Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death

NewsBot · Feb 28, 2017

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Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death
Dane K. Wukich, MD, Katherine M. Raspovic, DPM, Natalie C. Suder, MPH
Foot & Ankle Specialist February 1, 2017

Background. The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. Methods. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non–diabetes-related foot pathology. Results. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Conclusion. With diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy.
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Admin2 · Feb 28, 2017

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NewsBot · Aug 11, 2017

Patient Impressions of Possible Catastrophic Outcomes after Diabetic Foot Ulceration.
Vickers B et al
Curr Diabetes Rev. 2017 Jun 12. doi: 10.2174/1573399813666170612103814

BACKGROUND:
Diabetes mellitus (DM) and its complications are well studied; patients with diabetes may suffer from neuropathy and vascular issues, and associated with these, lower extremity ulceration. Ulcers are often refractory to treatment, and can be difficult for both patients and clinicians to manage. Such complications may lead to amputations, which in turn are a risk factor for death. However, in certain situations amputation may be the only option available, and may be used as reconstructive surgery, restoring function. The impacts of ulceration, amputation, use of prostheses, and other complications of diabetes on quality of life (QOL) are well studied. Similarly, the impact of QOL on overall health has been studied in some detail.
OBJECTIVE:
Not as well understood are patient expectations regarding amputation and ulceration, and patient knowledge of these outcomes. Specifically, it is not fully understood how patients view these complications prior to their occurrence. In this review we survey the literature for studies discussing these attitudes. Our objective was to perform a systematic review of the medical literature to understand how patients understand and anticipate the potential negative outcomes of ulceration and amputation. We also aimed to identify areas where there are gaps in patient knowledge, which could be addressed by clinicians.
RESULTS:
Our study yielded articles regarding impressions of patients with diabetes about their general health and outcomes. However, we did not discover much literature directly concerning attitudes toward catastrophic lower extremity outcomes before they occurred. We also identified that patients lack knowledge of management and complications of diabetes; both of these gaps provide an opportunity to better direct care for such patients.
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NewsBot · Oct 3, 2018

Perceived Concerns of Patients at Risk for Lower Extremity Amputation.
Cornell RS, Meyr AJ
Wounds. 2018 Feb;30(2):45-48. Epub 2017 Oct 20.

Despite a good understanding of risk factors for amputation and the development of multidisciplinary amputation prevention teams, thousands of lower limb amputations are performed on a daily basis. These amputations are often transformative events in the lives of patients with functional, psychological, social, and economic implications.

OBJECTIVE:
The objective of this investigation is to qualitatively and quantitatively explore the perceived concerns of patients with chronic wounds at risk for lower extremity amputation.

MATERIALS AND METHODS:
A guided, physician-administered survey was completed by consenting participants. The survey consisted of both open-ended questions and a 10-point scale for specific questions on a variety of potential patient concerns.

RESULTS:
Although some questions resulted in relatively high and low mean scores, 9 of the 13 specific questions produced a range of responses on a 10-point modified Likert scale. This indicates that there are not necessarily universal patient concerns and that every patient is different and should be treated as such. With that being said, however, the highest levels of concern (mean measurements ≥ 7/10) had to do with recurrence, function, walking, and self-sufficiency. The lowest levels of concern (mean measurement ≤ 5/10) had to do with pain, shoe gear considerations, cost, and cosmetic appearance of an amputation.

CONCLUSIONS:
It is the authors' hope that this investigation provides wound care professionals with information that will benefit their approach to the education and treatment of patients at risk for amputation as well as lead to future investigations into the emotional and psychological state of patients with chronic lower extremity wounds.
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NewsBot · Jun 12, 2022

Amputation and infection are the greatest fears in patients with diabetes foot complications
Dane K.Wukich et al
Journal of Diabetes and its Complications; 10 June 2022, 108222

Highlights
•Foot infection is feared to a greater degree in patients with diabetes related foot complications than death, blindness, heart attack, stroke or dialysis
•Minor lower extremity amputation is feared to a greater degree in patients with diabetes related foot complications than death, blindness, heart attack, stroke or dialysis
•Major lower extremity amputation is feared to a greater degree in patients with diabetes related foot complications than death, blindness, heart attack, stroke or dialysis
•There is no difference in the fear of infection, minor amputation or major amputation
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Aims
To determine the degree patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations fear complications (death, dialysis, heart attack, stroke, blindness, diabetic foot infection, minor and major lower extremity amputation [LEA]) that can occur and to assess if there is a difference between fears of patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations and diabetic patients without these complications.

Methods
478 patients completed an eight question Likert scale survey. The study group was defined as non-infected foot ulcers, neuropathic fractures and Charcot neuroarthropathy.

