Implementation of a patient-centered remote wound monitoring system for management of diabetic foot ulcers

Abstract

BackgroundRegular clinical assessment is critical to optimize lower extremity wound healing. However, family and work obligations, socioeconomic, transportation, and time barriers often limit patient follow-up. We assessed the feasibility of a novel, patient-centered, remote wound management system (Healthy.io Minuteful for Wound Digital Management System) for the surveillance of lower extremity wounds.MethodsWe enrolled 25 patients from our outpatient multidisciplinary limb preservation clinic with a diabetic foot ulcer, who had undergone revascularization and podiatric interventions prior to enrollment. Patients and their caregivers were instructed on how to use the digital management system and asked to perform one at-home wound scan per week for a total of 8 weeks using a smartphone application. We collected prospective data on patient engagement, smartphone app useability, and patient satisfaction.ResultsTwenty-five patients (mean age 65.5 ± 13.7 years, 60.0% male, 52.0% Black) were enrolled over 3 months. Mean baseline wound area was 18.0 ± 15.2 cm2, 24.0% of patients were recovering from osteomyelitis, and post-surgical WiFi stage was 1 in 24.0%, 2 in 40.0%, 3 in 28.0%, and 4 in 8.00% of patients. We provided a smartphone to 28.0% of patients who did not have access to one that was compatible with the technology. Wound scans were obtained by patients (40.0%) and caregivers (60.0%). Overall, 179 wound scans were submitted through the app. The mean number of wound scans acquired per patient was 0.72 ± 0.63 per week, for a total mean of 5.80 ± 5.30 scans over the course of 8 weeks. Use of the digital wound management system triggered an early change in wound management for 36.0% of patients. Patient satisfaction was high; 94.0% of patients reported the system was useful.ConclusionThe Healthy.io Minuteful for Wound Digital Management System is a feasible means of remote wound monitoring for use by patients and/or their caregivers.

Evaluation of mHealth Interventions in Wound Care: A Systematic Review Highlighting the Involvement of Informal Caregivers

“…Regarding the nature of wounds, the mentioned studies [12,13] and another study [14] from Switzerland primarily centered on pressure ulcers. In contrast, other studies [15,16] from Iran and the USA specifically delved into diabetic foot ulcers. Another study [17] from Taiwan adopted a more comprehensive approach, exploring a gamut of injuries, encompassing ulcers, skin grafts, burns/frictions, pressure ulcers, and trauma.…”

“…Another study [15] evaluated a patient-centered remote wound management system for monitoring lower extremity wounds. Their findings revealed that the system prompted early changes in wound management for a significant number of patients, with 94% finding the system functional.…”

“…On the other hand, Martins et al [12] scored a 3 indicating potential methodological limitations that might affect the robustness of the findings. Similarly, Keegan et al [15] were awarded a score of 4, pointing towards possible limitations in their research approach. Lastly, Amann et al [14] scored 5, denoting it as a moderate-quality study.…”

“…Lastly, Amann et al [14] scored 5, denoting it as a moderate-quality study. [13] 6/9 Martins et al [12] 3/9 Keegan et al [15] 4/9 Amann et al [14] 5/9…”

Bibliometric analysis of systematic review and meta-analysis on diabetic foot ulcer

“…Similarly, other standard therapies play a therapeutic role in unique ways. Debridement drastically reduces the risk of infection and amputation [ 35 , 36 ], dressings ensure that the wound is moist and exudation well controlled [ 37 , 38 ], platelet-derived products facilitate wound healing [ 39 , 40 ], glycaemic control delays microangiopathy [ 14 , 41 ], and telemedicine provides continuous, expert management guidance [ 10 , 42 ]. This study further emphasizes the significance of multidisciplinary care [ 43 , 44 ].…”