A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU)

Adiewere, P.; Gillis, Richard B.; Jiwani, Shahwar I.; Meal, Andy; Shaw, Ian; Adams, Gary G.

doi:10.1016/j.heliyon.2018.e00614

Cited by 55 publications

(68 citation statements)

References 36 publications

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“…Despite this myriad of forms available and education being ingrained in clinical practice all over the world, research on its effectiveness is limited. There is insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant ulcer risk reduction . However, education may improve knowledge and foot self‐care behaviour .…”

Section: Educating the Patient Family And Health Care Providersmentioning

confidence: 99%

“…There is insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant ulcer risk reduction . However, education may improve knowledge and foot self‐care behaviour . Therefore, education should aim to improve the patients foot care knowledge and self‐care behaviour and encourage the patient to adhere to the foot self‐care education provided.…”

Section: Educating the Patient Family And Health Care Providersmentioning

confidence: 99%

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Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Lavery

Monteiro‐Soares

et al. 2020

Diabetes Metabolism Res

375

609

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at‐risk patient about appropriate foot self‐care and treat any pre‐ulcerative sign on the foot. Instruct moderate‐to‐high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non‐surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high‐risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer‐free days, and to reduce the patient and health care burden of diabetic foot disease.

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Section: Educating the Patient Family And Health Care Providersmentioning

confidence: 99%

Section: Educating the Patient Family And Health Care Providersmentioning

confidence: 99%

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Lavery

Monteiro‐Soares

et al. 2020

Diabetes Metabolism Res

375

609

View full text Add to dashboard Cite

show abstract

“…Summary of the literature : We found two systematic reviews with meta‐analyses, including six RCTs of which three met our inclusion criteria and three did not, as well as one additional RCT . While some RCTs in these meta‐analyses included participants without neuropathy, thereby not meeting our inclusion criteria of “only at‐risk patients,” we decided to include a description of both meta‐analyses, as three of the six included RCTs did meet our inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Adiewere and colleagues performed a systematic review with meta‐analyses with low risk of bias, including six RCTs of which five were with high risk of bias and one with low risk of bias . In a combined random effect model comparing education about foot self‐care with usual care, meta‐analyses over a total of 1349 participants (680 intervention and 669 control) resulted in a risk ratio (RR) of 0.52 (95% CI, 0.23‐1.15; P = .11; I 2 : 90%) for ulcer prevention.…”

Section: Resultsmentioning

confidence: 99%

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Netten

Raspovic

Lavery

et al. 2020

Diabetes Metabolism Res

169

330

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Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non‐controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot‐related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight‐bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self‐management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non‐existent for the prevention of a first foot ulcer and non‐plantar foot ulcer.

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“…Although the effectiveness of educational intervention to the diabetic foot health is still in dispute at present (Adiewere et al, ; Presseau et al, ), patient education and self‐management support still have been recognised as a priority in global health (Chan, Gregg, Sargent, & Horton, ). However, the uptake of self‐care education is still very low in the world (Yuncken, Williams, Stolwyk, & Haines, ), partly because of logistical problems attending courses (Horigan, Davies, Findlay‐White, Chaney, & Coates, ) and healthcare professional communication (Harris et al, ).…”

Section: Discussionmentioning

confidence: 99%

An educational intervention on foot self‐care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers

Guo

2019

Journal of Clinical Nursing

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Aims and objectives To assess the effectiveness of a 12‐week educational intervention on foot self‐care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers in China. Background Diabetes with the coexistence of diabetic retinopathy and foot problems complicating diabetes not only represents a personal disaster, but also becomes a serious burden to public health in China. A foot self‐care educational intervention is both cost‐effective and feasible even in a health resource‐limited setting, which should be developed and evaluated. Design Quasi‐experimental. Methods From July–September 2017, we enrolled 80 eligible hospitalised diabetic retinopathy patients and their primary caregivers by convenient sampling method in a first‐class comprehensive hospital in Nantong, in China. Before and after the educational intervention that is in accordance with the TREND statement (for details, see the “Supplementary File 1”), researchers and subjects filled out the self‐designed questionnaire on foot problems complicating diabetes and the Diabetic Foot Self‐care Behavior Scale, respectively. Results Scores of foot self‐care behaviour among the subjects significantly improved from 54.19 ± 8.01–75.85 ± 5.04. The number of patients with fasting blood glucoses <7.0 mmol/L improved from 43 (53.75%)–80 (100%). The results of incidence of foot problems complicating diabetes were not statistically significant. The complete execution of each item in Diabetic Foot Self‐care Behavior Scale of subjects was apparently higher. Conclusions This educational intervention can facilitate positive foot self‐care behaviours among the diabetic retinopathy patients with visual disability and their primary caregivers in China. Relevance to clinical practice. This study adds to the evidence of the effectiveness of an educational intervention to foster positive foot self‐care behaviours. This educational intervention appears to be prospective in promoting diabetic home‐based self‐management in China, and the delivery method of the intervention may be applied to other chronic diseases.

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A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU)

Cited by 55 publications

References 36 publications

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

An educational intervention on foot self‐care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers

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