Perceptions of the ankle brachial index amongst podiatrists registered in Western Australia

Chen, Pamela Y; Lawford, Kaye M; Shah, Naiya; Bower, Virginia M

doi:10.1186/1757-1146-5-19

Cited by 12 publications

(14 citation statements)

References 15 publications

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“…Performing a comprehensive examination of the foot, including neurovascular and musculoskeletal assessments, is core general podiatry practice recommended by the Australian and New Zealand Podiatry Accreditation Council [ 28 ], thus, a high adherence rate to the diabetes guidelines for these items that relate is understandable. Performing an ABI or toe pressure was the only item to score below “very often” and aligned with a similar finding in a recent study of Western Australian podiatrists that reported 63% of podiatrists use the ABI [ 29 ]. These findings may also be expected as guideline recommendations typically suggest using an ABI or other non-invasive vascular assessment when pedal pulses are not readily palpable [ 4 ].…”

Section: Discussionsupporting

confidence: 83%

“…For all items reporting a low adherence rate, public-employed podiatrists reported higher adherence rates than private-employed podiatrists and also had greater access to multidisciplinary teams. Chen et al also found that rates of ABI use were also higher in public sector than private podiatry [ 29 ]. There are a variety of hypotheses why this may be the case including that public podiatrists see a larger volume of patients with diabetic foot ulcers in particular, and thus, more inclined to be aware of and use best practice management recommendations.…”

Section: Discussionmentioning

confidence: 99%

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How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

Quinton

Lazzarini

Boyle

et al. 2015

Journal of Foot and Ankle Research

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BackgroundDiabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors’ knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists’ diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council.MethodsA 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups.ResultsThree hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11–15 years median experience. Participants reported treating a median of 21–30 diabetes patients each week, including 1–5 with foot ulcers. Overall, participants registered median scores of at least “very often” (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: “never” (1 (1 – 3)) using total contact casting, “sometimes” (4 (2 – 5)) performing an ankle brachial index, “sometimes” (4 (1 – 6)) using University of Texas Wound Classification System, and “sometimes” (4 (3 – 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01).ConclusionsThis study provides the first baseline information on Australian podiatrists’ adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

Quinton

Lazzarini

Boyle

et al. 2015

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

show abstract

“…As the toe-brachial index (TBI) measurement is taken more distally in the lower limb there is a greater likelihood of detecting arterial pressure changes caused by stenosis located below the knee as occur in the presence of diabetes [9]. The digital arteries are also less likely to be affected by MAC [10][11][12], and these factors potentially make the TBI a more sensitive test for A C C E P T E D M A N U S C R I P T…”

Section: Introductionmentioning

confidence: 99%

Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease

Tehan

Bray²,

Chuter

2016

Journal of Diabetes and its Complications

100

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“…Hand-held Doppler ultrasound examination (Doppler) of pedal arteries is the most frequently used non-invasive vascular assessment modality utilised by podiatrists [ 8 ] for diagnosis and ongoing monitoring of PAD. Podiatrists generally use Doppler in two different ways, as part of an ankle brachial index (ABI) or as a standalone test [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Use of hand‐held Doppler ultrasound examination by podiatrists: a reliability study

Tehan

Chuter

2015

Journal of Foot and Ankle Research

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BackgroundHand held Doppler examination is a frequently used non-invasive vascular assessment utilised by podiatrists. Despite this, the reliability of hand-held Doppler has not been thoroughly investigated. Given the importance of Doppler in completing a vascular assessment of the lower limb, it is essential to determine the reliability of the interpretation of this testing method in practicing podiatrists.MethodsThis was a multi-centre inter and intra-rater reliability study. Four podiatrists (the raters) participated in this study, two public and two private practitioners. Three aspects of Doppler use were examined; (i) use of Doppler (i.e., technique and interpretation), (ii) interpretation of Doppler audio sounds, and (iii) interpretation of visual Doppler waveforms (i.e., tracings). Participants meeting current guidelines for vascular screening attended two testing sessions, 1 week apart at either the private practice (n = 32), or the public practice (n = 31). To assess use of Doppler, the raters evaluated the Doppler waveforms that they collected, rating them as mono-phasic or multi-phasic. To assess Doppler audio sounds and visual Doppler waveforms, raters were required to evaluate 30 audio recordings of Doppler sounds and 30 waveform tracings, respectively, that were previously recorded and chosen at random by the researchers. Cohen’s kappa (κ) statistics were used to calculate inter and intra-rater reliability using SPSS version 19.ResultsUse of Doppler demonstrated the lowest reliability for both pairs of clinicians (inter-rater reliability κ 0.20 to 0.24 and intra-rater reliability κ 0.27 to 0.42). The public podiatrists showed higher reliability in audio interpretation (inter-tester reliability κ 0.61, intra-tester reliability κ 1.00) compared to the private podiatrists (inter-tester reliability κ 0.31, intra-tester reliability κ 0.53). Evaluation of Doppler waveform tracings demonstrated highest reliability, with inter-rater reliability ranging from κ 0.77 to 0.90 and intra-rater reliability from κ 0.81 to 1.00.ConclusionsThere is a need for ongoing education for podiatrists using Doppler in clinical practice, as the reliability for the clinical use of the Doppler was low. This indicates that technique could be an issue. There is also a need to further evaluate if hand-held Doppler equipment, using the examinations that we evaluated, is suitable for use in the contexts examined in this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0097-2) contains supplementary material, which is available to authorized users.

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Perceptions of the ankle brachial index amongst podiatrists registered in Western Australia

Cited by 12 publications

References 15 publications

How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease

Use of hand‐held Doppler ultrasound examination by podiatrists: a reliability study

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