Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study

Schmidt, Brian M.; Wrobel, James S.; Munson, Michael; Rothenberg, Gary M.; Holmes, Crystal M.

doi:10.1016/j.diabres.2017.02.008

Cited by 41 publications

(26 citation statements)

References 26 publications

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“…Podiatry excels at limb salvage and our previous data demonstrated the value of podiatry integration into the diabetes clinics at Michigan Medicine and highlights the interdisciplinary teams' work resulting in increased limb salvage and lessening the amount of diabetes-related amputations. 8 STRIDE protocol aligns with appropriate levels of risk to target a personalized care, with the ultimate goals to reduce risk of severe infections, amputation, and death in this highly vulnerable population. The protocol maintained appropriate social and physical distance utilizing telehealth and delivers face-to-face standard of care only as needed, preventing the spread of disease among patients and providers.…”

Section: Discussionmentioning

confidence: 99%

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Strategies to educe severe diabetic foot nfections and complications uring pidemics (STRIDE)

Schmidt

Munson

Rothenberg

et al. 2020

Journal of Diabetes and its Complications

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Aims Patients with diabetes, including those with foot complications, are at highest risk for severe outcomes during the COVID-19 pandemic. Diabetic foot ulcers (DFU) present additional challenges given their superimposed risk for severe infections and amputations. The main objectives were to develop a triage algorithm to effectively risk-stratify all DFUs for potential complications, complying with social distancing regulations, preserving personal protective equipment, and to assess feasibility of virtual care for DFU. Methods Longitudinal study during the COVID-19 pandemic performed at a large tertiary institution evaluating the effectiveness of a targeted triage protocol developed using a combined approach of virtual care, electronic medical record data mining, and tracing for rapid risk stratification to derive optimal care delivery methods. 2868 patients with diabetes at risk for foot complications within last 12 months were included and rates of encounters, hospitalizations, and minor amputations were compared to one year prior. Results The STRIDE protocol was implemented in 1-week and eventually included 2600 patients (90.7%) demonstrating effective triage. During normal operations, 40% (938 of 2345) of all visits were due to DFUs and none were performed virtually. After implementation, 98% face-to-face visits were due to DFU, and virtual visits increased by 21,900%. This risk stratified approach led to similar low rates of DFU-related-hospitalization and minor amputation rates 20% versus 24% (p > 0.05) during and prior the pandemic, respectively. Conclusions Implementation of STRIDE protocol was effective to risk-stratify and triage all patients with diabetic foot complications preventing increase in hospitalization and amputations while promoting both social and physical distancing.

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Section: Discussionmentioning

confidence: 99%

“… 7 In spite of these grim facts, it has been established that multidisciplinary team management may reduce the rate of major amputation by more than 50% resulting in improved quality of life and life expectancy for these patients. 8. , 9.…”

Section: Introductionmentioning

confidence: 99%

Strategies to educe severe diabetic foot nfections and complications uring pidemics (STRIDE)

Schmidt

Munson

Rothenberg

et al. 2020

Journal of Diabetes and its Complications

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“…However, a publication from the United States suggested that there was an increase in hospital admissions for a diabetic foot ulcer after Medicare cancelled financial coverage in one US state for preventative treatment given by podiatrists . Two further studies suggested that there was a reduction in amputations following the introduction of integrated foot care that included both ulcer prevention and ulcer treatment …”

Section: Integrated Foot Carementioning

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

374

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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“…Twenty-six studies that reported outcomes for podiatric interventions in an MDT context were included in this systematic review. Of these, 3 sets of articles were from the same group of authors, [35][36][37][38] and [39,40]. The decision was made to exclude the oldest ones, based on the fact that the same data set was used.…”

Section: Literature Searchmentioning

confidence: 99%

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Blanchette

Brousseau-Foley

Cloutier

2020

Journal of Foot and Ankle Research

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Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity between team members and interventions. Podiatrists have been suggested as "gatekeepers" for the prevention and management of DFUs. The purpose of our study is to review the effect of podiatric interventions in MDTs on DFUs and LEAs. We conducted a systematic review of available literature. Data's heterogeneity about DFU outcomes made it impossible for us to include it in a meta-analysis, but we identified 12 studies fulfilling inclusion criteria that allowed for them to be included for LEA outcomes. With the exception of one study, all reported favourable outcomes for MDTs that include podiatry. We found statistical significance in favour of an MDT approach including podiatrists for our primary outcome (total LEAs (RR: 0.69, 95% CI 0.54-0.89, I 2 = 64%, P = 0.002)) and major LEAs (RR: 0.45, 95% CI 0.23-0.90, I 2 = 67%, P < 0.02). Our systematic review, with a standard search strategy, is the first to specifically address the relevant role of podiatrists and their interventions in an MDT approach for DFU management. Our observations support the literature that MDTs including podiatrists have a positive effect on patient outcomes but there is insufficient evidence that MDTs with podiatry management can reduce the risk of LEAs. Our study highlights the necessity for intervention descriptions and role definition in team approach in daily practice and in published literature.

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Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study

Cited by 41 publications

References 26 publications

Strategies to educe severe diabetic foot nfections and complications uring pidemics (STRIDE)

Strategies to educe severe diabetic foot nfections and complications uring pidemics (STRIDE)

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

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

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