Patient education for the prevention of diabetic foot ulcers

Gershater, Magdalena Annersten; Pilhammar, Ewa; Apelqvist, Jan; Alm-Roijer, Carin

doi:10.1002/edn.189

Cited by 36 publications

(26 citation statements)

References 38 publications

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“…In the past two decades, there have been several case–control studies on the effects of education and counselling techniques in patients with diabetes foot conditions, involving occupations such as nurses, social workers, psychologists and rehabilitation physicians 6,10,18‐20 . To our best knowledge, this is the first study reporting the effects of such counselling techniques delivered by podiatrists.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] Such methods are increasingly being used in chronic disease patients: Healthcare workers in various countries have reported the use of patient engagement and collaborative counselling methods in diabetic foot care. 6,9,10,[18][19][20][21] However, a review paper by Binning and colleagues 22 on Motivational Interviewing for the prevention of diabetic foot complications was unable to draw strong conclusions due to insufficient and low level of evidence. This reflects a need for good quality studies on the effects of contemporary counselling methods in podiatric diabetic foot care.…”

Section: Introductionmentioning

confidence: 99%

“…Collaborative methods involving Motivational Interviewing (MI) and Solutions Focused (SF) counselling, have been found to be effective in various areas of behavioural change such as smoking, diet, physical activity, and addiction 13‐17 . Such methods are increasingly being used in chronic disease patients: Healthcare workers in various countries have reported the use of patient engagement and collaborative counselling methods in diabetic foot care 6,9,10,18‐21 . However, a review paper by Binning and colleagues 22 on Motivational Interviewing for the prevention of diabetic foot complications was unable to draw strong conclusions due to insufficient and low level of evidence.…”

Section: Introductionmentioning

confidence: 99%

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A collaborative approach in patient education for diabetes foot and wound care: A pragmatic randomised controlled trial

Heng

Kwan

Ilya

et al. 2020

International Wound Journal

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Foot care education is an important strategy in reducing lower limb complications. There is evidence that contemporary communication approaches can improve patient education outcomes. To inform the potential of such methods in diabetic foot education, we trialled a collaborative approach in patient education counselling in a podiatry clinic. We conducted a single-blind pragmatic randomised controlled trial on 52 diabetes patients who had an active foot ulcer. Participants were randomised to either collaborative education or traditional didactic education. Outcomes on knowledge and self-care behaviours were collected via a pre and post study questionnaire (max score: 75). The study ended at 12 weeks or when the wound healed prior. 42 (80.7%) participants completed the study. The collaborative patient education group had a significant increase in score post-study (38.8 ± 8.5) compared to pre-study (32.8 ± 6.9; P < .001). The control group had no significant increase in score post study. The difference in scores between groups had a moderate effect size (d = 0.54). The use of a collaborative approach in patient education was able to produce significantly greater increase in knowledge retention and self-care behaviours, without the need for additional consultation time in a podiatry clinic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A collaborative approach in patient education for diabetes foot and wound care: A pragmatic randomised controlled trial

Heng

Kwan

Ilya

et al. 2020

International Wound Journal

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“…A pooled estimate of the effect of education on the incidence of foot ulceration at 6 months found that foot ulceration was not statistically significantly reduced in three trials of 423 people with diabetes mellitus (RR 1.04, 95% CI 0.55 to 1.97) ( Figure 12). [78][79][80] The heterogeneity (I 2 ) was 54%.…”

Section: Education Alone: Meta-analysismentioning

confidence: 97%

“…Researchers from Glasgow, UK, and Amsterdam, the Netherlands, conducted a SR to assess the effect of motivational interviewing on adherence to interventions to prevent diabetic foot ulceration. 60 A search of 11 databases for articles published until 2018 found one RCT 79 that met our eligibility criteria. The reviewers used a 21-item checklist designed to identify bias in and quality of studies of the foot in diabetes mellitus.…”

Section: Education Alonementioning

confidence: 99%

Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model

Crawford

Chappell

Lewsey

et al. 2020

Health Technol Assess

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Background Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation. Objectives Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis. Design We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis. Interventions The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated. Main outcome measure The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a ‘treat-all’ strategy. Data sources Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule. Review methods We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019. Results The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk. Limitations The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates. Conclusions There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable. Future work recommendations Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus. Study registration This study is registered as PROSPERO CRD42016052324. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.

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