Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

More documents

Recommendations

Info

Section 8: Diabetes Foot ProblemsIssueDoes patient education improve footcare and outcomes?RecommendationPeople with diabetes should receive specific footcare education.Evidence Statements• Footcare education for people with diabetes improves knowledge and may improveself care behaviourEvidence Level I• Footcare education for people with diabetes may prevent serious foot lesions andamputationEvidence Level I58
Background - Patient Education and Foot DiseaseAn integral part of any strategy to reduce diabetes foot problems requires people withdiabetes to have adequate knowledge to be able to take appropriate action to minimisetheir risk of developing foot complications (Levin, 1995). Deficiencies in self care offeet can occur because people with diabetes have received inadequate information orare not aware of the importance of, or are unable to perform, foot self care behaviour.One study showed that 89% of people with diabetes whose feet are at increased riskwere making multiple errors in their foot self care behaviour (Plummer & Albert,1995). Unfortunately the healthcare system does not currently provide easilyaccessible education or podiatry services for people with diabetes whose feet are “atrisk” (Fletton et al, 1995). Those who are physically unable to practice self footcaredue to age or a disability, like visual impairment, are often dependent on family orcarers who must also be involved in the educational process. Also people with a lowersocio-economic status have increased risk of foot ulceration and poorly fitting (or lackof) footwear (Day & Harkless, 1997).The extent and nature of the education necessary to prevent the development ofdiabetic foot problems and the means of selecting an appropriate educational strategyfor each person is another important consideration. There is a general lack ofconsistency of educational interventions which have used different methods, targetgroups, settings and methods of follow-up which has complicated interpretation ofeducational studies (Mason et al, 1999).Even the most successful published footcare education programmes have not alwayscontinued to be used in the institutions where they were developed (Pichert & Penha,1993). Footcare education programmes should be coordinated and not provideeducation to people with diabetes but staff should also receive education andprompting to perform routine footcare tasks.Evidence - Patient Education and Foot DiseaseFootcare education for people with diabetes improves knowledge and mayimprove self care behaviourValk et al (2002) conducted a Cochrane systematic review through searchingMedline, CINAHL and EMBASE, hand searching of wound care journals andrelevant conference proceedings and identified 8 prospective randomised controlledtrials which evaluated educational programmes for the prevention of foot ulcers inpeople with Type 1 or 2 diabetes. Four RCTs comparing intensive with briefeducational interventions were identified (Barth et al, 1991; Kruger et al, 1992;Ronnemaa et al, 1997; Malone et al, 1989). All four were performed in an outpatientcare setting. Patients' knowledge of foot care was reported in 3 of the 4 RCTs (Barthet al, 1991; Kruger et al, 1992; Ronnemaa et al, 1997). This outcome was significantlyimproved in 2 of the RCTs, at 6 months in one (Barth et al, 1991) and at 1 year in theother (Ronnemaa et al, 1997). In one RCT, foot care knowledge was not improved inthe intervention group at 6 months follow up (Kruger et al, 1992). However, this RCTstudied small groups (23 patients in the intervention group and 27 in the controlgroup), and also had a relatively high dropout rate.59
Page 1:
National Evidence Based Guidelinesf
Page 4:
Research OfficersMs Linda SmithPodi
Page 7 and 8: 2.2 Issues for Foot Problems in Typ
Page 9: • Aim to achieve the best possibl
Page 12 and 13: Background - Peripheral Neuropathy
Page 14 and 15: proportion of subjects with a durat
Page 16 and 17: and an OR 1.1-7.8. This study also
Page 18 and 19: Summary - Peripheral Neuropathy as
Page 20 and 21: Section 2: Diabetes Foot ProblemsIs
Page 22 and 23: predicting risk of amputation, 2.9
Page 24 and 25: Summary - Peripheral Vascular Disea
Page 28 and 29: Evidence - Foot Deformity and Previ
Page 30 and 31: people with both LJM and neuropathy
Page 32 and 33: Summary - Foot Deformity and Previo
Page 36 and 37: Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
Page 42 and 43: The other frequently reported metho
Page 44 and 45: side; and 82% having the same resul
Page 46 and 47: Evidence Table: Section 5Detection
Page 48 and 49: Background - Clinical Detection of
Page 50 and 51: pulse was bilaterally absent in 1.8
Page 52 and 53: Evidence Table: Section 6AuthorClin
Page 54 and 55: Background - Frequency of Foot Exam
Page 56 and 57: Summary - Frequency of Foot Examina
Page 60 and 61: Behaviour assessment scores, measur
Page 62 and 63: Mazzuca et al (1986) studies 532 pe
Page 64 and 65: with before the programme, after 1-
Page 66 and 67: Evidence Table: Section 8AuthorEffe
Page 68 and 69: Background - Glycaemic Control and
Page 70 and 71: In a previous Japanese randomised s
Page 72 and 73: Evidence Table: Section 9AuthorGlyc
Page 74 and 75: Background - Footwear to Reduce Ulc
Page 76 and 77: period. In addition people without
Page 78 and 79: Comparisons of in-shoe foot pressur
Page 80 and 81: The rate of plantar callus formatio
Page 82 and 83: Evidence Table: Section 10AuthorFoo
Page 84 and 85: Background - Foot Clinics and Multi
Page 86 and 87: A prospective non randomised contro
Page 88 and 89: Summary - Foot Clinics and Multi-di
Page 90 and 91: Section 12: Diabetes Foot ProblemsI
Page 92 and 93: and/or osteomyelitis; III - fore-fo
Page 94 and 95: Summary - Economic consequences•
Page 96 and 97: Section 13: Diabetes Foot ProblemsI
Page 98 and 99: Some ethnic groups are associated w
Page 100 and 101: Evidence Table: Section 13AuthorSoc
Page 102 and 103: Calle-Pascual AL, Duran A, Diaz A,
Page 104 and 105: Jannink MJ, van Dijk H, de Vries J,
Page 106 and 107: Moss SE, Klein R, Klein BE. The 14-
Page 108 and 109:
Soulier SM, Godsey C, Asay ED, Perr
Page 110 and 111:
Diabetes Foot Problems: General Ref
Page 112 and 113:
McNeely MJ, Boyko EJ, Ahroni JH, St
Page 114 and 115:
Diabetes Foot Problems: Other Refer
Page 116 and 117:
Caputo GM, Cavanagh PR, Ulbrecht JS
Page 118 and 119:
Garbalosa JC, Cavanagh PR, Wu G, Ul
Page 120 and 121:
Lavery LA, Armstrong DG, Wunderlich
Page 122 and 123:
Payne C. Regional variations of dia
Page 124 and 125:
Tovi J, Svanborg E, Nilsson BY, Eng
Page 126 and 127:
Criteria used to determine the suit
Page 128 and 129:
QUESTIONS KEY WORDS NO.ARTICLESIDEN
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
show all

Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?