Diabetic foot self care

NewsBot · May 13, 2022

Preventive foot self-care practice and associated factors among diabetic patients attending the university of Gondar comprehensive specialized referral hospital, Northwest Ethiopia, 2021
Enyew Getaneh Mekonen, Tizita Gebeyehu Demssie
BMC Endocr Disord. 2022 May 11;22(1):124

Background: Diabetes mellitus is emerging as a major worldwide health problem that has a social, financial, and developmental impact on developing countries. Foot complications are among the most serious and costly complications of diabetes which lead to lower extremity amputation due to diabetic foot ulcers. Poor diabetic foot self-care practice is identified by different studies as a major contributing factor to diabetic foot ulcers. Therefore, this study was intended to assess foot self-care practice and associated factors among diabetic patients attending the University of Gondar comprehensive specialized referral hospital.

Methods: A hospital-based cross-sectional study was conducted from July 1 to August 30, 2021, at the University of Gondar comprehensive specialized referral hospital. A systematic random sampling technique was employed to select 384 diabetic patients. A structured pretested interviewer-administered questionnaire was used to collect data. The data was entered in epi-info version 7, analyzed using SPSS version 21, and presented using frequencies, percentages, tables, and graphs. Bivariable and multivariable analyses were investigated using a binary logistic regression model. P-value < 0.05 and an odds ratio with a 95% confidence interval were used to determine the significance and strength of the association.

Results: Of the 384 diabetic patients, 46.4% (95% CI (41.1%-51.6%)) of them had poor foot self-care practice. Being male [AOR = 0.54, 95% CI (0.32, 0.89)], couldn't read and write and completed primary education [AOR = 2.35, 95% CI (1.01, 5.43)] & [AOR = 2.92, 95% CI (1.39, 6.12)], living in rural area [AOR = 3.84, 95% CI (1.91, 7.75)], having diabetic complications [AOR = 2.19, 95% CI (1.07, 4.46)], taking both injection and pills [AOR = 0.33, 95% CI (0.12, 0.88)], having previous information about foot care [AOR = 0.12, 95% CI (0.06, 0.24)], and family support [AOR = 0.57, 95% CI (0.34, 0.94)] were determinants of poor foot self-care practice.

Conclusion: The adherence of diabetic patients toward foot self-care practice was poor. Being male, having low educational status, living in a rural area, having diabetic-related complications, taking both injections and pills, not having previous information about foot care, and having poor family support increases the odds of having poor foot self-care practice. Giving health education to patients and their caregivers about the basic principles of diabetes foot care, like regular inspection of feet and appropriate footwear at their regular follow-up time, should be emphasized.
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NewsBot · May 16, 2022

Foot self-care behavior and its predictors in diabetic patients in Indonesia
BMC Research Notes, 2020, № 1

Objectives Previous studies have shown that diabetic foot ulcers are principally associated with improper foot self-care. Since appropriate foot self-care is essential to prevent diabetic foot-ulcers, any factors which can predict foot self-care behavior should be identified. However, until now, foot self-care behavior data and predictors of foot-care behavior in Indonesia remain unclear since such studies on Indonesian diabetic patients is very limited. Therefore, the purpose of this study was to investigate foot self-care behavior and to identify its predictors in Indonesia. The design of this study was cross-sectional. Cluster sampling was used, involving 546 type 2 diabetes mellitus patients registered in 22 primary healthcare centers. The questionnaires used in this study included the Diabetes Distress Scale, Beck Depression Inventory II, Family APGAR, Foot-Care Knowledge and Modified Diabetic Foot Care Behaviors. </jats:sec><jats:sec> Results Foot self-care behavior and knowledge about foot care were poor. The predictors of foot self-care behavior were age, educational level, diabetes distress, family support, and knowledge. It needs the program to improve foot self-care knowledge and the program to reduce the diabetes distress in Indonesian diabetic patients. In performing of these programs, families should be involved to improve the support toward foot self-care behavior in patients.
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NewsBot · Jun 4, 2022

Validity and reliability of the German translation of the Diabetes Foot Self-Care Behavior Scale (DFSBS-D)
Linda Lecker et al
PLoS One. 2022 Jun 3;17(6)

Introduction: Comprehensive regular foot self-care is one of the most critical self-management behaviors for people with diabetes to prevent foot ulcer development and related complications. Yet, adequate foot self-care is only practiced by very few of those affected. To improve diabetic foot syndrome prevention, a valid and reliable instrument for measuring daily foot-care routines in patients with diabetes is needed. However, no such instrument is currently available in the German language. This study, therefore, aims to translate and cross-culturally adapt the "Diabetic Foot Self-Care Behavior Scale" (DFSBS) into German (DFSBS-D) and evaluate its validity and reliability.

