60-Second Diabetic Foot Screen Tool

NewsBot · May 23, 2012

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Reliability and Predictive Validity of Inlow's 60-Second Diabetic Foot Screen Tool.
Murphy CA, Laforet K, Da Rosa P, Tabamo F, Woodbury MG.
Adv Skin Wound Care. 2012 Jun;25(6):261-266.

OBJECTIVE:
The purpose of this study was to assess Inlow's 60-Second Diabetic Foot Screen Tool to ascertain consistency of risk recognition for development of ulceration independent of specific assessor and practice setting. Screening tools that assist clinicians in identifying risk require validation. The objectives were to determine the intrarater reliability, interrater reliability, and predictive validity of Inlow's 60-Second Diabetic Foot Screen Tool in 2 healthcare settings.

DESIGN:
Following ethics board approval, a prospective observational study was completed.

SETTING AND PARTICIPANTS:
A convenience sample of 69 persons with diabetes was recruited: n = 26 from an acute care setting (dialysis) and n = 43 from long-term-care (LTC) setting.

MAIN OUTCOME MEASURES:
The screening tool was administered by 2 assessors independently to determine interrater reliability and later the same day by one of the assessors to determine intrarater reliability. Occurrence of foot ulcers or amputation was noted 1 to 5 months later to determine predictive validity.

MAIN RESULTS:
Reliability is reported per setting using the intraclass correlation coefficient (2.1) and 95% confidence intervals. Intrarater reliability: LTC 0.96 (0.93-0.98) right foot, 0.97 (0.95-0.98) left foot; dialysis 1.00 right and 1.00 left foot. Interrater reliability: LTC 0.92 (0.86-0.96) right foot, 0.93 (0.87-0.96) left foot; dialysis 0.83 (0.65-0.92) right foot and left foot. Predictive validity: Two subjects had events-1 ulcer and 1 amputation-that were associated with high Inlow's screening tool scores.

CONCLUSION:
This study demonstrates excellent interrater and intrarater reliability and provides preliminary information about predictive validity.
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Greg Fyfe · May 30, 2012

A couple of articles found online

Greg

NewsBot · Jan 12, 2013

A Prospective, Descriptive Study to Assess the Reliability and Usability of a Rapid Foot Screen for Patients with Diabetes Mellitus in a Complex Continuing Care Setting
Carreau L, Niezgoda H, Leblond S, Trainor A, Orsted H, Woodbury MG.
Ostomy Wound Manage. 2013 Jan;59(1):28-34.

Inlow's 60-second Diabetic Foot Screen is a paper-pencil tool developed to guide professionals in the completion of a quick foot assessment of persons with diabetes mellitus to determine recommended frequency of assessments. The tool has been used in various healthcare settings and its reliability and validity previously tested in acute and long-term care settings. The purpose of this study was to assess content, time to complete assessment, ease of use, and reliability of the tool in a complex continuing care setting. The tool includes questions about 10 variables; skin, nails, deformities, footwear, temperature, range of motion, sensation, pulses, dependent rubor, and erythema. Answers convert to a score ranging from 0 (low risk, yearly screenings) to 23 (high risk, weekly screenings). Using the tool, the study questionnaire, and a watch, three nurse assessors experienced in assessing the feet of persons with diabetes completed 70 assessments on 35 patients during a period of 30 days. Content areas assessed included significance of comorbidities and interval screening times. Mean time to complete the assessment was 7 minutes (range 2 to 21 minutes); 39% of assessments took 6 to 7 minutes. Times to perform assessment varied widely due to the functional and cognitive well-being of the patient. Inter-rater reliability was low (ICC 0.608 [95% confidence interval 0.349-0.781]), perhaps due to varying interpretations of assessment parameters related to the complexity of the study patient population. Comments suggest that some tool revisions may increase ease of use as well as tool validity and reliability, especially for complex care patients with multiple comorbidities.
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NewsBot · Jul 4, 2015

Tool for Rapid & Easy Identification of High Risk Diabetic Foot: Validation & Clinical Pilot of the Simplified 60 Second Diabetic Foot Screening Tool.
Woodbury MG, Sibbald RG, Ostrow B, Persaud R, Lowe JM
PLoS One. 2015 Jun 29;10(6):e0125578. doi: 10.1371/journal.pone.0125578. eCollection 2015.

