|
1
|
Simonsen NV, Klassen AF, Rae C, Mundy LR, Poulsen L, Pusic AL, Fan KL, Sørensen JA. The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study. Adv Wound Care (New Rochelle) 2025; 14:238-250. [PMID: 38775456 DOI: 10.1089/wound.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.
Collapse
Affiliation(s)
- Nina Vestergaard Simonsen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
| | - Andrea L Pusic
- Department of Surgery and Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar, MedStar Plastic and Reconstructive Surgery, Washington, USA
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
|
2
|
Bodhare T, Bele S, B B, M R, Francis J G, V S, Muthiah T, Rajh B. Health Costs and Quality of Life Among Diabetic Foot Ulcer Patients in South India: A Cross-Sectional Study. Cureus 2025; 17:e79950. [PMID: 40177452 PMCID: PMC11963437 DOI: 10.7759/cureus.79950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2025] [Indexed: 04/05/2025] Open
Abstract
INTRODUCTION The financial burden of managing diabetic foot ulcers (DFUs) can lead to catastrophic health expenditure (CHE) and financial hardship, ultimately impacting the quality of life (QoL) of patients. The relationship between healthcare costs and health-related quality of life (HRQoL) is critical for understanding the broader implications on patients' physical, psychological, and social well-being. METHODOLOGY A cross-sectional study was conducted among DFU patients selected using convenient sampling. A semi-structured questionnaire was used to assess patients' socio-demographic and clinical characteristics. HRQoL was assessed using the 36-Item Short Form Survey (SF-36). RESULTS The sample population was 173 patients, including 125 (72.3%) male and 48 (27.7%) female patients. The mean age was 57.80 ± 10.51 years. The total out-of-pocket expenditure (OOPE) amounted to Rs. 89317.51 ± 150378.81 ($1134.33 ± 1909.81). Around 81 (46.8%) patients were experiencing CHE. The socioeconomic status, duration of diabetes, and severity of wounds significantly influence the likelihood of experiencing CHE (p < 0.05). Lower QoL scores were obtained in the domain of physical functioning (37.23 ± 23.26), role physical (17.34 ± 30.55), and role emotional (18.11 ± 32.64). Gender, occupational status, comorbidities, wound duration, Wagner's grading of ulcers, and CHE significantly impact various domains of HRQoL (p < 0.05). CONCLUSION The substantial healthcare costs of managing DFUs can result in financial strain, negatively influencing patients' QoL. Therefore, it is essential to focus on both the financial implications of diabetes management and the enhancement of patients' QoL to achieve better health outcomes.
Collapse
Affiliation(s)
- Trupti Bodhare
- Community and Family Medicine, All India Institute of Medical Sciences, Madurai, Madurai, IND
| | - Samir Bele
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| | - Balakumaran B
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| | - Ramji M
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| | - Gavin Francis J
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| | - Shalini V
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| | - Thendral Muthiah
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| | - Bharath Rajh
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
| |
Collapse
|
|
3
|
Crowther RG, Robertson A, Fernando ME, Lazzarini PA, Sangla KS, Golledge J. Lower limb gait joint coordination variability in people with diabetes-related foot ulcers. Clin Biomech (Bristol, Avon) 2025; 121:106382. [PMID: 39579500 DOI: 10.1016/j.clinbiomech.2024.106382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 10/30/2024] [Accepted: 11/14/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND Diabetes-related foot ulcers pose substantial health risks globally, yet the biomechanical intricacies underlying their development remain incompletely understood. This study aimed to evaluate lower limb gait joint coordination variability in individuals with diabetes-related foot ulcers compared to those with diabetes (without diabetes-related foot ulcers) and healthy controls. METHODS A total of 99 participants (diabetes-related foot ulcers cases - 16, Diabetes controls - 50, Health controls - 33) compared three self-paced walking trials. Vector coding, a technique quantifying movement coordination, was employed, analysing hip-knee, knee-ankle, and hip-angle joint couplings in the sagittal plane. FINDINGS No significant differences in coordination variability were found among the groups. However, distinct coupling pattern frequencies emerged, with diabetes-related foot ulcers cases exhibiting unique anti-phase hip and ankle coupling frequency counts compared to healthy controls. INTERPRETATION These findings challenge conventional understandings of diabetes-related foot ulcers biomechanics and underscore the complexity of gait in this population.
Collapse
Affiliation(s)
- Robert G Crowther
- Exercise and Sports Science, School of Science and Technology, Armidale, New South Wales, Australia.
| | - Aaron Robertson
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Malindu E Fernando
- Gait Analysis Laboratory, Institute of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia; Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter A Lazzarini
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kunwarjit S Sangla
- Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| |
Collapse
|
|
4
|
Alahakoon C, Thanigaimani S, Singh TP, Drovandi A, Charles J, Fernando M, Lazzarini PA, Moxon JV, Golledge J. Association of remoteness and ethnicity with major amputation following minor amputation to treat diabetes-related foot disease. PLoS One 2024; 19:e0302186. [PMID: 38968185 PMCID: PMC11226033 DOI: 10.1371/journal.pone.0302186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/28/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Minor amputation is commonly needed to treat diabetes-related foot disease (DFD). Remoteness of residence is known to limit access to healthcare and has previously been associated with poor outcomes. The primary aim of this study was to examine the associations between ethnicity and remoteness of residency with the risk of major amputation and death following initial treatment of DFD by minor amputation. A secondary aim was to identify risk factors for major amputation and death following minor amputation to treat DFD. RESEARCH DESIGN AND METHODS This was a retrospective analysis of data from patients who required a minor amputation to treat DFD between 2000 and 2019 at a regional tertiary hospital in Queensland, Australia. Baseline characteristics were collected together with remoteness of residence and ethnicity. Remoteness was classified according to the 2019 Modified Monash Model (MMM) system. Ethnicity was based on self-identification as an Aboriginal and Torres Strait Islander or non-Indigenous person. The outcomes of major amputation, repeat minor amputation and death were examined using Cox-proportional hazard analyses. RESULTS A total of 534 participants were included, with 306 (57.3%) residing in metropolitan or regional centres, 228 (42.7%) in rural and remote communities and 144 (27.0%) were Aboriginal or Torres Strait Islander people. During a median (inter quartile range) follow-up of 4.0 (2.1-7.6) years, 103 participants (19.3%) had major amputation, 230 (43.1%) had repeat minor amputation and 250 (46.8%) died. The risks (hazard ratio [95% CI]) of major amputation and death were not significantly higher in participants residing in rural and remote areas (0.97, 0.67-1.47; and 0.98, 0.76-1.26) or in Aboriginal or Torres Strait Islander people (HR 1.44, 95% CI 0.96, 2.16 and HR 0.89, 95% CI 0.67, 1.18). Ischemic heart disease (IHD), peripheral artery disease (PAD), osteomyelitis and foot ulceration (p<0.001 in all instances) were independent risk factors for major amputation. CONCLUSION Major amputation and death are common following minor amputation to treat DFD and people with IHD, PAD and osteomyelitis have an increased risk of major amputation. Aboriginal and Torres Strait Islander People and residents of remote areas were not at excess risk of major amputation.
Collapse
Affiliation(s)
- Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Tejas P. Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - James Charles
- First Peoples Health Unit, Griffith University, Brisbane, Queensland, Australia
| | - Malindu Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter A. Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joseph V. Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| |
Collapse
|
|
5
|
Sharma A, S J. The effect of Tecar therapy on neurological disorders and nerve conduction velocity of lower limbs in peripheral neuropathy of type 2 diabetic patients: A six-week follow-up study. Turk J Phys Med Rehabil 2024; 70:289-290. [PMID: 38948642 PMCID: PMC11209323 DOI: 10.5606/tftrd.2024.14394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 07/02/2024] Open
Affiliation(s)
- Adarsh Sharma
- Department of Physiotherapy, Amar Jyoti Institute of Physiotherapy (University of Delhi), Karkardooma-Delhi, India
| | - Jeyanthi S
- Department of Physiotherapy, Amar Jyoti Institute of Physiotherapy (University of Delhi), Karkardooma-Delhi, India
| |
Collapse
|
|
6
|
Chang S, Jian Y, Liu C, Dal Prà I, Armato U, Chen X, Zhou J, Chen W, Zhang F, Nie K, De Santis D, Deng C, Wei Z. Combining antibiotic-loaded bone cement-based free vastus lateralis muscle-sparing flap with split-thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non-weight-bearing areas. Int Wound J 2024; 21:e14900. [PMID: 38705731 PMCID: PMC11070315 DOI: 10.1111/iwj.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Diabetic foot ulcers (DFUs) present significant challenges due to their associated amputation rates, mortality, treatment complexity and excessive costs. Our earlier work introduced a wound surgical integrated treatment (WSIT) for DFUs, yielding promising outcomes. This study focuses on a specific WSIT protocol employing antibiotic-loaded bone cement (ALBC) in the first Stage, and free vastus lateralis muscle-sparing (VLMS) flaps and split-thickness skin grafts (STSGs) in the second stage to repair non-weight-bearing DFUs. From July 2021 to July 2023, seven DFU patients (aged 47-71 years) underwent this treatment. Demographic data, hospital stay and repair surgery times were collected. Histological and immunohistochemical analyses assessed angiogenesis, collagen deposition and inflammation. SF-36 questionnaire measured pre- and postoperative quality of life. Preoperative ultrasound Doppler showed that the peak blood flow velocity of the recipient area artery was significantly >30 cm/s (38.6 ± 6.8 cm/s) in all patients. Muscle flap sizes varied from 8 × 3.5 × 1 to 18 × 6 × 2 cm. The operation time of the repair surgery was 156.9 ± 15.08 minutes, and the hospital stay was 18.9 ± 3.3 days. Histological analysis proved that covering DFUs with ALBC induced membrane formation and increased collagen, neovascularization and M2 macrophages fraction while reducing M1 macrophages one. All grafts survived without amputation during a 7- to 24-month follow-up, during which SF-36 scores significantly improved. A combination of ALBC with free VLMS flaps and STSGs proved to be safe and effective for reconstructing non-weight-bearing DFUs. It rapidly controlled infection, enhanced life quality and foot function, and reduced hospitalization time. We advocate integrating this strategy into DFU treatment plans.
Collapse
Affiliation(s)
- Shusen Chang
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Yang Jian
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Chenxiaoxiao Liu
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Ilaria Dal Prà
- Department of Surgery, Dentistry, Pediatrics & GynecologyUniversity of Verona Medical SchoolVeronaItaly
| | - Ubaldo Armato
- Department of Surgery, Dentistry, Pediatrics & GynecologyUniversity of Verona Medical SchoolVeronaItaly
| | - Xin Chen
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Jian Zhou
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Wei Chen
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Fang Zhang
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Kaiyu Nie
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Daniele De Santis
- Department of Surgery, Dentistry, Pediatrics & GynecologyUniversity of Verona Medical SchoolVeronaItaly
| | - Chengliang Deng
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Zairong Wei
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| |
Collapse
|
|
7
|
Mairghani M, Patton D, Sorensen J, Elmusharaf K, Jassim G, Eltahir O, Moore Z. Health-related quality of life in patients with diabetic foot ulcers in the Arab world: a systematic review. J Wound Care 2024; 33:253-261. [PMID: 38573904 DOI: 10.12968/jowc.2024.33.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To conduct a systematic review to identify the impact of diabetic foot ulceration (DFU) on health-related quality of life (HRQoL) in individuals within the Arab world. METHOD A PRISMA-guided systematic search for HRQoL studies in Arab populations was conducted in CINAHL, PubMed, Scopus and EBSCO. Relevant studies were critically appraised using the STROBE statement checklist. RESULTS A total of five studies were included. Three studies originated from Saudi Arabia, one from Jordan and one from Tunisia. The studies consistently demonstrated lower (poorer) HRQoL in patients with DFU, and worse HRQoL compared with both patients with diabetes and no DFU, and with healthy subjects. CONCLUSION This review confirmed the negative impact of DFU on HRQoL in individuals with diabetes. It also highlights the scarcity of HRQoL studies from the Arab world. However, given that all studies included were conducted between 2013-2019, this could reflect a growing interest in DFU and HRQoL in the Arab world, and could potentially indicate that more studies will follow. In light of this, there is a need for a renewed focus on the completion of a high-quality standardised approach to research in this region.