Material and methods: The DFSBS was translated from English into German using a forward-backward procedure as per previous recommendations. Factor analysis was used to study structural validity. To establish construct validity, 21 a priori hypotheses were defined regarding the expected correlation between scores on the new German version (i.e., DFSBS-D) and those of the following questionnaires measuring related constructs: (1) German version "Diabetes Self-Care Activities Measure" (SDSCA-G), (2) "Frankfurter Catalogue of Foot Self-Care" (FCFSP), and (3) "Short Form 36" (SF-36) and tested in 82 patients. To assess test-retest reliability, patients completed the DFSBS-D again after a 2-week interval. Test-retest reliability was assessed from stable patients' data (n = 48) by calculating two-way random-effects absolute agreement ICCs with 95% CI and Bland and Altman analyses. In addition, Cronbach's alpha was calculated as internal consistency measure.

Results: The 7-item DFSBS-D showed good structural validity. Its single factor explains 57% of the total sample variance. Of the 21 predefined hypotheses, 13 (62%) were confirmed. The DFSBS-D's internal consistency was good (Cronbach's alpha = 0.87). Test-retest reliability over a 2-week interval was also good (ICC 0.76).

Conclusion: The DFSBS was successfully translated into German. Statistical analyses showed good DFSBS-D structural validity, test-retest reliability, and internal consistency. Yet, construct validity may be debated.
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NewsBot · Jun 19, 2022

The Effect of Foot Care Education for Patients with Diabetes on Knowledge, Self-Efficacy and Behavior: Systematic Review and Meta-Analysis
Elif Yıldırım Ayaz et al
Int J Low Extrem Wounds. 2022 Jun 16

This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: -0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
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NewsBot · Jun 20, 2022

Foot self-care behaviour in type 2 diabetes adults with and
without comorbid heart failure
Fekadu Aga et al
Nursing Open. 2022;00:1–13.

Aims: To compare the correlates of foot self-care behaviours among type 2 diabetes
mellitus (T2D) adults with and without comorbid heart failure (HF).
Design: Cross-sectional, correlational, comparative design.
Methods: A 210 T2D adults (105 with HF and 105 without HF) participated from
August–December 2020. Foot self-care behaviour was measured using the foot
care subscale of the Summary of Diabetes Self-Care Activities (SDSCA) instrument.
A stepwise logistic regression analysis was used to explore variables predicting foot
self-care behaviour.
Results: The participants' mean age was 58.7 ± 10.9 years. Poor foot self-care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF.
Participants with HF-comorbidity were statistically significantly older and had higher
total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self-care behaviour in HF-comorbid
T2D adults. Marital status, social support and body mass index predicted foot selfcare behaviour in the non-HF group
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NewsBot · Jun 27, 2022

Knowledge of patients with type II diabetes
mellitus regarding preventive measures of foot
ulcer
Ali Sadiq Abd et al
International Journal of Health Sciences, 6(S2)

A foot ulcer is a dangerous diabetic problem caused by the
concurrent physiological activities of ischemia, neuropathy, and
infection in patients with type II diabetes mellitus. However, patients'
knowledge about foot care is essential for avoiding foot ulceration.A
cross-sectional descriptive design is carried out in the current study
from September 9th 2021 to May 9th 2022, in order to assess the
levels of knowledge of type II diabetic patients regarding preventive
measures of foot ulcers. A non-probability (purposive sample) of 300
diabetic patients type II. Data collected using a well-designed
questionnaire consists of three parts: Part I consists of demographic
data. Part II consists of Clinical Data. Part III includes Patients'
knowledge regarding preventive measures for foot ulcers. The findings
indicate there is a significant association between patients' knowledge
and (educational status and occupation). Also, there was a significant
association between patients' knowledge and (duration of the disease
and education about diabetes). The study concluded that patients
with type II diabetes have moderate knowledge about preventive
measures for foot ulcers.
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NewsBot · Jul 3, 2022

Design and Validation of a Self-care Evaluation Instrument to Prevent Diabetic Foot
Eugenia del Pilar Herrera Guerra and Lili Rosa Bautista Arellanos
Source

Objective. This work sought to design and validate a self-care instrument to prevent diabetic foot in Colombian adults with diabetes.

