No clinical benefit from targeted education in those with a diabetic foot ulcer

NewsBot · Sep 3, 2008

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Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial.
Lincoln NB, Radford KA, Game FL, Jeffcoate WJ.
Diabetologia. 2008 Aug 30. [Epub ahead of print]

AIMS/HYPOTHESIS: This observer-blind, randomised controlled trial was designed to determine the effect of a foot care education programme in the secondary prevention of foot ulcers.

METHODS: People with newly healed foot ulcers attending one of three specialist clinics were allocated to receive either targeted, one-to-one education or usual care, using a computer-generated random allocation sequence that had been prepared in advance but which was concealed from the clinical researcher. The primary outcome was ulcer incidence at 12 months. Secondary outcomes were ulcer incidence at 6 months and incidence of amputation, mood (Hospital Anxiety and Depression Scale) and quality of life (Diabetic Foot Ulcer Scale) at 6 and 12 months. Protective foot care behaviours (Nottingham Assessment of Functional Footcare) were assessed at 12 months.

RESULTS: There were 87 (mean [SD] age 63.5 [12.1] years) patients in the intervention group and 85 control patients (mean [SD] age 64.9 [10.9] years). The groups were comparable at baseline. No significant differences (p > 0.05) were observed between groups in ulcer incidence at either 6 months (intervention 30%, control 21%) or 12 months (intervention 41%, control 41%). Recommended foot care behaviours at 12 months were better in the intervention than in the control group (p = 0.03), but education had no significant (p > 0.05) effect on mood, quality of life or amputations.

CONCLUSIONS/INTERPRETATION: Even though the intervention was associated with improved foot care behaviour, there was no evidence that this programme of targeted education was associated with clinical benefit in this population when compared with usual care. The usefulness and optimal delivery of education to such a high-risk group requires further evaluation.
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Admin2 · Sep 3, 2008

Related:
Other diabetes self care threads
Other diabetic foot outcome threads
Organizational and personal bariers to diabetic foot care
Effectiveness of foot care education in children and adolescents with diabetes
Psychotherapy and diabetic foot complications

Craig Payne · Sep 3, 2008

Its good to see this well designed RCT supporting some studies that were not so well designed, but certainly starting to point to diabetic foot care education actually improving self care behaviours, but were suggesting that this improvement in behaviours was not actually leading to better outcomes in terms of morbidity from diabetic foot ulcers.

LuckyLisfranc · Sep 3, 2008

Just goes to show it is pointless having podiatrists expending energy on the boundless amounts of foot education foot education that permeates our public sector podiatry departments.

We would be far better off having these people putting energy into learning how to do significant inteventions, such as surgical incision & drainage and infection management, rather than the politically correct "let's have a chat about your feet".

Give them all a brochure and get on with fixing things, rather than talking about it.

LL

NewsBot · Dec 17, 2008

Medium-term effectiveness of a group educational intervention on foot care in patients with type 2 diabetes.
Ramon-Cabot J, Fernández-Trujillo M, Forcada-Vega C, Pera-Blanco G.
Equip d'Atenció Primària Mataró-1. Institut Català de la Salut. Mataró. Barcelona. España.
Enferm Clin. 2008 Nov-Dec;18(6):302-8.

AIM: To evaluate the medium-term effectiveness of a group educational intervention in primary care aimed at improving attitudes and skills in self-care of the feet in patients with type 2 diabetes, and to determine the optimal time for reintervention.

METHOD: We performed a before-after intervention study with a 24-month follow-up. The sample consisted of 76 patients with type 2 diabetes who underwent two group education sessions. Sociodemographic variables and variables related to the neurovascular status of the foot and with hygiene and self-care habits were measured. To compare the results, McNemar's test for paired data was used.

RESULTS: The mean age was 66 years and 51% were men. Skills performance before-after (8 months) the intervention were as follows: correct hygiene 41%-86%, good-medium hydration 80%-97%, daily foot washing 42%-68%, proper tools use 41%-79%, proper shoes 9%-33%, proper nails 26%-74% (all differences with p < 0.001). Among patients that improved due to the sessions, skills were still correct at 24 months in 76% (95% CI: 61%-90%) for hygiene, 100% for hydration, 70% for daily foot washing (95% CI: 51%-90%), 74% for proper tools use (95% CI: 58-90%), 55% for proper shoes (95% CI: 34%-77%) and 81% for proper nails (95% CI: 68%-94%).