Collapse
Affiliation(s)
- Maisoon Mairghani
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Converge: Centre for Chronic Disease and Population Health Research, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Omer Eltahir
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zena Moore
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
|
8
|
Waibel FWA, Uçkay I, Soldevila-Boixader L, Sydler C, Gariani K. Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review. Front Endocrinol (Lausanne) 2024; 14:1323315. [PMID: 38298183 PMCID: PMC10829909 DOI: 10.3389/fendo.2023.1323315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.
Collapse
Affiliation(s)
- Felix W. A. Waibel
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Soldevila-Boixader
- Infectious Diseases, Internal Medicine Department, Consorci Sanitari Integral-CSI, Sant Joan Despí Hospital, Barcelona, Spain
| | - Christina Sydler
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic Education, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
| |
Collapse
|
|
9
|
Byrnes J, Ward L, Jensen S, Sagoo M, Charles D, Mann R, Nghiem S, Finch J, Gavaghan B, McBride LJ, Lazzarini PA. Health-related quality of life in people with different diabetes-related foot ulcer health states: A cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states. Diabetes Res Clin Pract 2024; 207:111061. [PMID: 38104903 DOI: 10.1016/j.diabres.2023.111061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
AIMS Diabetes-related foot ulcers (DFU) are a leading cause of infection, hospitalisation and amputation. However, to our knowledge no studies have compared the health-related quality of life (HRQoL) of people with DFU that were infected, hospitalised or amputated. This study aimed to investigate and compare the HRQoL of different groups of people with healed, non-infected, infected, hospitalised, or amputated DFU. METHODS This was a multi-centre cross-sectional study measuring the HRQoL of patients, attending one of 18 Diabetic Foot Services across Queensland, Australia, with one of five DFU health states: healed, non-infected, infected, hospitalised, amputated. HRQoL was measured using the EQ-5D-5L to estimate age-sex adjusted utility values. RESULTS Of 376 included patients (mean age 63 (12) years, 75% male), age-sex adjusted HRQoL utility estimates (95% CIs) were: healed DFU 0.57 (0.51-0.64), non-infected DFU 0.55 (0.49-0.62), infected DFU 0.45 (0.36-0.55), hospitalised DFU 0.53 (0.42-0.64), and amputated DFU 0.55 (0.46-0.63). CONCLUSION People in any DFU health state have considerably reduced HRQoL, with greatest reductions in those with infected DFU. These findings provide valuable HRQoL estimates and comparisons for several different important DFU health states, adding to our understanding of the impact of DFU on HRQoL and facilitating future economic evaluations.
Collapse
Affiliation(s)
- Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia.
| | - Lauren Ward
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Sarah Jensen
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Manjeet Sagoo
- Diabetes Resource Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Danielle Charles
- Cairns Diabetes Centre, Cairns and Hinterland Hospital and Health Service, and Metro North Hospital and Health Service, Queensland, Australia
| | - Rebecca Mann
- Chronic Disease Brisbane South, Community and Oral Health, Inala Community Health Centre, Metro South Health, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Finch
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Belinda Gavaghan
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Liza-Jane McBride
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Peter A Lazzarini
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
|
10
|
Alkhalfan Y, Lewis TL, Kavarthapu V, Hester T. Investigation and management of diabetic foot osteomyelitis: An update for the foot and ankle orthopaedic surgeon. J Clin Orthop Trauma 2024; 48:102330. [PMID: 38274641 PMCID: PMC10806189 DOI: 10.1016/j.jcot.2023.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving endocrinologists, infectious disease specialists, vascular surgeons, orthopaedic surgeons, and wound care experts. Early diagnosis is paramount, facilitated by advanced imaging techniques such as magnetic resonance imaging (MRI) and bone scintigraphy. Once diagnosed, the treatment strategy hinges on a combination of medical and surgical interventions. Antibiotic therapy, guided by culture results, plays a central role in managing DFO. Tailored regimens targeting the specific pathogens involved are administered, often for prolonged durations. Surgical intervention becomes necessary when conservative measures fall short. Surgical approaches range from minimally invasive procedures, like percutaneous drainage, to more extensive interventions like debridement and bone resection. Prevention of DFO recurrence is equally vital, emphasising glycemic control, meticulous foot care, patient education, monitoring of at-risk signs, revascularization and early intervention when indicated. The management of diabetic foot osteomyelitis mandates a comprehensive strategy that addresses both the infectious and surgical aspects of the condition. A collaborative, interdisciplinary approach ensures timely diagnosis, tailored treatment, and holistic care. Further research into novel therapeutic modalities and long-term outcomes remains essential in refining the management of this complex and debilitating complication of diabetes.
Collapse
Affiliation(s)
- Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | | | - Venu Kavarthapu
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK
| | - Thomas Hester
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK
| |
Collapse
|
|
11
|
Mairghani M, Sorensen J, Elmusharaf K, Patton D, Moore Z. The health-related quality of life in patients with diabetic foot ulcers in the Kingdom of Bahrain. J Tissue Viability 2023; 32:465-471. [PMID: 37385873 DOI: 10.1016/j.jtv.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
AIMS The aims of this study were to assess the health-related quality of life (HRQoL) of adult Bahraini patients with diabetic foot ulcers (DFU) and to explore factors associated with poor HRQoL. METHODS Cross-sectional HRQoL data were obtained from a sample of patients in active treatment for DFU at a large public hospital in Bahrain. Patient-reported HRQOL was measured using the following instruments: DFS-SF, CWIS and EQ-5D. RESULTS The patient sample included 94 patients, with a mean age of 61.8 (SD: 9.9) years, 54 (57.5%) were males, and 68 (72.3%) were native Bahrainis. Poorer HRQoL was found among patients who were unemployed, divorced/widowed, and those with a shorter duration of formal education. Additionally, patients with severe DFUs, persisting ulcers, and a longer duration of diabetes reported statistically significantly poorer HRQoL. CONCLUSIONS Findings from this study demonstrate a low level of HRQoL among Bahraini patients with DFUs. A longer duration of diabetes, in addition to ulcer severity and status statistically significantly influence HRQoL.
Collapse
Affiliation(s)
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Declan Patton
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Zena Moore
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
|
12
|
Sadler S, Gerrard J, Searle A, Lanting S, West M, Wilson R, Ginige A, Fang KY, Chuter V. The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review. J Med Internet Res 2023; 25:e47608. [PMID: 37792467 PMCID: PMC10585435 DOI: 10.2196/47608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes. OBJECTIVE This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally. METHODS PubMed, Informit's Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies. RESULTS No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33%) provided functionality for participants to enter health-related data; 1 (17%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app. CONCLUSIONS The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes. TRIAL REGISTRATION PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd.
Collapse
Affiliation(s)
- Sean Sadler
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
| | - James Gerrard
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
- Central Australian Aboriginal Congress, Mparntwe (Alice Springs), Australia
| | | | - Sean Lanting
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
| | - Matthew West
- Western Sydney University, Campbelltown, Australia
| | - Rhonda Wilson
- University of Newcastle, Gosford, Australia
- Massey University, Auckland, New Zealand
| | | | - Kerry Y Fang
- Western Sydney University, Campbelltown, Australia
| | - Vivienne Chuter
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
| |
Collapse
|
|
13
|
Wang X, Hu X, Que H. Development of Patient-Reported Outcome Scale for Patients with Diabetic Foot and Its Reliability and Validity Test. Diabetes Metab Syndr Obes 2023; 16:2921-2927. [PMID: 37750093 PMCID: PMC10518140 DOI: 10.2147/dmso.s419841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/09/2023] [Indexed: 09/27/2023] Open
Abstract
Objective To construct a self-reported outcome scale for diabetic foot patients, and to test its reliability and validity. Methods Through literature reading and interviews with 30 patients, a pool of scale items was formed. The items were classified and sorted out according to the expected scale structure framework. After two rounds of expert consultation and a small range of test dressing, the initial scale was formed. Through the investigation of 85 patients with diabetic foot, item differentiation analysis, correlation analysis and exploratory factor analysis were used to screen the items. Cronbach's α coefficient, retest reliability and content and structure validity analysis were used to determine the feasibility and validity of the scale. Results The final scale included 4 first-level items and 22 second-level items. The critical ratio method showed that the scores of each item in the high group and the low group were significantly different (P < 0.05). Correlation analysis showed that the correlation coefficient between each item and the total score was 0.431 to 0.829; The content validity index of the scale was 0.91, the exploratory factor analysis identified three common factors, and the cumulative variance contribution rate was 75.381%. The confirmatory factor analysis showed that the model fit well. The Cronbach's α coefficient of the scale was 0.934 and the retest reliability coefficient was 0.926. Conclusion The self-reported outcome scale for diabetic foot patients has good reliability and validity, and can be used to investigate the health status of diabetic foot patients and evaluate the therapeutic effect.
Collapse
Affiliation(s)
- Xuanyu Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Xiaojie Hu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Huafa Que
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| |
Collapse
|
|
14
|
Søndergaard SF, Vestergaard EG, Andersen AB, Kolbæk R, Dahl M, Høgh A. How patients with diabetic foot ulcers experience telemedicine solutions: A scoping review. Int Wound J 2023; 20:1796-1810. [PMID: 36453130 PMCID: PMC10088844 DOI: 10.1111/iwj.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a common, complex and severe complication of diabetes that is associated with severely decreased health-related quality of life. Treatment of DFUs calls for a multi-sectoral approach, incorporating interdisciplinary care pathways. Telemedicine (TM) may be used as a communication tool between caregivers across healthcare sectors to obligate the need for close follow-up, including early intervention in preventing the recurrence of DFU. The objective of this review was to identify, examine and conceptually map the available literature on patients' experiences and views regarding the use of TM solutions among patients with DFUs. We identified the Population, Concept and Context to pinpoint the focus of this review, word the research question and title as well as facilitate the literature search strategy. The literature examined stems from 13 sources. We imposed no restrictions on the methodological approach of the included studies, neither on the format. During the review process, four main maps emerged: "A whole human not merely a hole in a human," "Less of a burden on the family, the community and the environment," "Competences and continuity of care are essential for high-quality care" and "The quality and modality of the technology." Further investigation from both the patients' and the multi-sectoral caregivers' perspective is needed, focusing on whatever modifications of the TM intervention may fit the DFU care pathway better.