Methods. Psychometric study in which an instrument was designed to measure self-care to prevent diabetic foot according to the Medium Range Theory of Self-care in chronic diseases. With a sample of 230 people with type-2 diabetes, construct validity was determined through exploratory and confirmatory factor analysis. Internal consistency was calculated with Cronbach's alpha coefficient.

Results. Favorable evidence of construct validity was obtained with a model consisting of three scales: self-care maintenance with a three-factor structure (accumulated variance 43%), α = 0.7, with good fit (????2= 64.698, p = 0.001; RMSEA = 0.066; RMSSR = 0.071; CFI = 0.936, NNFI = 0.910). Monitoring of self-care with presence of symptoms a two-factor structure was found, α = 0.950, with good fit (????2 = 266.837, p = 0.000; RMSEA = 0.321; RMSSR = 0.057; CFI = 0.848; NNFI = 0.789); and without symptoms, a single-factor structure (cumulative variance 84%), α = 0.9, acceptable fit (????2= 377.327, p < 0.001; RMSEA = 0.355; RMSSR = 0.073; CFI = 0.832; NNFI = 0.764). And self-care management with two-factor structure (cumulative variance 53.7%) α = 0.7, with good fit (????2 = 14.317, p = 0.014; RMSEA = 0.144; RMSSR = 0.063; CFI = 0.905; NNFI = 0.809).

Conclusions. The resulting instrument has adequate psychometric properties, consistent with the theoretical model of self-care in chronic diseases. Its use is recommended to evaluate self-care to prevent diabetic foot in populations similar to the study population.
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NewsBot · Oct 21, 2022

Design and Validation of a Self-care Evaluation Instrument to Prevent Diabetic Foot
Eugenia Del Pilar Herrera Guerra, Lili Rosa Bautista Arellanos
Invest Educ Enferm. 2022 Jun;40(2)

Objectives: This work sought to design and validate a self-care instrument to prevent diabetic foot in Colombian adults with diabetes.

Methods: Psychometric study in which an instrument was designed to measure self-care to prevent diabetic foot according to the Medium Range Theory of Self-care in chronic diseases. With a sample of 230 people with type-2 diabetes, construct validity was determined through exploratory and confirmatory factor analysis. Internal consistency was calculated with Cronbach's alpha coefficient.

Results: Favorable evidence of construct validity was obtained with a model consisting of three scales: self-care maintenance with a three-factor structure (accumulated variance 43%), α = 0.7, with good fit (2= 64.698, p = 0.001; RMSEA = 0.066; RMSSR = 0.071; CFI = 0.936, NNFI = 0.910). Monitoring of self-care with presence of symptoms a two-factor structure was found, α = 0.950, with good fit (2 = 266.837, p = 0.000; RMSEA = 0.321; RMSSR = 0.057; CFI = 0.848; NNFI = 0.789); and without symptoms, a single-factor structure (cumulative variance 84%), α = 0.9, acceptable fit (2= 377.327, p < 0.001; RMSEA = 0.355; RMSSR = 0.073; CFI = 0.832; NNFI = 0.764). And self-care management with two-factor structure (cumulative variance 53.7%) α = 0.7, with good fit (2 = 14.317, p = 0.014; RMSEA = 0.144; RMSSR = 0.063; CFI = 0.905; NNFI = 0.809).

