Prevention and Management of Diabetes-Related Foot Ulcers through Informal Caregiver Involvement: A Systematic Review

Abstract

Background. The literature remains unclear whether involving informal caregivers in diabetes self-care could lead to improved diabetic foot outcomes for persons at risk and/or with foot ulcer. In this review, we synthesized evidence of the impact of interventions involving informal caregivers in the prevention and/or management of diabetes-related foot ulcers. Methods. A systematic review based on PRISMA, and Synthesis Without Meta-analysis (SWiM) guidelines was conducted. MEDLINE (Ovid), Embase (Ovid), PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trial of the Cochrane Library databases were searched from inception to February 2021. The following MESH terms were used: diabetic foot, foot ulcer, foot disease, diabetes mellitus, caregiver, family caregiver ,and family. Experimental studies involving persons with diabetes, with or at risk of foot ulcers and their caregivers were included. Data were extracted from included studies and narrative synthesis of findings undertaken. Results. Following the search of databases, 9275 articles were screened and 10 met the inclusion criteria. Studies were RCTs ( n = 5 ), non-RCTs ( n = 1 ), and prepoststudies ( n = 4 ). Informal caregivers through the intervention programmes were engaged in diverse roles that resulted in improved foot ulcer prevention and/or management outcomes such as improved foot care behaviors, increased diabetes knowledge, decreased HbA1c (mmol/mol or %), improved wound healing, and decreased limb amputations rates. Engaging both caregivers and the person with diabetes in education and hands-on skills training on wound care and foot checks were distinctive characteristics of interventions that consistently produced improved foot self-care behavior and clinically significant improvement in wound healing. Conclusion. Informal caregivers play diverse and significant roles that seem to strengthen interventions and resulted in improved diabetes-related foot ulcer prevention and/or management outcomes. However, there are multiple intervention types and delivery strategies, and these may need to be considered by researchers and practitioners when planning programs for diabetes-related foot ulcers.

The Influence of 6-Month Interdisciplinary Accompaniment on Family Caregivers’ Knowledge and Self-Efficacy Regarding Diabetic Wound Care

“…Family caregivers play an important role in providing long-term care for people with DM ( Kristianingrum et al, 2021 ). Studies have shown that caregivers play diverse and significant roles in improving diabetes-related foot ulcer prevention and/or management outcomes ( Suglo et al, 2022 ). Another study also reported that family-based education intervention creates family empowerment to accelerate wound healing of diabetic foot ulcers ( Appil et al, 2022 ).…”

Exploring barriers and enablers of self‐management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care

“…Less emphasis has been placed on understanding the needs of family caregivers who are often involved in the DFU treatment process. Family caregivers support patients with DM self‐care by administering treatment and rendering practical assistance (such as wound care or transport), promoting/encouraging patients' self‐care and foot care behaviours through reminders and monitoring, synthesising, and communicating health information, and giving emotional support 26‐28 . The diverse and central roles that caregivers play in the patients' care underlie the complex and reciprocal influence between patients and caregivers.…”

Program Peningkatan Peran Caregiver Dalam Perawatan Sederhana Luka Diabetic Di Masa Pandemic Covid-19 Di Kota Yogyakarta

“…Dukungan keluarga (caregiver) sebagai faktor penting dalam kepatuhan manajemen penyakit kronik termasuk DM untuk mencegah keparahan luka seperti infeksi; seperti osteomyelitis dan mencegah amputasi (Messenger et al, 2019;Suglo et al, 2022). Dukungan keluarga (caregiver) merupakan bantuan yang dilakukan oleh anggota keluarga yang diharapkan memberikan kenyamanan baik fisik maupun psikologis.…”

“…Kegiatan edukasi kepada caregiver dilakukan secara langsung dengan mendemonstrasikan perawatan luka sederhana; seperti mengganti balutan luka, membersihkan luka dan teknik menutup kembali luka (gambar 1). Edukasi menjadi hal yang penting bagi keluarga dan pasien untuk mencegah perburukan kondisi luka, mencegah amputasi, dan mengoptimalkan proses penyembuhan luka (Dorresteijn, Jet al, 2014;Suglo, et al,2022).…”

“…Grafik peningkatan pengetahuan dan self-efficasy caregiver dalam perawatan sederhana ulkus Diabetic Keluarga (caregiver) memiliki peran yang sangat penting sebagai support system utama dalam menyediakan pelayanan perawatan dengan durasi yang lama (long-term care), termasuk pada pasien ulkus diabetic (Kristianingrum et al, 2021). Penelitian sebelumnya melaporkan bahwa peran keluarga (caregiver) signifikan dalam mencegah perburukan luka ulkus diabetic dan meningkatkan manegemen luka ulkus diabetic (Suglo et al, 2022). Dengan adanya program yang telah dilakukan ini, terdapat beberapa hasil yang positive bagi pasien dintaranya mencegah terjadinya keparahan luka, dan perburukan kondisi pasien dimasa pandemic covid-19, hal ini dapat terlihat pada salah satu contoh luka yang perkembangan proses penyembuhannya berjalan dengan baik karena dengan adanya peran dari caregiver (Gambar 3).…”