Collapse
Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical NursingRegional Hospital ViborgViborgDenmark
- VIA University College and Aarhus University, HealthAarhusDenmark
| | - Else Godsk Vestergaard
- Wound Nurse, Vascular Research Unit, Department of SurgeryViborg Regional HospitalViborgDenmark
| | - Anne Bendix Andersen
- Centre for Research in Clinical NursingRegional Hospital ViborgViborgDenmark
- VIA University College and Aarhus University, HealthAarhusDenmark
| | | | - Marie Dahl
- Vascular Research Unit, Department of SurgeryViborg Regional HospitalViborgDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Clinical ResearchUniversity of Southern Denmark and Odense University HospitalOdenseDenmark
| | - Annette Høgh
- Vascular Research Unit and Wound Centre. Department of SurgeryRegional Hospital Viborg, Region Central JutlandViborgDenmark
- Institute for Clinical MedicineAarhus UniversityAarhusDenmark
| |
Collapse
|
|
15
|
Hitchman LH, Totty JP, Cai P, Smith GE, Carradice D, Chetter IC. Extracorporeal shockwave therapy for diabetic foot ulcers: a feasibility study. J Wound Care 2023; 32:182-192. [PMID: 36930191 DOI: 10.12968/jowc.2023.32.3.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the feasibility of delivering extracorporeal shockwave therapy (ESWT) to patients with diabetic foot ulcers (DFUs). It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT offers any patient-reported benefits. METHOD In this single-centre, mixed methods feasibility study, patients with a DFU who met the eligibility criteria underwent ESWT three times over a seven-day period. Primary outcome was feasibility of delivering the intervention. Secondary outcomes included wound size, number of DFUs healed at 12 weeks and quality of life (QoL). Semi-structured interviews explored participants' experience of undergoing ESWT. RESULTS Of 106 patients screened, 24 (22.6%) were recruited. Following recruitment, two patients were withdrawn from the study with 22 patients included in the final analysis. The mean attendance at clinic was 90.9% and 65.1% for follow-up. The mean score for acceptability and tolerability was 9.86±0.48 (95% confidence interval (CI): 9.62-10.01) and 9.15±2.57 (95% CI: 7.87-10.42), respectively. There were no serious adverse events or side-effects. Of the DFUs, 45.5% healed during follow-up and QoL scores improved until eight weeks. Key themes identified from the qualitative interviews were: desire for fast healing; improved QoL; flexibility of new treatments; and accessibility of transport. CONCLUSION This study has shown that it is possible to recruit and retain patents into a single-arm study of ESWT for DFUs. This study supports development of a large randomised control trial to determine the clinical and cost-effectiveness of ESWT for DFU healing.
Collapse
Affiliation(s)
- Louise H Hitchman
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| | | | - Paris Cai
- Leeds University Teaching Hospitals, UK
| | - George E Smith
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| | - Daniel Carradice
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| | - Ian C Chetter
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| |
Collapse
|
|
16
|
Tehan PE, Burrows T, Hawes MB, Linton C, Norbury K, Peterson B, Walsh A, White D, Chuter VH. Factors influencing diabetes-related foot ulcer healing in Australian adults: A prospective cohort study. Diabet Med 2023; 40:e14951. [PMID: 36054775 PMCID: PMC10087534 DOI: 10.1111/dme.14951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population. RESEARCH DESIGN AND METHODS This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation. RESULTS A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m2 , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03). CONCLUSIONS In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.
Collapse
Affiliation(s)
- Peta Ellen Tehan
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Allied HealthMonash UniversityClaytonVictoriaAustralia
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Morgan Brian Hawes
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Clare Linton
- Gosford Hospital High Risk Foot ClinicCentral Coast Local Health DistrictGosfordUK
| | - Kate Norbury
- Wyong Hospital High Risk Foot ClinicCentral Coast Local Health DistrictGosfordNew South WalesAustralia
| | - Benjamin Peterson
- School of Health, Medical and Applied SciencesCQUniversity AustraliaNorth RockhamptonQueenslandAustralia
| | - Annie Walsh
- Liverpool High Risk Foot ClinicSouth Western Sydney Local health DistrictKogarahNew South WalesAustralia
| | - Diane White
- John Hunter Hospital High Risk Foot ClinicHunter New England Local health DistrictNew LambtonNew South WalesAustralia
| | - Vivienne Helaine Chuter
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| |
Collapse
|
|
17
|
Zhang Y, Carter HE, Lazzarini PA, Cramb S, Pacella R, van Netten JJ, Cheng Q, Derhy PH, Kinnear EM, McPhail SM. Cost-effectiveness of guideline-based care provision for patients with diabetes-related foot ulcers: A modelled analysis using discrete event simulation. Diabet Med 2023; 40:e14961. [PMID: 36135359 PMCID: PMC10946962 DOI: 10.1111/dme.14961] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
AIMS The provision of guideline-based care for patients with diabetes-related foot ulcers (DFU) in clinical practice is suboptimal. We estimated the cost-effectiveness of higher rates of guideline-based care, compared with current practice. METHODS The costs and quality-adjusted life-years (QALYs) associated with current practice (30% of patients receiving guideline-based care) were compared with seven hypothetical scenarios with increasing proportion of guideline-based care (40%, 50%, 60%, 70%, 80%, 90% and 100%). Comparisons were made using discrete event simulations reflecting the natural history of DFU over a 3-year time horizon from the Australian healthcare perspective. Incremental cost-effectiveness ratios were calculated for each scenario and compared to a willingness-to-pay of AUD 28,000 per QALY. Probabilistic sensitivity analyses were conducted to incorporate joint parameter uncertainty. RESULTS All seven scenarios with higher rates of guideline-based care were likely cheaper and more effective than current practice. Increased proportions compared with current practice resulted in between AUD 0.28 and 1.84 million in cost savings and 11-56 additional QALYs per 1000 patients. Probabilistic sensitivity analyses indicated that the finding is robust to parameter uncertainty. CONCLUSIONS Higher proportions of patients receiving guideline-based care are less costly and improve patient outcomes. Strategies to increase the proportion of patients receiving guideline-based care are warranted.
Collapse
Affiliation(s)
- Yuqi Zhang
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneAustralia
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Hannah E. Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
| | - Peter A. Lazzarini
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneAustralia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneAustralia
| | - Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUK
| | - Jaap J. van Netten
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Department of Rehabilitation Medicine, Amsterdam Movement SciencesAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Qinglu Cheng
- Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Patrick H. Derhy
- Clinical Access and Redesign UnitQueensland HealthBrisbaneAustralia
| | - Ewan M. Kinnear
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneAustralia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social WorkQueensland University of TechnologyBrisbaneAustralia
- Digital Health and Informatics DirectorateMetro South HealthBrisbaneAustralia
| |
Collapse
|
|
18
|
Ma L, Ma W, Lin S, Li Y, Ran X. Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form Scale for Chinese Diabetic Foot Ulcers Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14568. [PMID: 36361446 PMCID: PMC9659257 DOI: 10.3390/ijerph192114568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The quality of life (QoL) of diabetic foot ulcer patients is worse than that of diabetic patients. The Diabetic Foot Ulcer Scale-Short Form (DFS-SF) is a readily available instrument used to evaluate the quality of life of diabetic foot ulcer individuals. The aim of this study was to translate the DFS-SF into Chinese, followed by an evaluation of its validity and reliability. METHODS This study was conducted in two phases. In the first phase, we followed the Brislin's Translation and Back-translation model to translate the DFS-SF into Mandarin Chinese. In the second phase, we examined the reliability and validity of the Chinese version of the DFS-SF, where the reliability was assessed in terms of Cronbach's α coefficient, split-half reliability, and test-retest reliability, and validation of the scale was carried out through content validity, structure validity and criterion validity approaches. RESULTS A total of 208 participants were recruited for our study. The item-level content validity index (I-CVI) of the Chinese version of the Diabetic Foot Ulcer Scale varied from 0.800 to 1.000, the average scale-level content validity index (S-CVI/Ave) was 0.911, and the Cronbach's α coefficient of the scale was 0.952. Confirmatory factor analysis indicated good structural validity of the scale, with a Comparative Fit Index (CFI) = 0.920 and a root mean square error of approximation (RMSEA) of 0.069 (p < 0.001). The criterion-related validity results indicated that the subscales were significantly related to the subscales of the 36-Item Short-Form Health Survey (SF-36), with coefficients ranging from 0.116 to 0.571 (p < 0.05). DISCUSSION The translation and the examination of the scale rigidly followed the golden standard model, and the reliability observed in our study was similar to that of other studies. Furthermore, the validity assessment indicated that the scale structure was reliable. Therefore, the proposed scales may serve as a reliable instrument for the quality of life evaluation in the diabetic foot ulcers population. CONCLUSION The adaptation and validation of the Chinese version of the Diabetic Foot Ulcers Scale-Short Form were reliable, and it will be a reliable instrument to evaluate the QoL of Chinese diabetic foot ulcer patients.
Collapse
Affiliation(s)
- Lin Ma
- West China School of Nursing, Sichuan University, Chengdu 610041, China
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wanxia Ma
- Chengdu Second People’s Hospital, Chengdu 610017, China
| | - Shuang Lin
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yan Li
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xingwu Ran
- West China School of Nursing, Sichuan University, Chengdu 610041, China
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
|
19
|
Chen Y, Ding X, Zhu Y, Jia Z, Qi Y, Chen M, Lu J, Kuang X, Zhou J, Su Y, Zhao Y, Lu W, Zhao J, Hua Q. Effect of tibial cortex transverse transport in patients with recalcitrant diabetic foot ulcers: A prospective multicenter cohort study. J Orthop Translat 2022; 36:194-204. [PMID: 36263383 PMCID: PMC9576490 DOI: 10.1016/j.jot.2022.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Management of recalcitrant diabetic foot ulcer (DFU) remains difficult. Distraction osteogenesis mediates new bone formation and angiogenesis in the bone itself and the surrounding tissues. Recently it was reported that tibial cortex transverse transport (TTT) was associated with neovascularization and increased perfusion at the foot in patients with recalcitrant DFUs and facilitated healing and limb salvage. However, the findings were from several single-center studies with relatively small populations, which need to be confirmed in multicenter cohort studies with relatively large populations. Furthermore, the effect of this technique on patient's health-related quality of life is still unclear. METHODS We treated patients with recalcitrant (University of Texas wound grading system 2-C to 3-D and not responding to prior routine conservative and surgical treatments for at least 8 weeks) DFUs from seven centers using TTT (a 5 cm × 1.5 cm corticotomy followed by 4 weeks of medial and lateral distraction) between July 2016 and June 2019. We analyzed ulcer healing, major amputation, recurrence, health-related quality of life (physical and mental component summary scores), and complications in the 2-year follow-up. Foot arterial and perfusion changes were evaluated using computed tomography angiography and perfusion imaging 12 weeks postoperatively. RESULTS A total of 1175 patients were enrolled. Patients who died (85, 7.2%) or lost to follow-up (18, 1.7%) were excluded, leaving 1072 patients for evaluation. Most of the patients were male (752, 70.1%) and with a mean age of 60.4 ± 9.1 years. The mean ulcer size was 41.0 ± 8.5 cm2 and 187 (16.6%) ulcers extended above the ankle. During the follow-up, 1019 (94.9%) patients healed in a mean time of 12.4 ± 5.6 weeks, 53 (4.9%) had major amputations, and 33 (3.1%) experienced recurrences. Compared to preoperatively, the patients had higher physical (26.2 ± 8.3 versus 41.3 ± 10.6, p = 0.008) and mental (33.6 ± 10.7 versus 45.4 ± 11.3, p = 0.031) component summary scores at the 2-year follow-up. Closed tibial fracture at the corticotomy site was found in 8 (0.7%) patients and was treated using external fixation and healed uneventfully. There were 23 (2.1%) patients who had pin site infections and were treated successfully with dressing changes. Compared to preoperatively, the patients had more small arteries and higher foot blood flow (8.1 ± 2.2 versus 28.3 ± 3.9 ml/100 g/min, p = 0.003) and volume (1.5 ± 0.3 versus 2.7 ± 0.4 ml/100 g, p = 0.037) 12 weeks postoperatively. CONCLUSION TTT promotes healing, limb salvage, and health-related quality of life in patients with recalcitrant DFUs as demonstrated in this multicenter cohort study. The surgical procedure was simple and straightforward and the complications were few and minor. The effect of this technique was associated with neovascularization and improved perfusion at the foot mediated by the cortex distraction. The findings are required to confirm in randomized controlled trials.The Translational Potential of this Article: TTT can be used as an effective treatment in patients with recalcitrant DFUs. The mechanism is associated with neovascularization and consequently increased perfusion in the foot after operation.