Conclusions: The resulting instrument has adequate psychometric properties, consistent with the theoretical model of self-care in chronic diseases. Its use is recommended to evaluate self-care to prevent diabetic foot in populations similar to the study population.
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NewsBot · Jan 5, 2023

Factors Associated With Self-Efficacy of Foot Self-Care Among Patients With Diabetes Attending a Tertiary Care Center in Saudi Arabia
Musab Yousef Al Ayed et al
Int J Low Extrem Wounds. 2023 Jan 3

Several reports have shown self-efficacy to be a reliable way of predicting foot self-care behavior in patients with diabetes. However, at a global level in general, and in Saudi Arabia in particular, investigation of the factors related to self-efficacy in executing foot self-care continues to remain inadequate. This study endeavors to identify the factors associated with the self-efficacy of foot self-care among patients with diabetes in Saudi Arabia. From a tertiary diabetes care center in Saudi Arabia, 175 patients with diabetes were selected to participate in this cross-sectional study. Employing the Arabic version of the Foot Care Confidence Scale (FCCS), the principal end results and the sociodemographic, clinical, and psychosocial independent variables were collected and assessed. From the total reported FCCS score, the mean was found to be 28.1 ± 8.2. Multiple linear regression analysis indicated 2 independent factors were positively associated with a higher reported FCCS score; being middle-aged (< 60 years old) (β=0.31, P< .01) and having a higher score on the Foot Care Outcome Expectations Scale (FCOES) (β=0.36, P< .01). In conclusion, patients with diabetes in Saudi Arabia have a mild level of self-efficacy to perform the needed foot self-care. Therefore, this has turned the spotlight on the young or middle-aged < 60-year-old Saudi population with diabetes as the target group, making them the priority for future self-efficacy promotion programs to upgrade the level of foot self-care.
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NewsBot · Mar 13, 2023

Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: a cross-sectional study in Changsha, China
Nan Zhao et al
BMC Prim Care. 2023 Mar 13;24(1):68

Background: Diabetic foot is a serious complication of diabetes with a high disability and mortality rate, which can be prevented by early screening. General practitioners play an essential role in diabetic foot risk screening, yet the screening behaviors of general practitioners have rarely been studied in primary care settings. This study aimed to investigate foot risk screening behaviors and analyze their influencing factors among general practitioners.

Methods: A cross-sectional study was conducted among 844 general practitioners from 78 community health centers in Changsha, China. A self-designed and validated questionnaire was used to assess the general practitioner's cognition, attitude, and behaviors on performing diabetic foot risk screening. Multivariate linear regression was conducted to investigate the influencing factors of risk screening behaviors.

Results: The average score of diabetic foot risk screening behaviors among the general practitioners was 61.53 ± 14.69, and 271 (32.1%) always or frequently performed foot risk screening for diabetic patients. Higher training frequency (β = 3.197, p < 0.001), higher screening cognition (β = 2.947, p < 0.001), and more positive screening attitude (β = 4.564, p < 0.001) were associated with more diabetic foot risk screening behaviors, while limited time and energy (β=-5.184, p < 0.001) and lack of screening tools (β=-6.226, p < 0.001) were associated with fewer diabetic foot screening behaviors.

Conclusion: The score of risk screening behaviors for the diabetic foot of general practitioners in Changsha was at a medium level. General practitioners' diabetic foot risk screening behaviors may be improved through strengthening training on relevant guidelines and evidence-based screening techniques, improving cognition and attitude towards foot risk screening among general practitioners, provision of more general practitioners or nurse practitioners, and user-friendly screening tools
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NewsBot · Mar 21, 2023

Effect of a Podiatric Health Education Intervention on the Level of Self-care in Patients with Diabetes Mellitus
María Reina-Bueno et al
Adv Skin Wound Care. 2023 Apr 1;36(4):1-5

Objective: To test the effect of a podiatric health education activity on foot self-care and the degree of foot-related disability in a group of people with diabetes mellitus (DM) in the province of Seville. A pretest-posttest quasi-experimental design was used.

Methods: Twenty-nine people with DM participated. The intervention was a podiatric health education activity consisting of a 1-hour informative talk. Foot pain-related disability was measured using the Manchester Foot Pain and Disability Index. The degree of foot self-care was measured with the University of Malaga Foot Self-care questionnaire.

Results: One month after the intervention, both parameters had improved significantly. The mean score on the Manchester Foot Pain and Disability Index increased from 59.96 (SD, 8.69) at baseline to 67.39 (SD, 6.99) at 1 month, and the mean score on the University of Malaga Foot Self-care questionnaire improved from 11.65 (SD, 20.07) at baseline to 4.52 (SD, 5.47) after 1 month.

