The Effect of Telemedicine Follow-up Care on Diabetes-Related Foot Ulcers: A Cluster-Randomized Controlled Noninferiority Trial

Smith‐Strøm, Hilde; Igland, Jannicke; Østbye, Truls; Tell, Grethe S.; Hausken, Marie Fjelde; Graue, Marit; Skeie, Svein; Cooper, John G.; Iversen, Marjolein M.

doi:10.2337/dc17-1025

Cited by 68 publications

(143 citation statements)

References 28 publications

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“…73 A lower proportion of patients with an amputation was found in the telemedicine group (−8.3%, 95%CI: −16.3 to 0.5%). 73 Based on this RCT, four qualitative studies investigated the value of focus groups and individual semi-structured interviews of both patients and healthcare professionals. [74][75][76][77] Patients from both the telemedicine and the control group mentioned that the best wound care depends on a combination of competence and professional skills in wound management and continuity of care.…”

Section: Rct Wilbright Et Al Reported No Significant Difference In Umentioning

confidence: 85%

“…Recently, Smith‐Strøm et al found in a cluster randomized controlled noninferiority trial that weekly telemedicine consultations of the community nurse via an interactive Web‐based ulcer record and a mobile phone that enabled counseling and communication with the healthcare specialist in addition to outpatient clinic every 6 weeks, was non‐inferior to visiting the outpatient clinic every second week for ulcer treatment on time to healing (mean difference −0.43 months [95%CI: −1.50 to 0.65]) . A lower proportion of patients with an amputation was found in the telemedicine group (−8.3%, 95%CI: −16.3 to 0.5%) . Based on this RCT, four qualitative studies investigated the value of focus groups and individual semi‐structured interviews of both patients and healthcare professionals .…”

Section: Resultsmentioning

confidence: 99%

“…This is also shown by a prematurely terminated RCT in France, in which a lack of specialized nurses and a lack of confidence by healthcare providers in the telemedicine system used, resulted in a termination of inclusion of patients . Interestingly, the number of outpatient clinic visits did not decrease in the RCT from Rasmussen et al This was confirmed in the RCT from Smith‐Strøm where the total number of outpatient clinical consultations remained equal for the intervention and the control group . Subgroup analysis showed that the number of consultations decreased if patients lived further away from the clinic (>25 km) and if there was more experience with telemedicine consultations .…”

Section: Discussionmentioning

confidence: 99%

“…Audio, video, and online communication as telemedicine support tool has received quite some recent attention in the scientific literature. Two well‐designed RCTs show that this form of telemedicine is feasible and as effective as regular outpatient clinic visits in ulcer management . The significant higher mortality rate found by Rasmussen et al in the telemedicine group could not be explained by the authors …”

Section: Discussionmentioning

confidence: 99%

“…73 Subgroup analysis showed that the number of consultations decreased if patients lived further away from the clinic (>25 km) and if there was more experience with telemedicine consultations. 73 Taking these key factors into account in future trials and in clinical practice may improve potential for remote ulcer care.…”

Section: Photographic Imagingmentioning

confidence: 99%

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Telehealth and telemedicine applications for the diabetic foot: A systematic review

Hazenberg

Stegge

Baal

et al. 2019

Diabetes Metabolism Res

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Summary The aim of this systematic review is to assess the peer‐reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease. MEDLINE/PubMed was searched for peer‐reviewed studies on telehealth and telemedicine approaches for assessing, monitoring, preventing, or treating diabetic foot disease. Four modalities were formulated: dermal thermography, hyperspectral imaging, digital photographic imaging, and audio/video/online communication. Outcome measures were: validity, reliability, feasibility, effectiveness, and costs. Sixty‐one studies were eligible for analysis. Three randomized controlled trials showed that handheld infrared dermal thermography as home‐monitoring tool is effective in reducing ulcer recurrence risk, while one small trial showed no effect. Hyperspectral imaging has been tested in clinical settings to assess and monitor foot disease and conflicting results on its diagnostic use show that this method is still in an experimental stage. Digital photography is used to assess and monitor foot ulcers and pre‐ulcerative lesions and was found to be a valid, reliable, and feasible method for telehealth purposes. Audio/video/online communication is mainly used for foot ulcer monitoring. Two randomized controlled trials show similar healing efficacy compared with regular outpatient clinic visits, but no benefit in costs. In conclusion, several technologies with good psychometric properties are available that may be of benefit in helping to assess, monitor, prevent, or treat diabetic foot disease, but in most cases, feasibility, effectiveness, and cost savings still need to be demonstrated to become accepted and used modalities in diabetic foot care.

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