Collapse
Affiliation(s)
- Yan Chen
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Xiaofang Ding
- Department of Orthopaedics, Beijing Fulong Hospital, China
| | - Yueliang Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, China
| | - Zhongwei Jia
- Department of Orthopaedics, People's Hospital of Shanxi Province, China
| | - Yong Qi
- Department of Orthopaedics, The Second People's Hospital of Guangdong Province, China
| | - Mingyong Chen
- Department of Orthopaedics, Guizhou Aerospace Hospital, China
| | - Jili Lu
- Department of Orthopaedics, Baise People's Hospital, China
| | - Xiaocong Kuang
- Department of Physiopathology, Preclinical School of Guangxi Medical University, China
| | - Jia Zhou
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, China
| | - Yongfeng Su
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Yongxin Zhao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - William Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Jinmin Zhao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Qikai Hua
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| |
Collapse
|
|
20
|
Johnson MJ, Wukich DK, Nakonezny PA, Lavery LA, La Fontaine J, Ahn J, Truong DH, Liu GT, VanPelt M, Kim PJ, Raspovic KM. The Impact of Hospitalization for Diabetic Foot Infection on Health-Related Quality of Life: Utilizing PROMIS. J Foot Ankle Surg 2022; 61:227-232. [PMID: 34389216 DOI: 10.1053/j.jfas.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/26/2020] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
Diabetic foot infections (DFI) are an increasingly common cause of hospitalizations. Once hospitalized with DFI, many patients require some level of amputation, often undergoing multiple operations. With increasing importance on patient-centered metrics, self-reported health-related quality of life (HRQOL) tools have been developed. This prospective cohort study aimed assessed the impact of DFI on HRQOL. Two hundred twenty-four patients completed the 29-item Patient-Reported Outcome Measurement Information System (PROMIS) and 12-Item Short Form (SF-12) survey. Secondary outcomes using the Foot and Ankle Ability Measures survey were obtained and included in the analysis. The study group was comprised of hospitalized patients with DFIs (n = 120), and the control group was comprised of patients with diabetes who were evaluated for routine outpatient foot care (n = 104); diabetic foot screening, wound care, onychomycosis, and/or callosities. Using this cohort, a propensity score-matched sample of hospitalized patients with DFI (n = 35) and control group patients (n = 35) was created for comparative analysis. The 2-independent sample t test was used to test for group differences on each of the PROMIS subscale outcomes. Using PROMIS, we found that hospitalized patients with DFI reported significantly worse HRQOL in 6 of 7 subscales (physical function, anxiety, depression, fatigue, social role, pain intensity; p value range: .0001-.02) compared to outpatients with diabetes evaluated for routine foot care. There was no significant difference between the 2 groups on sleep disturbance (p = .22). Patients hospitalized for DFI report lower HRQOL compared to patients with diabetes receiving routine outpatient foot care.
Collapse
Affiliation(s)
- Matthew J Johnson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul A Nakonezny
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - David H Truong
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George Tye Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael VanPelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul J Kim
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
|
21
|
Zhu X, Olsson MM, Bajpai R, Järbrink K, Tang WE, Car J. Health-related quality of life and chronic wound characteristics among patients with chronic wounds treated in primary care: A cross-sectional study in Singapore. Int Wound J 2021; 19:1121-1132. [PMID: 34854234 PMCID: PMC9284657 DOI: 10.1111/iwj.13708] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
Chronic wounds commonly decrease patients' quality of life. Understanding how chronic wounds impact a patient's health‐related quality of life (HRQoL) is important for healthcare service delivery and treatment management. This study explored HRQoL among patients suffering from chronic wounds and investigated associations with patients' socio‐demographics and wound characteristics. Two hundred and thirty‐three patients across six primary care clinics were assessed and responded to a survey that collected information on socio‐demographic, wound characteristics, and HRQoL using the EQ‐5D‐5L instrument. Data were analysed by descriptive statistics and generalised linear models. The mean age of patients was 61.2 (SD: 14.6) years; 68.2% were males; and 61.8% were of Chinese origin. Arterial ulcers had the greatest negative impact on HRQoL related to mobility, self‐care, pain/discomfort and anxiety/depression, and the lowest VAS mean score 62.31 (SD: 28.3; range: 0‐100) indicating the worst health. HRQoL related to mobility was significantly associated with age (β = 0.008, P < .001), non‐Chinese ethnicity (β = 0.25, P = .001), mixed ulcers (β = −0.41, P = .022), atypical hard‐to‐heal wounds (β = −0.38, P = .021), wounds with low (β = 0.24, P = .044) to moderate (β = 0.29, P = .018) exudate level, and a wound duration ≥6 months (β = 0.19, P = .033). The findings can be used to improve healthcare delivery for patients with chronic wound to optimise their HRQoL.
Collapse
Affiliation(s)
- Xiaoli Zhu
- Nursing Services, National Healthcare Group Polyclinics, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Maja Magdalena Olsson
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,School of Medicine, Keele University, Staffordshire, UK
| | - Krister Järbrink
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wern Ee Tang
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
|
22
|
Gennai S, Leone N, Covic T, Migliari M, Lonardi R, Silingardi R. Health-related quality of life outcomes and Hospitalization length of stay after micro-fragmented autologous adipose tissue injection in minor amputations for diabetic foot ulceration (MiFrAADiF trial): results from a randomized controlled single-center clinical trial. INT ANGIOL 2021; 40:512-519. [PMID: 34515448 DOI: 10.23736/s0392-9590.21.04570-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The diabetic foot ulcer (DFU) is a high prevalence complication that significantly impairs the health-related quality of life (HRQoL) and is characterized by prolonged hospital length of stay (LOS). The impact of the micro-fragmented autologous adipose tissue injection at the minor amputation wound in the case of DFU (MiFrAADiF) on HRQoL and LOS compared to the standard care has not been determined yet. METHODS This was a two-arm, 6-month, individually randomized controlled single-center clinical trial. A 1:1 randomization to local injection of autologous micro-fragmented adipose tissue (treatment group; n=57) or standard clinical care (control group; n=57) was performed. The primary objective was the HRQoL. The secondary endpoint was the LOS. HRQoL was assessed with the Medical Outcomes Study 36-item Short-Form Health Survey which provides 2 scores focused on physical (PCS) and mental functioning (MCS). The trial was registered in ClinicalTrials.gov (NCT03276312). RESULTS The type of treatment (p=0.009) and the time elapsed since surgery (p= 0.0000) demonstrated a significant improvement on PCS. The MCS improvements resulted in a non-significant association with treatment (p= 0.21). The time elapsed since surgery showed a significant influence on the MCS (p= 0.0000). The mean LOS was 16.2 days and 24.4 days for the treatment and the control group respectively (p= 0.025). CONCLUSIONS The MiFrAADiF trial demonstrated a significant improvement in terms of physical HRQoL and a significant reduction of the hospital length of stay after injection of micro-fragmented autologous adipose tissue in diabetic patients' minor amputations wound.
Collapse
Affiliation(s)
- Stefano Gennai
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Leone
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy -
| | - Tea Covic
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Lonardi
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
|
23
|
Psychometric Validation of the Cardiff Wound Impact Schedule Questionnaire in a Spanish Population with Diabetic Foot Ulcer. J Clin Med 2021; 10:jcm10174023. [PMID: 34501471 PMCID: PMC8432453 DOI: 10.3390/jcm10174023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot ulcers (DFU) negatively affect the quality of life (QoL) of people with diabetes. The Cardiff Wound Impact Schedule (CWIS) questionnaire has been designed to measure the QoL of people with chronic foot wounds. However, no studies have been specifically designed to validate this instrument in a Spanish population. In this prospective study, a total of 141 subjects with DFU were recruited. DFU was determined by performing physical examinations. Medical records were exhaustively reviewed to collect clinical variables. The CWIS was transculturally adapted by a group of experts and a group of patients with DFU. The SF-36 and EQ-5D generic instruments were used as reference tools. The questionnaires were administered at 7 days and 4, 12, and 26 weeks after the baseline assessment by personal interview with each of the study subjects. The psychometric properties of the instrument were assessed using statistical methods. The content validity had an average of 3.63 (90.7% of the maximum score of 4). The internal consistency of the CWIS subscales had a standardized Cronbach’s alpha range from 0.715 to 0.797. The reproducibility was moderate with an intraclass correlation coefficient (ICC) range from 0.606 to 0.868. Significant correlations between CWIS domains and SF-36 and EQ-5D subscales were observed, demonstrating a good criterion validity of the CWIS questionnaire (p < 0.001). However, the construct validity of the CWIS was not validated with a comparative fit index (CFI) of 0.69, a root mean square error of approximation (RMSEA) of 0.09, and a standardized root mean square residual (SRMR) of 0.10. The sensitivity to changes over time was optimal in the three domains (i.e., social life, well-being, and physical symptoms) (p < 0.001). In conclusion, the Spanish version of the CWIS shows acceptable psychometric properties to assess the QoL of subjects with DFU, except for its construct validity.
Collapse
|
|
24
|
Transtibial Amputation with Removal of the Tibial Intramedullary Nail: Hardware Removal in a Retrograde Manner. Case Rep Orthop 2021; 2021:6654969. [PMID: 34336331 PMCID: PMC8313345 DOI: 10.1155/2021/6654969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Transtibial amputation is the preferred strategy for treating a diabetic foot with an infection and necrosis. However, if a tibial intramedullary nail was previously inserted into the ipsilateral lower extremity, the nail must be removed to perform the transtibial amputation. In this special situation, the removal of the tibial intramedullary nail can cause various complications after transtibial amputation. We present a case and surgical technique report of a 46-year-old male with an uncontrolled diabetic foot with tibial intramedullary nail insertion. With the nail and ankle fixed by distal interlocking screws, a below-knee amputation was performed by removing the nail and the amputated limb together. This surgical method is expected to reduce postoperative complications such as infections and patella instability after the amputation of a diabetic foot.
Collapse
|
|
25
|
Clinical Study of MEBO Combined with Jinhuang Powder for Diabetic Foot with Infection. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5531988. [PMID: 34335813 PMCID: PMC8294956 DOI: 10.1155/2021/5531988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/30/2021] [Indexed: 02/08/2023]
Abstract
Background To investigate the efficacy and safety of MEBO combined with Jinhuang powder for the treatment of diabetic foot with infection. Methods From August 2015 to August 2019, patients with diabetic foot in our hospital were divided into the treatment group and control group. The treatment group was treated with moist exposed burn ointment (MEBO) combined with Jinhuang powder, while the control group was treated with MEBO only. Results After one week of treatment, the effective rate in the treatment group was 100%, and the effective rate in the control group was only 76%. The difference between the two groups was statistically significant (P < 0.05). The wound pain score was 2.40 ± 1.38 in the treatment group and 3.76 ± 1.85 in the control group. The difference was statistically significant (P < 0.01). After one month of treatment, the effective rate of wound healing was 92.0% in the treatment group and 68% in the control group. The difference between the two groups was statistically significant (P < 0.05). Conclusion MEBO combined with Jinhuang powder is effective in treating diabetic foot with infection wound.