Results
Of the 478 patients, 121 (25.3 %) had diabetic foot ulcers, Charcot neuroarthropathy or neuropathic fractures and dislocations and 357 (74.7 %) did not. The study group had significantly higher odds of reporting extreme fear of foot infection (OR 2.8, 95 % CI 1.8–4.5), major LEA (OR 2.8, 95 % CI 1.8–4.4), minor LEA (OR 2.3, 95 % CI 1.5–3.5), blindness (OR 2.0, 95 % CI 1.3–3.2), dialysis (OR 2.0, 95 % CI 1.1–3.3), and death (OR 2.4, 95 % CI 1.4–4.2). In the study group highest rated fear measures were foot infection (3.71, SD 1.23), minor amputation (3.67, SD 1.45) and major amputation (3.63, SD 1.52). There were no significant differences in the mean fear of infection, minor amputation or major amputation.

Conclusion
Patients with diabetic foot ulcers, Charcot neuroarthropathy or neuropathic fractures and dislocations reported higher fear ratings of diabetes-related complications compared to those without these complications.
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NewsBot · Feb 3, 2023

Thoughts and experiences regarding leg amputation among patients with diabetic foot ulcers: A phenomenological study
Ka-Huen Yip, Yuk-Chiu Yip, Wai-King Tsui
30 January 2023

Despite lower-limb amputation being common among patients with diabetic foot ulcers, few studies have qualitatively investigated the patients' perspectives. Therefore, this study aimed to explore the thoughts and experiences of patients with diabetic foot ulcers regarding lower-limb amputation in Hong Kong. A phenomenological study using individual, semi-structured interviews was conducted with 18 participants with foot ulcers recruited in Hong Kong between July and September 2022. The interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach and a constant comparison strategy. The results highlighted four substantial themes: (a) coping or being alone and taciturn, (b) altered appearance impacting one's sense of maintaining social relations, (c) thoughts about self-efficacy and encountering a new normal, and (d) the possibility of a reduced gap in physical consequences between the old and new self. This study provided different perspectives of patients with a history of diabetic foot ulcers, even in cases where lower-limb amputation has not yet been performed. The results demonstrate that lower-limb amputation is considered a forbidden topic. This makes it culturally difficult for Chinese patients to discuss the matter with healthcare authorities and family members. Healthcare workers should be aware of how they communicate regarding lower-limb amputation.
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NewsBot · Feb 23, 2023

Amputation Acceptance: A Survey of Factors Influencing the Decision to Undergo Lower Extremity Amputation
Gina Cach et al
J Foot Ankle Surg. 2023 Jan 11;S1067-2516(23)00003-0

Accepting to undergo amputation is an arduous process often fraught with confusion, fear, and uncertainty. To assess how to best facilitate discussions with at-risk patients, we surveyed lower extremity amputees about their experiences surrounding this decision-making process. Patients who underwent lower extremity amputation at our institution from October 2020 to October 2021 were asked to complete a 5-item telephone survey assessing their decision to undergo amputation and postoperative satisfaction. Retrospective chart review of respondent demographics, comorbidities, operative details, and complications was conducted. Of 89 lower extremity amputees identified, 41 (46.07%) responded to the survey, with the majority undergoing below-knee amputations (n = 34, 82.93%). At a mean follow-up of 5.90 ± 3.45 months, 20 patients (48.78%) were ambulatory. Surveys were completed at a mean of 7.74 ± 4.03 months since amputation. Factors that helped patients decide to undergo amputation included discussions with doctors (n = 32, 78.05%) and concern for worsening health (n = 19, 46.34%). Deteriorating ability to walk (n = 18, 45.00%) was the most common concern prior to surgery. Recommendations by survey respondents to ease the decision-making process included speaking with amputees (n = 9. 22.50%), more discussions with doctors (n = 8, 20.00%), and access to mental health and social services (n = 2, 5.00%); however, many had no recommendations (n = 19, 47.50%), and most were pleased with their decision to undergo amputation (n = 38, 92.68%). Despite most patients primarily citing satisfaction with their decision to undergo lower extremity amputation, it is critical to consider factors that affect patient decisions and recommendations to improve this decision-making process.
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NewsBot · May 2, 2023

Diabetic Amputations in 2023 are Still More Frightening Than Death-Act Now Before it is Too Late
Cynthia Formosa et al
Int J Low Extrem Wounds. 2023 Apr 20

Despite huge medical and technological advances to date for the diagnosis, monitoring, and management of diabetic foot complications, their prevalence is still alarmingly high. Patients' quality of life may be severely compromised. Patients may fear amputations more than death. An effort to minimize the impact of these complications and to ensure prompt access to care for everyone is still required. Urgent therapeutic measures should become possible when needed. Improved physician training in and management of peripheral arterial disease are also vital. We need to act now before it is too late. This will definitely be one of the greatest challenges for 2023 and the years to come.
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