory activity in response to hotspots reduce the risk of a DFU in moderate or high risk people with a low level of certainty.

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Effects of training podiatrists to use imagery‐based motivational interviewing when treating people with diabetes‐related foot disease: a mixed‐methods pilot study

Cited by 10 publications

References 68 publications

Where do you stand? An exploration of perspectives toward feet, foot health, and footwear using innovative digital methods

Where do you stand? An exploration of perspectives toward feet, foot health, and footwear using innovative digital methods

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Efficacy of at home monitoring of foot temperature for risk reduction of diabetes‐related foot ulcer: A meta‐analysis

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