Establishing the national top 10 priority research questions to improve diabetes-related foot health and disease: a Delphi study of Australian stakeholders

Abstract

IntroductionDiabetes-related foot disease is a large cause of the global disease burden yet receives very little research funding to address this large burden. To help address this gap, it is recommended to first identify the consensus priority research questions of relevant stakeholders, yet this has not been performed for diabetes-related foot disease. The aim of this study was to determine the national top 10 priority research questions for diabetes-related foot health and disease from relevant Australian stakeholders.Research design and methodsA modified three-round Delphi online survey design was used to seek opinions from relevant Australian stakeholders including those with diabetes or diabetes-related foot disease or their carers (consumers), health professionals, researchers and industry. Participants were recruited via multiple public invitations and invited to propose three research questions of most importance to them (Round 1), prioritize their 10 most important questions from all proposed questions (Round 2), and then rank questions in order of importance (Round 3).ResultsAfter Round 1, a total of 226 unique questions were proposed by 210 participants (including 121 health professionals and 72 consumers). Of those participants, 95 completed Round 2 and 69 completed Round 3. The top 10 priority research questions covered a range of topics, including health economics, peripheral neuropathy, education, infection, technology, exercise, and nutrition. Consumers prioritized peripheral neuropathy and prevention-related questions. Health professionals prioritized management-related questions including Australia’s First Peoples foot health, health economics and infection questions.ConclusionsThese priority research questions should guide future national research agendas, funding and projects to improve diabetes-related foot disease burdens in Australia and globally. Future research should focus on consumer priority research questions to improve the burden of diabetes-related foot disease on patients and nations. Further research should also investigate reasons for different priorities between consumers and health professionals.

Exercise in adults admitted to hospital with diabetes-related foot ulcers: a pilot study of feasibility and safety

“…The potential for exercise and its role in reducing the risk of complications associated with DFU has been identi ed as a research priority by health providers and consumers (15).There are however, a number of known barriers for participation in exercise for this patient group that should be considered (11). The current study demonstrated that the presence of a DFU was viewed as a barrier to exercise participation by the majority of participants at the commencement of the study.…”

“…The role and effect of exercise for adults with active DFU has not been widely investigated. This knowledge gap has been identi ed by The International Working Group on the Diabetic Foot (IWGDF) as an important area for future research and was amongst the top ten research priorities for Australian stakeholders which included consumers and health professionals (15). To overcome apparently con icting recommendations in this vulnerable group, we aimed to determine whether undertaking exercise in people admitted to hospital with an acute DFU is feasible, acceptable and safe.…”

Cost‐effectiveness of guideline‐based care provision for patients with diabetes‐related foot ulcers: A modelled analysis using discrete event simulation

“…10 Evaluation of the cost and health benefits of increasing the provision of guideline-based care to patients with DFU has been consistently recommended by global IWGDF guidelines, 7 and most recently voted the top national priority research question among diabetes-related foot disease patients, health professionals, research and industry stakeholders in Australia. 11 A recent systematic review on the cost-effectiveness of guideline-based diabetes care found evidence to suggest that guidelinebased DFU care can reduce costs and increases health benefits compared with existing clinical practice. 12 However, the review concluded that most studies to date were based on data from older clinical trials, retrospective cohorts of expert opinion and future economic studies that utilise more recent data from real-world cohorts were needed.…”

Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes

“…5 Likewise, a Delphi study of key stakeholders in Australia identified that education to improve self-care practices was one of the key priorities for future research to improve diabetes-related foot health and disease. 6 With appropriate disease management and effective self-care behaviors, many complications, including DFUs, are deemed to be entirely avoidable. 1 3 7 8 While the role of the HCP in helping patients to effectively manage their diabetes remains a crucial aspect of diabetes care, the International Working Group on the Diabetic Foot has cited good foot self-care behaviors as a key approach to prevent the development of DFUs.…”

“…Accordingly, ever-increasing importance is given to strategies aimed at preventing the development of DFUs—so much so that the James Lind Alliance in partnership with the National Institute for Health and Care Research identified this as one of the top 10 foot health research priorities in the UK 5. Likewise, a Delphi study of key stakeholders in Australia identified that education to improve self-care practices was one of the key priorities for future research to improve diabetes-related foot health and disease 6. With appropriate disease management and effective self-care behaviors, many complications, including DFUs, are deemed to be entirely avoidable 1 3 7 8.…”