Interclinician variation in diabetes foot assessment- a national lottery?

admin · Jan 21, 2005

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Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Diabetic Medicine
Volume 22 Issue 2 Page 196 - February 2005

Abstract
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.

Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.

Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.

Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial assessment. We therefore recommend that more attention is placed on training for objective clinical testing, at both pre- and postgraduate levels.
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Guldemond · Jan 24, 2005

Reports from the Dutch national lottery

We performed a study in three professional groups of foot care specialists from which the results also showed a large intra- and interclinician variation regarding foot examination as found in the Manchester study: well done!! The concerned articles are currently submitted and will soon be published: ‘Testing the proficiency of foot therapists to identify locations with relatively elevated plantar pressures’ and ‘comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction’.
A better understanding of and consensus about the mechanisms underpinning foot examination and foot orthoses therapy is needed in order to improve the clinical process of foot care. This must lead to unambiguous guidelines that enable improved education and consequently less variation between therapists.

Cheers :D

Nick Guldemond, researcher
Dept. Orthopaedic Surgery
University Hospital Maastricht
P.O. Box 5800
6202 AZ Maastricht
The Netherlands
Phone: +31 (0)43 3875031
Fax: +31 (0)43 3874893
ngu@orthop.unimaas.nl

NewsBot · Mar 30, 2023

What are the current diabetic foot assessment methods in private podiatry practices in Flanders, Belgium: an exploratory mixed method study
Irene Vansteenland, Rachel Forss
J Foot Ankle Res. 2023 Mar 27;16(1):17. doi: 10.1186/s13047-023-00615-1.

Background: Diabetic foot assessments detect patients at risk for developing a diabetes-related foot ulceration and can significantly reduce the risk of amputation. In order to organize this assessment effectively, diabetic foot assessment guidelines are required according to the International Working Group of the Diabetic Foot. However, these international guidelines have not been adapted into a national guideline for podiatrists in Flanders, Belgium. This study aims to identify the methods and guidelines currently used to assess the diabetic foot in private podiatry practices in Flanders, Belgium and to explore the podiatrists' opinions on developing a national diabetic foot assessment guideline.

Methods: This exploratory mixed method study was composed of an anonymous online survey comprising of open- and closed-ended questions followed by 1:1 online semi-structured interviews. Participants were recruited via e-mail and a closed private Facebook group of podiatry alumni. Data was analyzed using SPSS statistics and thematic analysis described by Braun and Clarke.

Results: This study showed that the vascular assessment of the diabetic foot exists solely of a medical history and palpation of the pedal pulses. Non-invasive tests such as doppler, toe brachial pressure index or ankle brachial pressure index are seldom used. Only 66% reported to use a guideline for the diabetic foot assessment. There was a variety of reported guidelines and risk stratification systems in use in private podiatry practices in Flanders, Belgium.

Conclusion: Non-invasive tests such as the doppler, ankle brachial pressure index or toe brachial pressure index are rarely used for the vascular assessment of the diabetic foot. Diabetic foot assessment guidelines and risk stratification systems to identify patients at risk for developing a diabetic foot ulcer were not frequently used. International guidelines of the International Working Group of the Diabetic Foot have not yet been implemented in private podiatry practices in Flanders, Belgium. This exploratory research has provided useful information for future research studies.
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