The effect of transitional care on the prevention of diabetic foot ulcers in patients at high risk for diabetic foot

Liu, Jianping; Chen, Tiangui; Wang, Shuo; Liu, Huanning

doi:10.1007/s13410-019-00736-z

Cited by 7 publications

(30 citation statements)

References 24 publications

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“…It is an effective extension of standard care with a strong humanistic aspect. 44,45 Our study results indicate that, compared to standard care, continuous nursing care significantly lowers the incidence of wound infection, foot ulcer, and complications in DF patients. This can be attributed to: first, continuous nursing care educates patients at risk of infection before discharge, providing health knowledge education and lectures on the aetiology of DF infection, its development and prognosis, detailing post-discharge medication and precautions, and conducting regular follow-up visits; second, continuous care involves rational assessment of the patient's DF condition, optimizing the care plan in accordance with actual situations, such as instructing family members to monitor the patient, choosing appropriate footwear, reducing pressure on the affected foot, maintaining foot cleanliness, and applying skincare products to ulcerated areas to keep them dry; third, regularly providing patients or their families with DF healthcare knowledge, encouraging reasonable physical exercise to restore foot function, promote lower limb blood circulation, improve immunity, and dietary control to prevent other complications.…”

Section: Discussionmentioning

confidence: 70%

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Application of continuing nursing intervention on wound infection and ulcers in patients with diabetic foot: A meta‐analysis

Li,

Xu,

Chen

et al. 2024

International Wound Journal

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This meta‐analysis systematically evaluates the impact of continuous nursing care interventions on wound infections and ulcerations in patients with diabetic foot. A comprehensive computerized search was conducted, from database inception to November 2023, in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for randomized controlled trials (RCTs) examining the application of continuous nursing care in diabetic foot. Two researchers independently screened the literature, extracted data, and conducted quality assessments based on inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. A total of 23 RCTs involving 1813 diabetic foot patients were included. The analysis revealed that, compared to standard care, the implementation of continuous nursing care significantly reduced the incidence of wound infections (OR = 0.22, 95% CI: 0.15–0.32, p < 0.001) and complications (OR = 0.19, 95% CI: 0.14–0.25, p < 0.001), as well as the occurrence of foot ulcers (OR = 0.21, 95% CI: 0.12–0.35, p < 0.001). This study demonstrates that the application of continuous nursing care in diabetic foot patients can effectively reduce the occurrence of wound infections, foot ulcers, and complications, thereby facilitating patient recovery.

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Section: Discussionmentioning

confidence: 70%

“…The greatest advantage and characteristic of continuous nursing care is that it extends beyond in‐hospital implementation, continuing after the patient's discharge. It is an effective extension of standard care with a strong humanistic aspect 44,45 …”

Section: Discussionmentioning

confidence: 99%

Application of continuing nursing intervention on wound infection and ulcers in patients with diabetic foot: A meta‐analysis

Li,

Xu,

Chen

et al. 2024

International Wound Journal

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“…The 29 eligible RCTs included 3891 participants from 16 countries, with sample sizes of 40 to 749 participants, and had follow-up durations ranging from 2 weeks to 26 months. Five studies recruited participants with active foot ulcers, 25,32,37,48,49 six trials included past ulcer amongst the inclusion criteria, 30,33,35,36,40,45 one trial included participants with ESRF and in the remaining trials the reporting of inclusion and exclusion criteria was very limited but did suggest high-risk participants were included (Table 1 and Table S2). Overall 12 trials were considered to have included participants at high risk of DFD [25][26][27]30,32,[34][35][36][37][38]40,48,49 (Table 1).…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Five studies recruited participants with active foot ulcers, 25,32,37,48,49 six trials included past ulcer amongst the inclusion criteria, 30,33,35,36,40,45 one trial included participants with ESRF and in the remaining trials the reporting of inclusion and exclusion criteria was very limited but did suggest high-risk participants were included (Table 1 and Table S2). Overall 12 trials were considered to have included participants at high risk of DFD [25][26][27]30,32,[34][35][36][37][38]40,48,49 (Table 1). Authors of five studies were contacted for additional data, 21,24,25,42,49 but none responded.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…The education programs were diverse, ranging from short, single individualised education sessions to multiple comprehensive group-based sessions (Table 2 and Table S3). Thirteen studies provided a single education session of up to 2 h duration, nine delivered to individual participants, 22,24,27,32,[34][35][36]44,48 including two in the participants' homes, 27,35 and four delivered a single education session to a group of participants. 30,37,40,42 Ten included multiple group sessions, 21,23,25,26,29,31,34,39,43,49 and one delivered multiple individualised one-on-one sessions to dialysis patients.…”

Section: Description Of Interventionsmentioning

confidence: 99%

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Effectiveness of educational interventions for diabetes‐related foot disease: A systematic review and meta‐analysis

Drovandi,

Seng,

Golledge

2023

Diabetes Metabolism Res

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This systematic review and meta‐analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes‐related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot‐care knowledge and self‐care behaviours. Meta‐analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB‐2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2 = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2 = 38%) and HbA1c levels (standardized mean difference −0.73; 95% CI −1.26, −0.20, I2 = 93%) without affecting all‐cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2 = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self‐care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self‐care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow‐up are needed.

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Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta‐analysis

Netten

Raspovic

Lavery

et al. 2023

Diabetes Metabolism Res

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AimsPrevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual 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 and meta‐analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof.Materials and MethodsWe searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non‐controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta‐analysis (using Mantel‐Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE.ResultsFrom the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non‐controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31–0.84) and pressure‐optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26–1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37–1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24–1.17), flexor tenotomy (1 RCT, 7 non‐controlled studies, no meta‐analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58–1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration.ConclusionsVarious interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure‐optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high‐quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low‐to‐moderate risk of ulceration.

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The effect of transitional care on the prevention of diabetic foot ulcers in patients at high risk for diabetic foot

Cited by 7 publications

References 24 publications

Application of continuing nursing intervention on wound infection and ulcers in patients with diabetic foot: A meta‐analysis

Application of continuing nursing intervention on wound infection and ulcers in patients with diabetic foot: A meta‐analysis

Effectiveness of educational interventions for diabetes‐related foot disease: A systematic review and meta‐analysis

Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta‐analysis

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