Collapse
|
|
26
|
Riandini T, Pang D, Toh MPHS, Tan CS, Liu DYK, Choong AMTL, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia 2021; 64:1538-1549. [PMID: 33885933 PMCID: PMC8187215 DOI: 10.1007/s00125-021-05441-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Diabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population. METHODS This was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation. RESULTS Between 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 person-years of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA1c (p < 0.001), lower (p < 0.001) or missing (p = 0.002) eGFR, greater or missing BMI (p < 0.001), missing LDL-cholesterol (p < 0.001) at diagnosis, and ever-smoking (p < 0.001) were associated with higher hazard of DRLEC. Retinopathy (p < 0.001), peripheral vascular disease (p < 0.001), poorer HbA1c (p < 0.001), higher (p = 0.009) or missing (p < 0.001) LDL-cholesterol and missing BMI (p = 0.008) were associated with higher hazard of amputation in those with DRLEC. Indian ethnicity (p = 0.007) was associated with significantly lower hazard of amputation. CONCLUSIONS/INTERPRETATION This study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.
Collapse
Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Matthias P H S Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Daveon Y K Liu
- Information Management, Group Health Informatics, National Healthcare Group, Singapore, Republic of Singapore
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore, Republic of Singapore
| | - Sadhana Chandrasekar
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
| |
Collapse
|
|
27
|
Wukich DK, Liu GT, Raspovic K, Vicenzi F. Biomechanical Performance of Charcot-Specific Implants. J Foot Ankle Surg 2021; 60:440-447. [PMID: 33612405 DOI: 10.1053/j.jfas.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/30/2020] [Indexed: 02/03/2023]
Abstract
Over the past 2 decades, an increased number of diabetic Charcot neuroarthropathy reconstructions have been performed. Despite advances in implant technology, arthrodesis complication rates remain high. This study examined the biomechanical properties (4-point bending, cantilever bending, and thread pullout resistance) of intramedullary implants designed for midfoot reconstruction. Large implants included A1 (7.4 mm cannulated stainless steel beam), B1 (6.5 mm solid titanium bolt), and C1 (7.0 mm cannulated titanium beam). Smaller implants included A2 (5.4 mm cannulated stainless steel beam) and C2 (5.0 mm solid titanium bolt). Four-point bending testing compared flexural properties of the body of the implants. Cantilever-bending testing was performed with the maximum bending moment being applied off the main thread of the implant to assess the thread portion. Thread pullout strength was tested by fixing the implants to a Sawbone block on a platform, and the distal portion of the implant in a clamp connected to loading actuator. Implant A1 demonstrated higher stiffness, force to failure, and fatigue compared to implants B1 and C1 (p < .05). Pullout strength of implant A1 was higher than implant B1 (p < .05). Thread fatigue strength of implant A1 was higher than implant C1 (p < .05). Implant A2 demonstrated higher stiffness, force to failure, tip fatigue strength, and thread pullout strength compared to implant C2 (p < .05), while implant C2 demonstrated higher body fatigue failure than implant A2 (p < .05). Alteration of beam/bolt parameters influences the biomechanical performance of implants used in Charcot reconstruction. Greater stiffness resists deformation, providing improved stability. Greater static failure load and fatigue limit improves the implant's ability to withstand higher and repetitive loads before failing This study should stimulate further clinical research to determine if these biomechanical properties translate into reduced implant failure rates and improved clinical outcomes in patients with diabetic Charcot neuroarthropathy.
Collapse
Affiliation(s)
- Dane K Wukich
- Professor and Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - George T Liu
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine Raspovic
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Federico Vicenzi
- Engineer, Department of Research, Development and Innovation, Orthofix Srl, Bussolengo, Italy
| |
Collapse
|
|
28
|
Wukich DK, Raspovic K, Liu GT, Van Pelt MD, Lalli T, Chhabra A, Nakonezny P, La Fontaine J, Lavery L, Kim PJ. Are the Sanders-Frykberg and Brodsky-Trepman Classifications Reliable in Diabetic Charcot Neuroarthropathy? J Foot Ankle Surg 2021; 60:432-435. [PMID: 33549422 DOI: 10.1053/j.jfas.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess the intra- and inter-reader reliability of the 2 Charcot neuroarthropathy classifications (Sanders-Frykberg and Brodsky-Trepman), as well as Eichenholtz staging. We hypothesized that the inter-reader reliability, with respect to these 3 classification systems, would be moderate at best. Digital radiographic images were organized in a digital slide presentation without clinical information. All 5 reviewers underwent a standard training session administered by the principal investigator, reviewing 5 cases of Charcot neuroarthropathy. Images of 55 cases of Charcot neuroarthropathy and 5 normal cases were distributed to each of the 5 physicians electronically, who independently rated all 60 cases according to the 3 classification systems. The 95% confidence interval of the intraclass correlation coefficient estimate for Sanders-Frykberg was 0.9601 to 0.9833 at week 0 and 0.9579 to 0.9814 at week 8, which can be regarded as "excellent" reliability. For Trepman-Brodsky, the 95% confidence interval of the intraclass correlation coefficient estimate was 0.8463 to 0.9327 at week 0 and 0.8129 to 0.9226 at week 8, which can be regarded as "good" to "excellent" reliability. For Eichenholtz, the 95% confidence interval of the intraclass correlation coefficient estimate was 0.6841 to 0.8640 and 0.6931 to 0.8730 at weeks 0 and 8, respectively, which can be regarded as "moderate" to "good" reliability. The classification systems of Charcot neuroarthropathy are an important tool for communication among physicians. Based on the results at our institution, the Sanders-Frykberg classification exhibited the best inter-reader performance. The Trepman-Brodsky classification exhibited good to excellent reliability as well. The intraclass correlation coefficient of the Eichenholtz classification was moderate to good.
Collapse
Affiliation(s)
- Dane K Wukich
- Professor and Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Katherine Raspovic
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Assistant Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael D Van Pelt
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Trapper Lalli
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul Nakonezny
- Associate Professor, Department of Clinical Sciences (Biostatistics), University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence Lavery
- Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul J Kim
- Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
|
29
|
Fu XJ, Hu SD, Peng YF, Zhou LY, Shu T, Song DD. Observation of the effect of one-to-one education on high-risk cases of diabetic foot. World J Clin Cases 2021; 9:3265-3272. [PMID: 34002135 PMCID: PMC8107901 DOI: 10.12998/wjcc.v9.i14.3265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a common chronic disease, and its global incidence is on the rise. The disease is directly attributed to insufficient insulin efficacy/secretion, and patients are often accompanied by multiple complications. Diabetic foot is one of the most common complications of diabetes. Diabetic feet have ulcers and infections, which can eventually lead to amputation. Basic nursing care, such as lowering blood pressure and preventing foot skin infections in clinical nursing work, has positive significance for the prevention and control of diabetic feet.
AIM To explore the positive significance of one-to-one education in high-risk cases of diabetic foot.
METHODS This observation included 98 high-risk cases of diabetic foot in our hospital during the period from August 2017 to October 2019, and these patients were randomly divided into the basic nursing group and the one-to-one education group with 49 patients per group. The basic nursing group only received routine basic nursing, while the one-to-one education group gave patients one-to-one education on the basis of basic nursing. After nursing, the self-care ability and compliance behavior of the two groups were evaluated and compared between these two groups. The knowledge mastery of the patient and the satisfaction of nursing were accounted.
RESULTS The assessment results of patients (self-care responsibility, self-care skills, self-concept and self-care knowledge) were significantly higher in the one-to-one education group than in the basic nursing group. The scores of compliance behaviors (foot bathing, shoes and socks selection, sports health care) in the one-to-one education group were significantly higher than those in the basic nursing group. Patients in the one-to-one education group had a significantly higher level of knowledge mastery and satisfaction of nursing than the basic nursing group.
CONCLUSION One-to-one education for high-risk cases of diabetic foot is helpful to improve the cognition and self-care ability of patients with diabetic foot, to ensure that patients follow the doctor’s advice of self-care and to improve their nursing satisfaction.
Collapse
Affiliation(s)
- Xia-Jun Fu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Shi-Di Hu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Yin-Fang Peng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Ling-Yan Zhou
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Ting Shu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Dan-Dan Song
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| |
Collapse
|
|
30
|
Huang J, Chen J, Xiong S, Huang J, Liu Z. The effect of low-level laser therapy on diabetic foot ulcers: A meta-analysis of randomised controlled trials. Int Wound J 2021; 18:763-776. [PMID: 33751853 PMCID: PMC8613395 DOI: 10.1111/iwj.13577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
Our purpose was to perform a meta‐analysis to evaluate the effect of Low‐level laser therapy (LLLT) on diabetic foot ulcers (DFUs). The PubMed, Cochrane, Embase, Web of Science, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang databases were searched systematically up to August 27, 2020. Studies that met the inclusion criteria were included in the analysis. A total of 13 randomised controlled trials (RCTs) and 413 patients were analysed. Compared with the control group, LLLT significantly increased the complete healing rate (risk ratio [RR] = 2.10, 95% confidence interval [CI] 1.56‐2.83, P < .00001), reduced the ulcer area (standardised mean difference [SMD] = 3.52, 95% CI 1.65‐5.38, P = .0002), and shortened the mean healing time (SMD = −1.40, 95% CI −1.90 to −0.91, P < .00001) of patients with DFUs. The quality of the evidence was very low according to the GRADE system. LLLT is a promising and effective adjuvant treatment to accelerate the healing of DFUs. Further evidence from larger samples and higher quality RCTs is needed to prove the effect of LLLT and to determine the most appropriate parameters for the healing of DFUs.
Collapse
Affiliation(s)
- Jing Huang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangqiong Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuyuan Xiong
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingui Huang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiping Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
|
31
|
Røikjer J, Jensen MH, Vestergaard P, Sørensen AM, Laursen HVB, Ejskjaer N. Twenty years with diabetes and amputations: a retrospective population-based cohort study. Diabet Med 2020; 37:2098-2108. [PMID: 31990417 DOI: 10.1111/dme.14251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/13/2023]
Abstract
AIM To investigate the trends in non-traumatic lower limb amputation in people with and without diabetes. METHODS From the Danish National Patient Register, all people with either type 1 or type 2 diabetes (n = 462 743) as well as a group of people without diabetes from the general population (n = 1 388 886) were identified and separated into three groups based on diabetes type. Among these, 17 265 amputations were identified between 1997 and 2017 and stratified into trans-femoral amputations, trans-tibial amputations and amputations below the ankle using surgical codes. Annual changes were described using least-squares linear regression. RESULTS The yearly mean decrease in incidence rate of amputation per 1000 person-years was -0.032 [95% CI: -0.062, -0.001], -0.022 [-0.032, -0.012] and -0.006 [-0.009, -0.003] for trans-femoral amputation, -0.072 [-0.093, -0.052], -0.090 [-0.102, -0.078] and -0.015 [-0.016, -0.013] for trans-tibial amputation, and -0.055 [-0.080, -0.020], -0.075 [-0.090, -0.060] and -0.011 [-0.014, -0.007] for amputation below the ankle in people with type 1 diabetes, people with type 2 diabetes and people without diabetes, respectively. CONCLUSIONS Over recent decades, the incidence of amputation has decreased significantly in people with diabetes and in the general population without diabetes.