Conclusions: Therapeutic education increases the level of self-care and decreases the degree of foot-related disability in people with DM.
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NewsBot · Mar 29, 2023

Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care

NewsBot · Mar 30, 2023

Factors influencing foot care behaviour among patients with diabetes: An integrative literature review
Ming Wei Jeffrey Woo, Jiao Cui
Nurs Open. 2023 Mar 27

Aim: The aim of the study was to examine factors influencing diabetic foot care behaviours (DFCBs) among patients with diabetes.

Design: An Integrative review using the Whittemore & Knafl five-stage framework.

Methods: A systematic search was performed to retrieve relevant peer-reviewed literature published in English between 2011 and 2020 across three electronic databases: CINAHL, Medline (PubMed) and Scopus. Following the quality appraisal, 35 papers were included in this review.

Results: This review revealed that patients' DFCBs were suboptimal. Additionally, four emerging themes, namely: demographic characteristics as predictors of diabetic foot care behaviour were identified as the predictors of DFCB; illness beliefs and perceptions as predictors of diabetic foot care behaviour; foot care knowledge as a predictor of diabetic foot care behaviour and foot care education as a predictor of diabetic foot care behaviour. This calls for nurses to devise educational strategies that adequately address these determinants to drive long-term positive DFCB among patients
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NewsBot · Apr 6, 2023

Importance of interprofessional collaboration in teaching diabetic foot self-management: Perceptions of health care professionals
Sushma Prabhath et al
Medical Journal Armed Forces India 3 April 2023

Background
Diabetes and associated diabetic foot ulcers require coordinated management, including several health care professional (HCPs). Therefore, an interprofessional (IP) team-based approach is essential for effectively managing and educating the population on diabetic foot self-management strategies. However, the perceptions of the HCPs related to the importance of IP teamwork in diabetic foot care and their readiness to work in an IP team are less explored.

Methods
This qualitative study aimed to investigate the HCPs' perception on the importance of IP collaboration in diabetic foot care and their readiness to work as part of an IP team in teaching patients’ effective diabetic foot self-management techniques. The study includes seven HCPs involved in diabetic foot management patient education and treatment. In-depth interviews using an interview guide and a thematic analysis of the interview transcripts were undertaken.

Results
Every participant was strongly motivated to be an IP team member. The following themes were identified that supported IP team-based approach in diabetic foot care: ‘patient-centric practices,’ ‘comprehensive care,’ ‘teamwork and coordination for improved patient outcome,’ ‘integrated approach,’ ‘professional knowledge amalgamation,’ ‘time-management,’ ‘education in a favorable environment,’ ‘constant motivation and support through educational modules,’ and ‘commitment and policy reforms.’

Conclusions
The HCPs' were aware about the benefits of IP team-based approach in diabetic foot care. They further expressed their willingness to work as part of an IP team and suggested appropriate teaching methods for diabetic foot self-management. This manuscript thus attempts to create an awareness about the importance of IP approach in teaching the proper practices of diabetic foot care. The problems faced in implementing an IP approach in diabetic foot care and the possible solutions are also discussed.
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NewsBot · Apr 8, 2023

Improving Adherence to Treatment Plans in Diabetes Patients With Neuropathic Foot Wounds
Ann-Marie Irons, Mary Elizabeth Pounders
J Dr Nurs Pract. 2023 Mar 1;16(1):36-43

Background: In southeast states, diabetes continues to rise. Medical expenses are higher for -individuals diagnosed with diabetes-related complications, and poor outcomes are associated with missed appointments for wound treatment. Objective: The aim of this clinical practice contribution was to implement interventions to increase adherence to appointments and treatment plans in an outpatient wound clinic. Methods: Project participants over 18 years of age who were at risk for or have neuropathic foot wounds and are on weekly treatment regimens were recruited. Clinic staff were surveyed on the perceived success of and willingness to continue the interventions. Results: All staff surveyed agreed or strongly agreed that an automated reminder system and incentive program would make a significant impact on the patient's quality of life and worth the time and effort for staff to continue implementation. No patients in the control group required admission to acute care for treatment. Conclusions: Going forward with implications for future practice, these interventions demonstrated both the importance of adherence to outpatient appointments and opportunities to promote patient engagement. Implications for Nursing: Improving attendance at outpatient clinic appointments is significant for the delivery of quality patient care. By managing chronic conditions in the outpatient setting, complications can be reduced.
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NewsBot · Apr 18, 2023

"Self-care of the feet in people with type 2 diabetes. A qualitative study"
María Isabel Bonilla-Carrasco et al
Enferm Clin (Engl Ed). 2023 Apr 13;S2445-1479(23)00021-8.

