The validity and reliability of remote diabetic foot ulcer assessment using mobile phone images

Netten, Jaap J. van; Clark, Damien; Lazzarini, Peter A; Janda, Monika; Reed, Lloyd

doi:10.1038/s41598-017-09828-4

Cited by 65 publications

(64 citation statements)

References 35 publications

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“…At the same time, however, sharing information with clinicians creates challenges in terms of information ownership, security and privacy [36]. It also raises the question of accuracy, with previous studies highlighting that mobile phone images of DFUs in isolation may not be sufficient for clinicians to make reliable diagnosis [37]. Furthermore, it would also require a change in organizational practices, where clinicians receive time and remuneration for reviewing such information without the patient present.…”

Section: Principal Resultsmentioning

confidence: 99%

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

Ploderer¹,

Brown²,

Seng³

et al. 2018

Preprint

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Background: Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs. Objective: We aimed to evaluate the usability and usefulness of a new mobile application to engage people with DFUs in self-care. Methods: We developed a new mobile application, "MyFootCare", to engage patients with DFU through goal-setting, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extracts and monitors DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centred design process with 11 participants with DFUs. Data were collected through semi-structured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analysed qualitatively through thematic analysis. Results: Key themes were: (1) Participants already used mobile phone photos to monitor their DFU progress, but (2) had limited experience with using smartphone applications. (3) Participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress. (4) Participants were ambivalent about the MyFootCare goal setting and diary features, commenting that these features were useful but also that it was unlikely that they would use them. (5) Participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress. Conclusions: MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data is useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, i.e., by refining the process of taking and analysing DFU photos and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions, and to trial it with people with DFUs and their carers.

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Section: Principal Resultsmentioning

confidence: 99%

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

Ploderer¹,

Brown²,

Seng³

et al. 2018

Preprint

Self Cite

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“…Using support vector machines, they could determine the wound boundaries even more accurately . Van Netten et al found that assessment of diabetic foot ulcers using a mobile phone compared to live assessment (as reference), gave strong support for the decision for per‐wound debridement, but low interobserver reliability [kappa ( k ) = 0.09 ‐ 0.49] and a moderate intra‐observer reliability ( k = 0.47 ‐ 0.64) for assessing the presence of ischemia, infection, granulation, slough, tracking or tunneling, moist or an exuding wound, cellulitis, or erythema …”

Section: Resultsmentioning

confidence: 99%

“…More recently, Van Netten et al concluded that there was a low interobserver and moderate intraobserver reliability in the diagnosis of a variety of diabetic foot problems based on mobile phone images . Overall, these findings suggest that digital (mobile phone) images have applicability in some areas of assessment of pre‐signs of ulceration, but are limited in use in others.…”

Section: Discussionmentioning

confidence: 99%

“…Type of Approach/Technology Dermal thermography Infrared 19 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]37 Thermistor 2 35,36 Liquid-crystal 3 [38][39][40] Hyperspectral imaging 11 [41][42][43][44][45][46][47][48][49][50][51] Photographic imaging 13 [52][53][54][55][56][57][58][59][60][61][63][64][65] Dermal thermography + photographic imaging 1 62 Audio/video/online communication 12 [66][67]…”

Section: Number Of Studies Referencesmentioning

confidence: 99%

“…56 Using support vector machines, they could determine the wound boundaries even more accurately. 57 58 Bus et al showed that with using a photographic foot imaging device intended for home use, a good agreement between live and photographic assessment (>74%) and between repeated photographic assessments (>82%) could be obtained for assessing the presence of abundant callus, ulceration and for the absence of signs. 59 This was T A B L E 2 Assessment of risk of bias in the included (non)randomized controlled trials 60 Outcomes were also reliable between repeated photographic assessments (k = 0.70-1.00).…”

Section: Photographic Imagingmentioning

confidence: 99%

See 2 more Smart Citations

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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Skin‐Inspired Antibacterial Conductive Hydrogels for Epidermal Sensors and Diabetic Foot Wound Dressings

Zhao

Song

et al. 2019

Adv Funct Materials

437

298

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Recently, artificial intelligence research has driven the development of stretchable and flexible electronic systems. Conductive hydrogels are a class of soft electronic materials that have emerging applications in wearable and implantable biomedical devices. However, current conductive hydrogels possess fundamental limitations in terms of their antibacterial performance and a mechanical mismatch with human tissues, which severely limits their applications in biological interfaces. Here, inspired by animal skin, a conductive hydrogel is fabricated from a supramolecular assembly of polydopamine decorated silver nanoparticles (PDA@Ag NPs), polyaniline, and polyvinyl alcohol, namely PDA@Ag NPs/CPHs. The resultant hydrogel has many desirable features, such as tunable mechanical and electrochemical properties, eye‐catching processability, good self‐healing ability as well as repeatable adhesiveness. Remarkably, PDA@Ag NPs/CPHs exhibit broad antibacterial activity against Gram‐negative and Gram‐positive bacteria. The potential application of this versatile hydrogel is demonstrated by monitoring large‐scale movements of the human body in real time. In addition, PDA@Ag NPs/CPHs have a significant therapeutic effect on diabetic foot wounds by promoting angiogenesis, accelerating collagen deposition, inhibiting bacterial growth, and controlling wound infection. To the best of the authors' knowledge, this is the first time that conductive hydrogels with antibacterial ability are developed for use as epidermal sensors and diabetic foot wound dressing.

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The validity and reliability of remote diabetic foot ulcer assessment using mobile phone images

Cited by 65 publications

References 35 publications

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

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

Skin‐Inspired Antibacterial Conductive Hydrogels for Epidermal Sensors and Diabetic Foot Wound Dressings

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