Collapse
Affiliation(s)
- J Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M H Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - P Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine and Endocrinology, Aalborg University, Aalborg, Denmark
| | - A M Sørensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - H V B Laursen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - N Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
|
32
|
Shah H, Shah R, Sanghani H, Lakhani N. Health related quality of life (HRQoL) and its associated surgical factors in diabetes foot ulcer patients. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.2/83.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim. To evaluate the health-related quality of life (HRQOL) in DFU patients and its association with different surgical parameters in a tertiary care teaching hospital. Methodology. A total of 70 DFU patients from surgery department were enrolled and their demographic details, surgical examination and treatment related parameter were recorded. HRQOL was evaluated using Cardiff Wound Impact Questionnaire. Association of different surgical parameters as predictors of HRQOL was statistically evaluated. Results. Mean age of the study patients was 53.92 ± 9.27 with male preponderance and male: female ratio of 1.5:1. All the patients in the study suffered from type 2 diabetes and mean duration of the diabetes was 8.0±1.4 year. Mean BMI of the study patients was 23.36 ±1.4. All patients of DFU showed deteriorated HRQOL with mean score of 42.2±15.13 in social domain, 17.12±7.43 in wellbeing, 75.33±27.06 in physical domain and total score of 146.56±45.46. Increasing age, female gender, increased BMI, alcohol addiction found to be significantly associated with the deteriorated quality of life with respect to all four major domains which include Social life (P<0.001), wellbeing (P<0.07), physical symptoms (P<0.001) and Overall Quality of life (P<0.001). Surgical parameters like treatment for ulcer, regular follow up, larger size of ulcer, more than one ulcer, and ulcer on planter surface and chronic and recurrent ulcer significantly affect social domain, wellbeing and physical symptoms and total score (p<0.05). Control of blood sugar levels with non-pharmacological measures, OHA or insulin significantly improve Qol (p<0.05). Conclusions. Surgical parameters like site, size, number and duration of ulcer, treatment and blood sugar control significantly affect Qol. Multidisciplinary approach with holistic view is required for management of DFU patients for better quality of life.
Collapse
|
|
33
|
Iversen MM, Igland J, Smith-Strøm H, Østbye T, Tell GS, Skeie S, Cooper JG, Peyrot M, Graue M. Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo). BMC Endocr Disord 2020; 20:157. [PMID: 33087074 PMCID: PMC7580005 DOI: 10.1186/s12902-020-00637-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer-Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants' health, well-being and quality of life. TRIAL REGISTRATION Clinicaltrials.gov , NCT01710774 . Registered October 19th, 2012.
Collapse
Affiliation(s)
- Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway.
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hilde Smith-Strøm
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - John G Cooper
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Mark Peyrot
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
| | - Marit Graue
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
| |
Collapse
|
|
34
|
Amesz SF, Klein TM, Meulendijks AM, Nguyen TV, Blome C, Roodbol PF, van Montfrans C. A translation and preliminary validation of the Dutch Wound-QoL questionnaire. BMC DERMATOLOGY 2020; 20:5. [PMID: 32843014 PMCID: PMC7449034 DOI: 10.1186/s12895-020-00101-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/10/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic wounds have a major impact on patients' health-related quality of life (HRQoL). Therefore, measuring HRQoL is an indispensable part of the treatment of patients with chronic wounds. The aim of this study was to translate and validate the Wound-QoL, a wound-specific HRQoL questionnaire, in a Dutch population. METHODS The Wound-QoL was translated into Dutch according to the international standards. Patients with chronic wounds were asked to complete questionnaires at baseline (T0) and after six weeks (T1), including Wound-QoL, EQ-5D-3L (a generic questionnaire to measure HRQoL) and a visual analogue scale (VAS) measuring wound pain. If patients were not able to complete the questionnaire by themselves, it was read out to them by a nurse. Further data were obtained from medical records. RESULTS Of the 120 patients included, 64 (53.3%) completed the questionnaire by themselves. To 55 patients (45.8%), the questionnaire was read out. The internal consistency of the Wound-QoL global score was high at both time points (T0: Cronbach's α = 0.89, T1: Cronbach's α = 0.92). The item selectivity for global score ranged from r = 0.25 to r = 0.77 at T0 and from r = 0.40 to r = 0.79 at T1. Overall, the self-completion and read-out subgroups showed similar internal consistency and item selectivity scores. With regard to convergent validity, significant correlations were found between Wound-QoL and EQ-5D-3L (T0: r = - 0.45, p < 0.001, T1: r = - 0.50, p < 0.001) as well as between Wound-QoL and pain VAS (T0: r = 0.23, p = 0.012, T1: r = 0.37, p = 0.001) at both time points. Responsiveness analyses showed significant correlations between changes in Wound-QoL and changes in EQ-5D-3L (r = - 0.37, p < 0.001), pain VAS (r = 0.24, p = 0.044) and wound size (r = 0.24, p = 0.013). The self-completion and read-out subgroups showed differences in convergent validity and responsiveness. CONCLUSIONS The results indicate that the Dutch version of the Wound-QoL has positive psychometric properties. However, more research is needed to further explore the differences between self-completed and read-out questionnaires.
Collapse
Affiliation(s)
- Stella F Amesz
- University of Groningen, Faculty of Medical Sciences, Kerkstraat 4, 8162RS, Epe, the Netherlands.
| | - Toni M Klein
- German Centre for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Audrey M Meulendijks
- Research Group Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, the Netherlands
| | - Tuong-Vi Nguyen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christine Blome
- German Centre for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petrie F Roodbol
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
|
35
|
Martinez-Gonzalez D, Dòria M, Martínez-Alonso M, Alcubierre N, Valls J, Verdú-Soriano J, Granado-Casas M, Mauricio D. Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form in Spanish Subjects. J Clin Med 2020; 9:jcm9082497. [PMID: 32756508 PMCID: PMC7465700 DOI: 10.3390/jcm9082497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/21/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a chronic complication that negatively affects the quality of life (QoL) of diabetic patients. In Spain, there is no specifically designed and validated instrument to assess the QoL of patients with DFU. Our aim was to adapt the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire to a Spanish population and validate it. A prospective, observational design was used. The DFS-SF was administered by personal interview. The validated SF-36 and EQ-5D generic instruments were used as reference tools. The reliability, validity, and sensitivity to changes were assessed using standard statistical methods. A sample of 141 patients with DFU was recruited. The content validity was 3.46 on average (maximum score of 4). The internal consistency of the DFS-SF subscales showed a standardized Cronbach’s α range between 0.720 and 0.948. The DFS-SF domains showed excellent reproducibility measures (intraclass correlation coefficient from 0.77–0.92). The criterion validity was good with significant correlations between each DFS-SF subscale and its corresponding SF-36 and EQ-5D subscales (p < 0.001). However, the questionnaire structure was not validated (comparative fit index = 0.844, root mean square error of approximation = 0.095, and standardized root mean square residual = 0.093). The instrument showed high sensitivity to ulcer changes over time (p < 0.001). The adapted and validated Spanish version of the DFS-SF questionnaire has good psychometric properties and shows good sensitivity to ulcer changes, although the construct validity was not optimal. The adapted questionnaire will be a useful tool specifically to assess the QoL in subjects with diabetic foot ulcers in the clinical and research settings in Spain.
Collapse
Affiliation(s)
- Dolores Martinez-Gonzalez
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain; (D.M.-G.); (N.A.)
| | - Montserrat Dòria
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Camí de les Escoles S/N, 08916 Badalona, Spain;
- Diabetic Foot Unit, University Hospital Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain
| | - Montserrat Martínez-Alonso
- Systems Biology and Statistical Methods for Biomedical Research, IRBLleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain; (M.M.-A.); (J.V.)
| | - Nuria Alcubierre
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain; (D.M.-G.); (N.A.)
| | - Joan Valls
- Systems Biology and Statistical Methods for Biomedical Research, IRBLleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain; (M.M.-A.); (J.V.)
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Carretera de Sant Vicent del Raspeig s/n, 03080 Alicante, Spain;
- Grupo Nacional de Estudio y Asesoramiento de Úlceras por Presión (GNEAUPP) Steering Committee, 26004 Logroño, Spain
| | - Minerva Granado-Casas
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain; (D.M.-G.); (N.A.)
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Camí de les Escoles S/N, 08916 Badalona, Spain;
- Correspondence: (M.G.-C.); (D.M.)
| | - Didac Mauricio
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Rovira Roure, 80, 25198 Lleida, Spain; (D.M.-G.); (N.A.)
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08041 Barcelona, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, 08041 Barcelona, Spain
- Faculty of Medicine, University of Vic (UVIC/UCC), 08500 Vic, Spain
- Correspondence: (M.G.-C.); (D.M.)
| |
Collapse
|
|
36
|
McCarthy M, Yates T, Webb D, Game F, Gray L, Davies MJ. Health impacts of seated arm ergometry training in patients with a diabetic foot ulcer: protocol for a randomised controlled trial. BMJ Open 2020; 10:e039062. [PMID: 32565482 PMCID: PMC7311002 DOI: 10.1136/bmjopen-2020-039062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Once diagnosed with a diabetic foot ulcer (DFU), patients are advised to offload, keeping pressure off the foot in order to facilitate ulcer healing. An increase in offloading is often accompanied by reductions in physical activity which can worsen the overall health of patients.While unable to perform traditional forms of upright activity, one mode of exercise that would allow patients to be physically active while adhering to offloading instruction is seated arm ergometry. The merits of tailored aerobic exercise in DFU remain unexplored. METHODS AND ANALYSIS This is a prospective open-label randomised controlled trial. Participants will be randomised to one of two groups, an exercise intervention group or control. The intervention group are required to undertake arm ergometry training at a moderate intensity (65%-75% HRpeak), three times per week for 12 weeks as individually prescribed by an exercise physiologist, while the control group will continue to receive standard care alone. Assessment of outcome measures will occur at baseline and after the intervention period, these will include: a seated VO2 peak test, a blood sample, a short physical performance battery, a dual-energy X-ray absorptiometry scan and completing a range of health-based questionnaires. The above will be used to determine: cardiorespiratory fitness, metabolic health, physical function, body composition and quality of life, respectively. Ulcer area will also be measured as an approximate marker of ulcer healing. ETHICS AND DISSEMINATION This trial has been approved by 'Yorkshire & The Humber-Leeds West Research Ethics Committee' (19/YH/0269). Trial results will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN16000053. Registered in accordance with WHO Trial Registration Data Set (version 1.3.1).