BACKGROUND:
Most diabetic foot amputations are caused by ulcers on the skin of the foot i.e. diabetic foot ulcers. Early identification of patients at high risk for diabetic foot ulcers is crucial. The 'Simplified 60-Second Diabetic Foot Screening Tool' has been designed to rapidly detect high risk diabetic feet, allowing for timely identification and referral of patients needing treatment. This study aimed to determine the clinical performance and inter-rater reliability of 'Simplified 60 Second Diabetic Foot Screening Tool' in order to evaluate its applicability for routine screening.
METHODS AND FINDINGS:
The tool was independently tested by n=12 assessors with n=18 Guyanese patients with diabetes. Inter-rater reliability was assessed by calculating Cronbach's alpha for each of the assessment items. A minimum value of 0.60 was considered acceptable. Reliability scores of the screening tool assessment items were: 'monofilament test' 0.98; 'active ulcer' 0.97; 'previous amputation' 0.97; 'previous ulcer' 0.97; 'fixed ankle' 0.91; 'deformity' 0.87; 'callus' 0.87; 'absent pulses' 0.87; 'fixed toe' 0.80; 'blisters' 0.77; 'ingrown nail' 0.72; and 'fissures' 0.55. The item 'stiffness in the toe or ankle' was removed as it was observed in only 1.3% of patients. The item 'fissures' was also removed due to low inter-rater reliability. Clinical performance was assessed via a pilot study utilizing the screening tool on n=1,266 patients in an acute care setting in Georgetown, Guyana. In total, 48% of patients either had existing diabetic foot ulcers or were found to be at high risk for developing ulcers.
CONCLUSIONS:
Clinicians in low and middle income countries such as Guyana can use the Simplified 60-Second Diabetic Screening Tool to facilitate early detection and appropriate treatment of diabetic foot ulcers. Implementation of this screening tool has the potential to decrease diabetes related disability and mortality.
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NewsBot · Jan 30, 2021

Sixty-second screening for diabetic foot disease : a comparison of two Nigerian teaching hospitals : original research
M.A. Olamoyegun et al
Wound Healing Southern Africa Vol. 8, No. 2

Objectives: This study identified diabetic patients at high risk of diabetic foot disease, using a 60-second screening tool in two Nigerian teaching hospitals. This is important as diabetic foot is the most common reason for diabetic-related hospitalisation and often requires amputation. It is known that patients who undergo any form of amputation are at increased risk of further amputations. However, when patients are diagnosed early and offered adequate care using a multidisciplinary approach, the rate of amputation decreases significantly. Design: This was a cross-sectional study. Consecutively consenting patients with diabetic mellitus who present at both hospitals (University of Ilorin Teaching Hospital and Lautech Teaching Hospital) were recruited into the study. Subjects and setting: The patients had diabetic mellitus and were attending the endocrinology clinic at both hospitals. Sixty-five patients were recruited from the University of Ilorin Teaching Hospital, Ilorin, while 64 patients were recruited from the Lautech Teaching Hospital, Ogbomoso, for the study. Outcome measures: The patients were screened using the 60-second screening tool. This identified patients at high risk of developing diabetic foot who would therefore need further intervention. Results: The study patients were predominantly in the sixth and seventh decade of life (60% at the University of Ilorin Teaching Hospital, and69% at Lautech Teaching Hospital). Fifteen per cent of patients with a previous ulcer were at the University of Ilorin Teaching Hospital, and 28% at Lautech Teaching Hospital. Deformity was recorded in some patients. Eleven per cent of the patients experienced loss of protective sensation at the University of Ilorin Teaching Hospital, and 30% at Lautech Teaching Hospital. Overall, there was at least one risk factor for 35% of patients at the University of Ilorin Teaching Hospital, and 55% at Lautech Teaching Hospital. Conclusion: Screening for diabetic foot is paramount in reducing the morbidity and mortality associated with the condition. This identifies high-risk patients who require further care. Therefore, efforts should be concentrated on Screening.
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NewsBot · May 16, 2022

To study the Diabetic Foot at risk using an A 60 second Foot Screening Tool and Risk classification based on the comprehensive foot examination in patients of diabetes - At a Tertiary care Center East India
Kishore Behera, Uttam Soren1 & Binod Kumar Behera
Endocrine Abstracts (2022) 81 EP410 | DOI: 10.1530/endoabs.81.EP410

Introduction: The aetiology of a diabetic foot ulcer is multifactorial. The three principal components that ascertain the likelihood of ulceration in a diabetic foot are peripheral neuropathy, repeated minor trauma and deformity. Aims:To find the prevalence of diabetes patients having the foot at risk using the Simplified 60-Second Diabetic Foot Screen tool (SSDFST).