Objective: To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care.

Method: Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these.

Results: A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviours despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford.

Conclusions: The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.
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NewsBot · May 15, 2023

Perceptions of Australians with diabetes-related foot disease on requirements for effective secondary prevention
Aaron Drovandi et al
Aust J Rural Health. 2023 Apr 24.

Introduction: Secondary prevention is essential in reducing recurrence of diabetes-related foot disease (DFD) but is frequently poorly implemented in clinical practice.

Objective: To explore the perceptions of people with diabetes-related foot disease (DFD) on their self-perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program.

Design: Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi-structured interviews. Interviews were audio-recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD.

Findings and discussion: Participants had high self-perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care.

Conclusion: People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support.
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NewsBot · May 29, 2023 at 5:44 AM

Diabetes foot self-care practices in the German population
Sascha Schmidt, Herbert Mayer, Eva-Maria Panfil
13 October 2008

Aim. The object of this study was to find out which self-care activities patients with diabetes perform to prevent diabetic foot syndrome (DFS) and to look for differences between patient groups (diabetes education and foot at risk).

Background. Besides the importance of screening patients at risk to develop a DFS and the clinical interventions, it is also necessary to involve the patient with diabetes in the self-care of their feet. There is no information in Germany concerning self-care activities carried out by patients for the prevention of DFS.

Design. A cross-sectional study.

Method. A secondary analysis of the data used in the study for the development of the ‘Frankfurter Catalogue of Foot Self-Care – Prevention of Diabetic Foot Syndrome’. Two hundred and sixty-nine patients with type 1 and type 2 diabetes were included. The study population was divided into different training experience groups and foot at risk groups based on self-reported data.

Results. Patients who had participated in more than three education programmes performed significantly better self-care than patients who had no or only one training programme. Patients with a foot at risk for the development of diabetic foot ulcer perform more adequate self-care regarding professional assistance in foot care, but are not more active in the self-control of the feet, shoes and socks.

Conclusions. There are self-care deficits regarding self-control of feet, shoes and socks. Based on the data it seems to be that more than three education programmes are needed to lead to performance of adequate self-care. Especially patients with a foot at risk need more professional support for their daily self-care activities to prevent DFS or further foot complications.

Relevance to clinical practice. The first findings support that it might be helpful to identify patients with self-care deficits and therefore to improve patients daily foot self-care.
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NewsBot · May 29, 2023 at 6:04 AM

Validity and reliability of the German translation of the Diabetes Foot Self-Care Behavior Scale (DFSBS-D).
Lecker L, Stevens M, Thienel F, Lazovic D, van den Akker-Scheek I, Seeber GH
PLoS ONE 17(6): e0269395. https://doi.org/10.1371/journal.pone.0269395

Introduction
Comprehensive regular foot self-care is one of the most critical self-management behaviors for people with diabetes to prevent foot ulcer development and related complications. Yet, adequate foot self-care is only practiced by very few of those affected. To improve diabetic foot syndrome prevention, a valid and reliable instrument for measuring daily foot-care routines in patients with diabetes is needed. However, no such instrument is currently available in the German language. This study, therefore, aims to translate and cross-culturally adapt the "Diabetic Foot Self-Care Behavior Scale" (DFSBS) into German (DFSBS-D) and evaluate its validity and reliability.

Material and methods
The DFSBS was translated from English into German using a forward-backward procedure as per previous recommendations. Factor analysis was used to study structural validity. To establish construct validity, 21 a priori hypotheses were defined regarding the expected correlation between scores on the new German version (i.e., DFSBS-D) and those of the following questionnaires measuring related constructs: (1) German version "Diabetes Self-Care Activities Measure" (SDSCA-G), (2) "Frankfurter Catalogue of Foot Self-Care" (FCFSP), and (3) "Short Form 36" (SF-36) and tested in 82 patients. To assess test-retest reliability, patients completed the DFSBS-D again after a 2-week interval. Test-retest reliability was assessed from stable patients’ data (n = 48) by calculating two-way random-effects absolute agreement ICCs with 95% CI and Bland and Altman analyses. In addition, Cronbach’s alpha was calculated as internal consistency measure.