Collapse
Affiliation(s)
- Matthew McCarthy
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Webb
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Laura Gray
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
|
37
|
Walch AM, Cobb CE, Tsaih SW, Cabrera SM. The medical transition of young adults with type 1 diabetes (T1D): a retrospective chart review identifies areas in need of improvement. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:10. [PMID: 32514267 PMCID: PMC7254679 DOI: 10.1186/s13633-020-00080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The transition process from pediatric to adult care in individuals with T1D has long-term ramifications on health outcomes. Recognition of differences in care delivery and changes made in management during this time may improve the process. We hypothesized that pediatric providers would be less likely to address T1D-related comorbidities than their adult counterparts, highlighting opportunities to strengthen care. METHODS A retrospective chart review of patients aged 16-21 years diagnosed with T1D before age 18 was performed. Data on diagnosis, screening, and management of hypertension, dyslipidemia, microalbuminuria, retinopathy, and neuropathy were collected for 1 year before and 1 year after transition to adult care. The 'ADA Standards of Medical Care in Diabetes' were used to determine adherence to the above parameters. Data before and after transition was compared by Fischer's Exact and Exact McNemar tests. RESULTS Complete medical records for 54 subjects were reviewed before and after transition from pediatric to adult care providers within a single academic medical system (52% male; 78% Caucasian). Transition to adult care occurred at a mean age of 18 years. Mean length of transition was 7.8 months with no significant change in an individual's HbA1c over that time. Over the transition period, there was no difference in diagnoses of hypertension or the use of anti-hypertensive. Adherence to lipid and retinopathy screening was similar across the transition period; however, adherence to microalbuminuria screening was higher after the transition to adult providers (p = 0.01). Neuropathy screening adherence was overall poor but also improved after transition (p < 0.001). CONCLUSIONS Overall, there were no significant changes in the diagnosis or management of several T1D-related comorbidities during the transition period in a small cohort of young adults with T1D. The transition length was longer than the recommended 3-months, highlighting an opportunity to improve the process. There was no deterioration of glycemic control over this time, although HbA1c values were above target. Adult providers had significantly higher rates of adherence to screening for microalbuminuria and neuropathy than their pediatric counterparts, but adherence for neuropathy was quite poor overall, indicating a need for practice improvement.
Collapse
Affiliation(s)
- Abby M. Walch
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| | - Carmen E. Cobb
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| | - Susanne M. Cabrera
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| |
Collapse
|
|
38
|
Okoro T, Sikirica V, Casillas L, Brion T, Devine J, Ong V, Howard K. Elicitation of disease concepts in patients with diabetic foot ulcers: a qualitative study. J Wound Care 2020; 29:S38-S45. [PMID: 32412892 DOI: 10.12968/jowc.2020.29.sup5a.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify in-depth information directly from patients with diabetic foot ulcers (DFU) on DFU symptoms, impacts on functioning and effects on health-related quality of life (HRQoL). METHOD Semi-structured, qualitative concept elicitation interviews were conducted with patients with DFUs (Wagner grade 1 or 2) until saturation was reached. Qualitative analysis (using MAXQDA, VERBI GmbH, Germany) of interview transcripts was conducted to identify concepts relevant to patients with DFUs, based on the frequency of mentions, and elucidate themes regarding impacts on HRQoL. RESULTS Of the 18 participants, most were male (n=14; 78%) and 10 (56%) presented with a Wagner grade of 1. Frequently reported symptoms were pain/discomfort (n=15; 83%), weeping/discharge (n=10; 56%), bleeding (n=10; 56%) and swelling (n=8; 44%). Overall, patients reported more impacts than symptoms-wound care/treatment burden (n=14; 78%), limitations on exercise/physical activity (n=13; 72%), mobility limitations (n=12; 67%), and offloading (n=12; 67%) were the most frequently mentioned. Based on findings from the patient interviews, a draft conceptual model was developed outlining interrelationships between DFU symptoms, impacts, and HRQoL from the patient perspective. CONCLUSION Qualitative interviews captured the breadth of disease-related concepts of direct importance to patients. The draft conceptual model developed from the analysis can help identify measures or instruments for use in assessing patient-reported symptoms or HRQoL in clinical practice and may have wider research applicability, including evaluation of treatment benefits in patients with DFUs.
Collapse
Affiliation(s)
| | | | | | - Triza Brion
- ICON Clinical Research, South San Francisco, CA, US
| | - Jacob Devine
- ICON Clinical Research, South San Francisco, CA, US
| | - Vivien Ong
- ICON Clinical Research, South San Francisco, CA, US
| | | |
Collapse
|
|
39
|
Sayyed Kassem L, Aron DC. The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 2020; 15:71-81. [PMID: 32176560 DOI: 10.1080/17446651.2020.1737520] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.
Collapse
Affiliation(s)
- Laure Sayyed Kassem
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
|
40
|
Adem AM, Andargie AA, Teshale AB, Wolde HF. Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study. Diabetes Metab Syndr Obes 2020; 13:3703-3711. [PMID: 33116720 PMCID: PMC7569060 DOI: 10.2147/dmso.s280152] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
AIM The incidence of a diabetic foot ulcer (DFU) is increasing over the previous decade with an increasing prevalence of diabetes mellitus (DM). Despite the increasing incidence of DFU, there is limited information about the problem in Ethiopia. Hence, this study aimed to investigate the incidence of DFU and its predictors among newly diagnosed DM patients who were on follow-up at Felege Hiwot Referral Hospital. METHODS Institution-based retrospective follow-up study was conducted at Felege Hiwot Referral Hospital among newly diagnosed DM patients from January 1, 2009, to December 31, 2018. A simple random sampling method was used to select 401 study participants from a total of 723 eligible population. Data was entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was estimated using person-years of observation and Nelson-Aalen cumulative hazard function, showing the cumulative probability of diabetic foot ulcer, was done. The best model (Gompertz) was selected using the AIC and log-likelihood method. Hazard ratio (HR) with its 95% confidence interval was computed and variables having a p-value less than 0.05 in the multivariable model were considered to be significantly associated with DFU. RESULTS A total of 387 patients were followed retrospectively for a median follow-up time of 95 months. Out of all, 66 (17.05%) patients developed DFU with an incidence rate of 4 cases per 100 person-years of observation. Diabetic nephropathy (adjusted hazard ratio (AHR) = 2.37, 95% CI: 1.33-54.24), diabetic retinopathy (AHR = 5.56, 95% CI: 2.64-11.74), and increased body mass index (AHR = 1.13, 95% CI: 1.01-1.27) were found to increase the hazard of DFU. CONCLUSION The incidence of DFU was relatively high. Diabetic nephropathy, diabetic retinopathy, and body mass index were its significant predictors. Therefore, close monitoring of patients with co-morbidities and increased body mass index should be considered to reduce DFU.
Collapse
Affiliation(s)
- Ali Mekonen Adem
- Department of Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Asrat Atsedeweyn Andargie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Achamyeleh Birhanu Teshale Email
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
|
41
|
Rezaie W, Lusendi F, Doggen K, Matricali G, Nobels F. Health-related quality of life in patients with diabetic foot ulceration: study protocol for adaptation and validation of patient-reported outcome measurements (PROMs) in Dutch-speaking patients. BMJ Open 2019; 9:e034491. [PMID: 31874898 PMCID: PMC7008415 DOI: 10.1136/bmjopen-2019-034491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Diabetic foot ulceration (DFU) is a common late-stage complication of diabetes with a large impact on health status and quality of life. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients' views on their well-being. The DFU Scale Short Form (DFS-SF) is a validated disease-specific PROM for measuring health-related quality of life among DFU patients. The Lower Extremity Functional Scale (LEFS) is another PROM that can be used to measure physical functioning in patients with lower extremity disorders. The LEFS is not yet validated for DFU. Both instruments are not validated in the Dutch language. The purpose of this study is to culturally adapt and validate the DFS-SF and LEFS questionnaires for Belgian Dutch-speaking patients with DFU. METHODS AND ANALYSIS This study will be conducted as a monocentre observational cohort study in DFU patients presenting at a hospital-based multidisciplinary diabetic foot clinic. Data will be collected from the medical electronic files and from DFS-SF, LEFS and five-level EuroQol five-dimension questionnaires that will be presented to the patients at defined time points. Reproducibility, internal consistency, floor and ceiling effects, construct validity and responsiveness will be assessed for the DFS-SF and LEFS. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Ethics Committee of Onze-Lieve-Vrouw Hospital (Aalst, Belgium). The results of the study will be disseminated through peer-reviewed publications and conference presentations.
Collapse
Affiliation(s)
- Wahid Rezaie
- Orthopaedics & Trauma, Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Flora Lusendi
- Health Services Research Unit, Belgian Scientific Institute of Public Health, Brussel, Belgium
| | - Kris Doggen
- Health Services Research Unit, Belgian Scientific Institute of Public Health, Brussel, Belgium
| | - Giovanni Matricali
- Multidisciplinary Diabetic Foot Clinic, KU Leuven Hospital, Leuven, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| |
Collapse
|
|
42
|
Chicharro-Luna E, Pomares-Gómez FJ, Ortega-Ávila AB, Marchena-Rodríguez A, Blanquer-Gregori JFJ, Navarro-Flores E. Predictive model to identify the risk of losing protective sensibility of the foot in patients with diabetes mellitus. Int Wound J 2019; 17:220-227. [PMID: 31691513 DOI: 10.1111/iwj.13263] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/15/2022] Open
Abstract
Diabetic neuropathy is defined as the presence of symptoms and signs of peripheral nerve dysfunction in diabetics. The aim of this study is to develop a predictive logistic model to identify the risk of losing protective sensitivity in the foot. This descriptive cross-sectional study included 111 patients diagnosed with diabetes mellitus. Participants completed a questionnaire designed to evaluate neuropathic symptoms, and multivariate analysis was subsequently performed to identify an optimal predictive model. The explanatory capacity was evaluated by calculating the R2 coefficient of Nagelkerke. Predictive capacity was evaluated by calculating sensitivity, specificity, and estimation of the area under the receiver operational curve. Protective sensitivity loss was detected in 19.1% of participants. Variables associated by multivariate analysis were: educational level (OR: 31.4, 95% CI: 2.5-383.3, P = .007) and two items from the questionnaire: one related to bleeding and wet socks (OR: 28.3, 95% CI: 3.7-215.9, P = .001) and the other related to electrical sensations (OR: 52.9, 95% CI: 4.3-643.9, P = .002), which were both statistically significant. The predictive model included the variables of age, sex, duration of diabetes, and educational level, and it had a sensitivity of 81.3% and a specificity of 95.5%. This model has a high predictive capacity to identify patients at risk of developing sensory neuropathy.
Collapse
Affiliation(s)
- Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain
| | | | - Ana Belen Ortega-Ávila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Ana Marchena-Rodríguez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | - Emmanuel Navarro-Flores
- Department of Nursing, Faculty of Nursing and Podiatry, Frailty Research Organized Group, Universidad de Valencia, Valencia, Spain
| |
Collapse
|
|
43
|
Johnson MJ, Crisologo PA, Truong DH, Wukich DK, Oz OK, La Fontaine J, Lavery LA. Erbium: Yttrium Aluminum Garnet Laser Accelerates Healing in Indolent Diabetic Foot Ulcers. J Foot Ankle Surg 2019; 58:1077-1080. [PMID: 31679662 DOI: 10.1053/j.jfas.2019.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/17/2019] [Accepted: 07/18/2019] [Indexed: 02/03/2023]
Abstract
The objective of the study was to evaluate the effect of the erbium:yttrium aluminum garnet (YAG) laser on diabetic foot ulcers (DFUs) that had not responded to standard care. We retrospectively evaluated 22 nonhealing DFUs that received at least 4 weeks of standard wound care, demonstrated poor healing response, and subsequently were treated with an erbium:YAG laser. We measured the percent wound area reduction (PWAR) for the 4 weeks before initiating laser therapy and the PWAR for 4 weeks after the initiation of laser therapy. Erbium:YAG laser treatment consisted of 2 components: debridement and resurfacing. The laser settings were the same for all treatments. We used the paired t test to compare pretreatment with posttreatment wound area reduction. During the 4-week period before the initiation of laser therapy, the average PWAR was -33.6%. Four weeks after initiating treatment with the erbium:YAG laser, the average PWAR was 63.4% (p = .002) and 72.7% of wounds had ≥50% PWAR. By 12 weeks, 50% of wounds had healed. Erbium:YAG laser therapy accelerated DFU healing in a cohort of patients with ulcers that had been unresponsive to standard of care therapy.