Objectives: To find out the diabetic foot at risk.1. To ascertain the dispersal of various categories of the foot at risk in patients with diabetes and the factors that modify it2. To find out the association of neuropathy to the various diabetes risk factors.Materials and Methods This was a cross-sectional study comprising of 128 patients; a detailed history and examination including neurological and vascular assessment were performed attending a Tertiary Care Hospital. Patients were screened for the risk of diabetic foot using the SSDFST. The detection of loss of protective sensation (LOPS) using a simple 10-g monofilament test (10 g M) was highly predictive of subsequent ulceration had been reported by the Seattle Diabetic Foot Study. Foot at risk was correlated with demographic and clinical features. Data were analyzed using descriptive and inferential statistics, significant at P = 0.05.

Results: Out of 128 patients;92(72%), 36(28%) were male and female respectively. The mean duration of diabetes was 7.42 ± 6.233 years (range 1-27). The mean age, BMI, of the study population was 53.125±10.997 years; 25.93±4.464 kg/m2 respectively. sOut of 128 patients, 82(64%) were normal without any risk factor for diabetic foot, and 46 (36%) patients had at least one risk factor for the diabetic foot using SSDFST. About 36% of patients were combinedly qualified for the foot at risk into (category 1, 2 and 3); among which 06 (5%) were placed under (category 1). 18 (14%) patients were classified into risk category 2 with LOPS +PAD and 22 (17%) into category 3 with a history of ulcer and /or amputation. The duration of diabetes, previous foot ulcer, deformity, absent pedal pulses, active ulcers, neuropathy, all these factors (P = 0.05) were significantly associated with neuropathy measured by 10 g M. Conclusions Our study revealed that one-third of our patients had at least one risk factor for the diabetic foot by using an SSDFST. About one-fifth of our patients had neuropathy detected by monofilaments. One-tenth of the study population were aware of proper foot care practice.
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NewsBot · May 2, 2023

How do patients and healthcare professionals
experience foot examinations in diabetes care? – a
randomised controlled study of digital foot
examinations versus traditional foot examinations
Ulla Hellstrand Tang et al
Research Square

Background: Digital solutions in healthcare can facilitate and improve care. However, the experiences and
usefulness of using either digital foot examinations or traditional foot examinations need to be
evaluated.
The aims of the study were to evaluate:
1) the differences in patient experiences, having their foot examined supported by the Clinical Decision
Support System (CDSS) as compared with having their foot examined in traditional practice,
2) how healthcare professionals (HCP), by using the CDSS, experienced the routine compared with
performing the foot examination as in traditional practice.
Methods
Of a total of 141 patients, 100 patients with diabetes were single-blind digitally randomised to one of two
parallel arms: having their foot examined by an HCP using a CDSS (n=47) or having their foot examined
as in traditional practice (n=53) at the Department of Prosthetics and Orthotics at Sahlgrenska University
Hospital, Gothenburg, Sweden. Patients filled in a modified version of the National Patient Survey (NPS)
and the Orthotics and Prosthetics Users’ Survey (OPUS) at study end. Two HCPs, working at a
Department of Prosthetics and Orthotics, answered surveys regarding the interaction between the patient
and the CPO.
Results: Patients, aged 65±14 years, perceived a high level of satisfaction with the service at the
department, regardless of the method used. No significant differences between groups were found when
evaluated by 27 questions in the NPS or the OPUS, with scores of 67.17±12.18 vs. 66.35±16.52 (p=0.78)
for the intervention and control group respectively. One hundred per cent of the patients were risk
classified in the intervention group compared with 2% in the control group.
Conclusions: Patients perceived a high level of satisfaction with the services at the DPO, regardless of the
method used for the foot examination. All the patients were risk classified in the intervention group. The
HCPs found that, by using the CDSS, the foot examination was structured and followed clinical
guidelines. Furthermore, the documentation in the electronic health record was thorough, even though
further improvements, such as integration with co-existing health record systems, were requested.
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NewsBot · Aug 2, 2023

Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals: Qualitative Study
Susanne Andersson et al
Source

Background:
Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual’s quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals.

Objective:
The study aimed to validate a structured foot examination form by assessing health care professionals’ experiences of working with it “foot side” when examining patients with diabetes.

Methods:
Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users’ data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled “Optimised care of persons with diabetes and foot complications,” with Västra Götaland Region as the responsible health care authority, where the results will be further developed.

Results:
Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned.

Conclusions:
The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines.
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60-Second Diabetic Foot Screen Tool

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Inlow 7-2-woodbury.pdf

Inlow 7-2-orsted.pdf

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60-Second Diabetic Foot Screen Tool

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Greg Fyfe Active Member

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