Results
The 7-item DFSBS-D showed good structural validity. Its single factor explains 57% of the total sample variance. Of the 21 predefined hypotheses, 13 (62%) were confirmed. The DFSBS-D’s internal consistency was good (Cronbach’s alpha = 0.87). Test-retest reliability over a 2-week interval was also good (ICC 0.76).

Conclusion
The DFSBS was successfully translated into German. Statistical analyses showed good DFSBS-D structural validity, test-retest reliability, and internal consistency. Yet, construct validity may be debated.
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NewsBot · May 29, 2023 at 6:05 AM

Knowledge and Practice of the Preventive and Care Methods for Diabetic Foot Among the Caregivers of Diabetic Patients in Saudi Arabia
Hassan Ali A AlZubaidi et al
Cureus. 2023 Apr 20;15(4):e37887

Background Diabetic foot syndrome is a complex and multifactorial disease process involving neuropathy, peripheral arterial disease, osteomyelitis, diabetic foot ulcer (DFU), and amputation. DFUs are a common and burdensome manifestation of the syndrome, responsible for diabetes-related morbidity and mortality. Successful management of DFU requires collaboration between patients and caregivers. This study assesses the knowledge, experience, and practices of the caregivers of diabetic foot patients in Saudi Arabia, highlighting the need for targeted interventions to improve knowledge and practices in certain subgroups of caregivers. Method The primary objective of this study was to evaluate the proficiency and practicality of caregivers who provide care to patients with diabetic foot in the Kingdom of Saudi Arabia. To accomplish this, a cross-sectional study was conducted among caregivers of diabetic foot patients who were aged 18 years or older and living in Saudi Arabia. The participants were randomly chosen to ensure that the sample was representative. The data collection process involved the distribution of a structured online questionnaire via various social media platforms. Prior to the distribution of the questionnaire, the participants were informed about the study's objectives, and their informed consent was obtained. Additionally, adequate measures were taken to ensure the confidentiality of the participants and their caregiving status. Results Among the initial pool of 2990 participants, 1023 individuals were excluded from the study due to their status as non-caregivers of diabetic patients or being under the age of 18 years. Consequently, the final sample size consisted of 1921 caregivers. The majority of the participants were female (61.6%), married (58.6%), and had a bachelor's degree (52.4%). The findings revealed that 34.6% of caregivers were attending to patients with diabetic foot, of which 8.5% reported poor foot status and 9.1% reported amputation. Caregivers reported examining the patient's feet in 75.2% of cases, and the feet were cleaned and moisturized by either the patient or caregiver. Nails were trimmed by 77.8% of caregivers, and 49.8% of them did not permit patients to walk barefoot. Moreover, knowledge of diabetic foot care was positively correlated with being female, having a post-graduate degree, having personal experience with diabetes, caring for a patient with diabetic foot, and having prior experience in treating diabetic foot. Conversely, lower knowledge levels were associated with divorced or unemployed caregivers and those residing in the northern region. Conclusion The present study highlights that caregivers of diabetic foot patients in Saudi Arabia possess a satisfactory level of knowledge and follow appropriate practices regarding foot care. Nonetheless, it is imperative to identify specific subgroups of caregivers who may require additional education and training to improve their knowledge and practices concerning diabetic foot care. The results of this study could potentially inform the design of tailored interventions aimed at reducing the significant burden of morbidity and mortality attributed to diabetic foot syndrome in the Saudi Arabian context.
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Diabetic foot self care

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MyFootCare: An application to actively engage people in their diabetic foot ulcer self-care

Mobile app for Diabetic Foot Self-Care

Validation of a booklet on self-care with the diabetic foot

Topical Esmolol Hydrochloride for Diabetic Foot Ulcers

Diabetic Foot Ulcers in Skin of Color

Leech therapy and Ayurveda for diabetic foot ulcers

Relaxation to help diabetic foot ulcer healing

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Diabetic foot self care

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MyFootCare: An application to actively engage people in their diabetic foot ulcer self-care

Mobile app for Diabetic Foot Self-Care

Validation of a booklet on self-care with the diabetic foot

Topical Esmolol Hydrochloride for Diabetic Foot Ulcers

Diabetic Foot Ulcers in Skin of Color

Leech therapy and Ayurveda for diabetic foot ulcers

Relaxation to help diabetic foot ulcer healing

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