Collapse
Affiliation(s)
- Matthew J Johnson
- Fellow, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Peter A Crisologo
- Research Fellow, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - David H Truong
- Fellow, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Professor and Chairman, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Orhan K Oz
- Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
|
44
|
Placental Membrane Provides Improved Healing Efficacy and Lower Cost Versus a Tissue-Engineered Human Skin in the Treatment of Diabetic Foot Ulcerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2371. [PMID: 31592387 PMCID: PMC6756673 DOI: 10.1097/gox.0000000000002371] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/07/2019] [Indexed: 01/03/2023]
Abstract
Supplemental Digital Content is available in the text. Aseptically processed dehydrated human amnion and chorion allograft (dHACA) (AmnioBand) has shown great promise in the treatment of recalcitrant diabetic foot ulcers (DFUs) when compared with standard wound care but has not yet been compared to any other tissue forms used in treating DFUs. The hypothesis was to conduct a randomized controlled trial in which dHACA was compared to one of the earliest and most commonly accepted tissue-engineered skin substitutes (TESS) (Apligraf) in the treatment of nonhealing DFUs over a period of 12 weeks to assess the superiority of healing.
Collapse
|
|
45
|
Wheble GAC, Emam AT, Khan UM. Limb salvage in diabetic foot disease: A classification to aid successful reconstruction. J Plast Reconstr Aesthet Surg 2019; 72:1110-1120. [PMID: 30954413 DOI: 10.1016/j.bjps.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/14/2019] [Accepted: 03/10/2019] [Indexed: 01/18/2023]
Abstract
Diabetes is a global epidemic. If poorly managed, innocuous injury in a diabetic foot leads to intractable ulceration, bone and joint destruction and subsequent major amputation. It is estimated that every week in the UK there are 100 lower limb amputations of which 80 could have been prevented had diabetes been better managed. It is widely recognised that prevention is critical; nonetheless diabetic foot lesions continue to increase in prevalence. Reconstruction of diabetic foot lesions has a dismal reputation despite promising published work. Reconstruction in the correctly chosen patient can be successful. Multiple classification systems and scores have been published, but these do not guide the clinician as to which lesions are reconstructible, and those in which attempts to salvage are futile. These patients would be better served with primary amputation. A tertiary referral centre's experience of diabetic foot reconstruction over 7 years is presented in a series of 22 consecutive patients who were assessed using a new classification system. Twenty-four flaps were performed all of which were either complex (n = 7) or complicated (n = 17) wounds as per our classification. Five patients (22%) had donor site healing problems, but only one flap (5%) in the series failed. Average follow-up was 23 months (range 4-75 months) and all patients were ambulant at discharge. Our simple classification system and aggressive approach to excision and reconstruction of diabetic foot lesions is a useful adjunct to existing systems, and helps promote the cause that limb salvage is warranted in these challenging cases when appropriately managed.
Collapse
Affiliation(s)
- G A C Wheble
- Department of Plastic & Reconstructive Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom; Defence Medical Services, DMS Whittington, Whittington Barracks. Lichfield, Staffordshire WS14 9PY, United Kingdom.
| | - A T Emam
- Department of Plastic & Reconstructive Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
| | - U M Khan
- Department of Plastic & Reconstructive Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
| |
Collapse
|
|
46
|
AlSadrah SA. Impaired quality of life and diabetic foot disease in Saudi patients with type 2 diabetes: A cross-sectional analysis. SAGE Open Med 2019; 7:2050312119832092. [PMID: 30815259 PMCID: PMC6385329 DOI: 10.1177/2050312119832092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/29/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives: This study aimed to assess the overall health-related quality of life in type 2 diabetes mellitus patients with diabetic foot disease compared to diabetic patients without diabetic foot and to identify the clinical utility of this assessment. Methods: A total of 250 consecutive patients with type 2 diabetes mellitus (100/150 with/without diabetic foot, respectively) were interviewed. The questionnaires of the 36-item short-form survey and region-specific foot and ankle ability measure were applied. Wagner–Meggitt wound classification was used for foot-ulcer evaluation. Follow-up of patients for 3–6 weeks was done to identify the potential clinical short outcomes of diabetic foot ulcers. Results: Type 2 diabetes mellitus patients with diabetic foot exhibited poor mental and physical health consequences. Females had more prevalence of forefoot lesions, larger ulcer size, advanced Wagner grade, and higher frequency of unhealed ulcers. Receiver operating characteristic curve analysis demonstrated high value of foot and ankle ability measure and 36-item short-form questionnaires to discriminate type 2 diabetes mellitus patients with and without diabetic foot at cutoff values of 66 and 49.6, respectively. Foot and ankle ability measure questionnaire also showed high performance for differentiating the clinical outcome of foot ulcer. Total foot and ankle ability measure subscale score above the cutoff value of 65.5 could discriminate patients with complete healing and unhealed ulcer lesions at a high sensitivity and specificity. Conclusion: The current findings confirm the impact of diabetic foot disease on type 2 diabetes mellitus overall health-related quality of life reflected in 36-item short-form questionnaire and foot and ankle ability measure questionnaire which showed high discriminative values for type 2 diabetes mellitus patient sub-grouping. Their application in routine clinical health assessment with continuous medical education programs is highly recommended to achieve a better health-related quality of life.
Collapse
Affiliation(s)
- Sana A AlSadrah
- Department of Preventive Medicine, Governmental Hospital Khobar, Health Centers in Khobar, Ministry of Health, Khobar, Saudi Arabia
| |
Collapse
|
|
47
|
Lin CW, Armstrong DG, Lin CH, Liu PH, Hung SY, Lee SR, Huang CH, Huang YY. Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Res Care 2019; 7:e000795. [PMID: 31749971 PMCID: PMC6827817 DOI: 10.1136/bmjdrc-2019-000795] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To study the prevalence and trends of lower extremity complications of diabetes over an 8-year period in a single nation. RESEARCH DESIGN AND METHODS Nationwide data for people with type 2 diabetes (T2D) and diabetic foot complications (DFCs) were analyzed over an 8-year period (2007-2014) from National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision disease coding. The DFCs were defined as ulcers, infections, gangrene, and hospitalization for peripheral arterial disease (PAD). Trends of patient characteristics, foot presentation, and the execution of major procedures were studied, including lower-extremity amputations (LEAs). RESULTS Along with the T2D population increasing over time, the absolute number of people with DFCs increased by 33.4%, but retained a prevalence of around 2% per year. The annual incident of LEAs decreased from 2.85 to 2.06 per 1000 T2D population (p=0.001) with the major LEA proportion decreasing from 56.2% to 47.4% (p<0.001).The mean age of patients increased from 65.3 to 66.3 years and most of the associated comorbidities of diabetes were increased. For example, end-stage renal disease increased from 4.9% to 7.7% (p=0.008). The incidence of gangrene on presentation decreased from 14.7% to 11.3% (p<0.001) with a concomitant increase in vascular interventions (6.2% to 19.5%, p<0.001). CONCLUSIONS DFCs remain a sustained major medical problem. These nationwide long-term data suggest trends toward older people with greater comorbidities such as PAD and renal disease. Nevertheless, promising trends of reducing gangrene on presentation paired with increases in vascular interventions support continued vigilance and rapid, coordinated interdisciplinary diabetic foot care.
Collapse
Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, California, USA
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Shu-Ru Lee
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| |
Collapse
|
|
48
|
Baliga M, Simon P, Pereiera D, Mathai R, George T, Abraham S, D'Souza O. Quality of life in diabetics with different complications: A cross-sectional study with patients visiting a hospital on an outpatient basis. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
49
|
Tzeravini E, Tentolouris A, Tentolouris N, Jude EB. Advancements in improving health-related quality of life in patients living with diabetic foot ulcers. Expert Rev Endocrinol Metab 2018; 13:307-316. [PMID: 30381974 DOI: 10.1080/17446651.2018.1541403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) constitutes a burden to patients with diabetes deteriorating their quality of life. Health related quality of life (HRQoL) can now be quantified with the use of specific tools; some of them provide a holistic approach to patients' well-being, while others are disease specific or even region specific. Many of these tools are applicable to patients with DFU. This review will present current data about the impact different interventions in the management of DFU on quality of life related parameters. AREAS COVERED We performed a search of literature using keywords 'diabetes mellitus', 'diabetic foot ulcer', 'diabetic foot', 'health related quality of life', 'quality of life' and 'SF-36' to identify studies that contained data about the relationship between different interventions and quality of life of patients with diabetic foot ulcers. EXPERT COMMENTARY Available data are not sufficient to conclude on the impact of interventions aimed to heal DFU on HRQoL. There is need for more, better designed studies and meta-analysis to estimate the effect of treatments on HRQoL in patients with DFUs. The development of new, diabetic foot specific tools will help to improve our knowledge in this field.
Collapse
Affiliation(s)
- Evangelia Tzeravini
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Anastasios Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Nikolaos Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Edward B Jude
- b Department of Medicine, Diabetes Centre , Tameside Hospital NHS Foundation Trust , Ashton-under-Lyne , UK
- c Department of Medicine , Manchester University , Manchester , UK
- d Manchester Metropolitan University , Manchester , UK
| |
Collapse
|
|
50
|
Jarl G. Methodological considerations of investigating adherence to using offloading devices among people with diabetes. Patient Prefer Adherence 2018; 12:1767-1775. [PMID: 30254428 PMCID: PMC6143128 DOI: 10.2147/ppa.s175738] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Foot ulcers are a diabetic complication associated with significant morbidity, mortality, and amputation risk. Offloading devices prevent and heal foot ulcers, but adherence to using these devices is low. The reasons for nonadherence are unclear, and study results are difficult to compare due to methodological heterogeneity. This paper explores aspects of investigating adherence to using offloading devices among people with diabetes and provides recommendations for future studies, focusing on study designs, definitions of adherence, measurement methods, and conceptual frameworks. Most studies use a cross-sectional observational study design, limiting the potential to establish the temporal sequence between predictors and adherence, rule out confounding factors, and establish causality. Studies defining adherence as the length of time the device is worn have often used self-report to measure adherence, which may be unreliable. Studies using activity monitors to measure adherence have defined adherence as the number of steps taken with the device, which excludes weight-bearing activities where no steps are taken. Conceptual frameworks are not made explicit in the current quantitative research. It is concluded that future studies should use a longitudinal design with observational studies to identify patient groups prone to nonadherence and factors that influence adherence and experimental studies to evaluate interventions to improve adherence, focusing on these patient groups and factors. Furthermore, adherence should be defined in terms of relative adherence to using offloading devices during all weight-bearing activities, and objective measurement of adherence (using accelerometers and temperature monitors) should be used whenever possible. Clearly defined conceptual frameworks should guide the choice of factors to include in the study and the analysis of their interactions. By implementing these recommendations, research could provide a stronger evidence base in the future, supporting interventions to increase adherence and thereby improve outcomes for people with diabetic foot complications.
Collapse
Affiliation(s)
- Gustav Jarl
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,
| |
Collapse
|