CONCLUSIONS: The intervention improved all the skills studied. The effects of the sessions were still evident after 24 months in more than 70% of patients for all the variables studied except proper shoe use. Group education favors skills improvement. We suggest repeating the intervention every 24 months.
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Craig Payne · Dec 17, 2008

NewsBot said: ↑

The intervention improved all the skills studied.
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BUT, this is the issue highlighted in the first study in post one. The skills may have imporved but does that actually lead to better outcomes? The first study suggests not.

NewsBot · Jun 16, 2009

The effectiveness of foot care education on people with type 2 diabetes in Tehran, Iran.

Vatankhah N, Khamseh ME, Jahangiri Noudeh Y, Aghili R, Baradaran HR, Safai Haeri N.
Prim Care Diabetes. 2009 Jun 11. [Epub ahead of print]

AIM: The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the foot at risk in Tehran, Iran.

METHODS: One hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours. Each participant in the study received a single 20min education session individually. The mode of the intervention was face-to-face.

RESULTS: The applied educational intervention aimed at patients with type 2 diabetes has improved their knowledge and practice about diabetic foot care (P<0.0001 and P=0.011; Wilcoxon Signed Ranks test, respectively). Knowledge and practice scores were increased significantly after the education in the lean group (BMI</=25) rather than the obese ones.

CONCLUSIONS: In conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs
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Heather J Bassett · Jun 26, 2009

Perhaps all that talking is worthwhile after all.
Cheers

NewsBot · Oct 13, 2010

Impact of a diabetic foot care education program on lower limb amputation rate
Abdullah M Al-Wahbi
Vascular Health and Risk Management October 2010 , Volume 2010:6 Pages 923 - 934

Background: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.
Method: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.
Results: The before group contained 20 patients (17 males) and the after group contained 21 patients (16 males). There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.
Conclusion: The program, although evaluated at an early stage, has increased the awareness of both patients and health care staff about the prevention and management of diabetic foot disease, and decreased the rate of lower extremity amputation. We believe that the statistical proof of its impact will be evident in the final evaluation.
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NewsBot · Dec 10, 2010

Foot care education in patients with diabetes at low risk of complications: a consensus statement
A. McInnes, W. Jeffcoate, L. Vileikyte, F. Game, K. Lucas, N. Higson, L. Stuart, A. Church, J. Scanlan, J. Anders
Diabetic Medicine

Aims To define and agree a practical educational framework for delivery by all healthcare professionals managing patients with diabetes, particularly those at low risk of developing foot complications.

Methods A consensus meeting of a multidisciplinary expert panel. Prior to the meeting, relevant clinical papers were disseminated to the panel for review. The consensus was largely based upon the experts’ clinical experience and judgement.

Results Four main health behaviours were identified for those at low risk of developing foot complications, namely:, control of blood glucose levels; attendance at annual foot screening examination; reporting of any changes in foot health immediately; and the engagement in a simple daily foot care routine.

Conclusion There is currently little evidence-based literature to support specific foot care practices. Patients with diabetes at low risk of developing complications should be encouraged to undertake a basic foot care regimen to reduce their likelihood of developing complications
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NewsBot · Aug 27, 2011

Comparison of three types of diabetic foot ulcer education plans to determine patient recall of education.
Gravely SS, Hensley BK, Hagood-Thompson C.
J Vasc Nurs. 2011 Sep;29(3):113-119.

Type 2 diabetes affects almost 4% of the world's population and the rates of amputation range from 43.9 per 100,000 per year among Americans. As healthcare providers, we can motivate our patients and improve compliance if we better understand the learning styles of our patients. The need to better prepare patients and caregivers to manage illnesses and participate as partners in their care has been recognized as a national priority. This study of educational preferences for diabetic patients with a risk for developing foot ulcers utilizes a written education plan provided by the hospital and a video developed by the staff of the vascular surgery inpatient unit. One hundred participants were initially requested; however, the final sample of 30 individuals completed the study from the beginning of hospitalization to day of discharge. The majority of patients were able to increase their post-education test scores using the video education tool. A significant difference between the pretest and posttest scores for the groups who received video education was found. In contrast, although there was an improvement in pretest and posttest scores for the written-material-only group and the written/video material group, this difference was not statistically significant. Diabetes in adults is increasing in our community; however, the sample size was not representative of the population. A follow-up study is needed to provide more evidence of patient preferences when education about their illness is presented in any format.
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