A Randomized Pilot Study of improving Foot Care in Home Health Patients With Diabetes Diabetes Foot Self-care Practices in a Rural, Triethnic Population Foot Care: Knowledge Retention and Self-care Practices Foot Education Improves Knowledge and Satisfaction Among Patients at High Risk for Diabetic Foot Ulcer Evaluation of the impact of an educational initiative in diabetic foot management. Improving Foot Self-Care Behaviors With Pies Sanos Long-Term Effects of One Year of Intensified Podiatric Activities on Foot-Care Knowledge and Self-Care Habits in Patients With Diabetes Intensive education improves knowledge, compliance, and foot problems in type 2 diabetes. Self-Care Associated with Home Exercises in Patients with Type 2 Diabetes Mellitus Evaluation of the Impact of Podiatrist Care in the Primary Prevention of Foot Problems in Diabetic Subjects Sources of evidence for systematic reviews of interventions in diabetes. Foot Care Practices, Services and Perceptions of Risk among Medicare Beneficiaries with Diabetes at High and Low Risk for Future Foot Complications Diabetic Foot Disease, Self-Care and Clinical Monitoring in Adults with Type 2 Diabetes: The Alberta's Caring for Diabetes (ABCD) Cohort Study. Behaviors predicting foot lesions in patients with non-insulin-dependent diabetes mellitus Reducing lower-extremity amputations due to diabetes. Application of the staged diabetes management approach in a primary care setting. Enhancing Diabetes Self-care Among Rural African Americans With Diabetes Evaluation of the effect of nurse education on patient-reported foot checks and foot care behaviour of people with diabetes receiving haemodialysis.
PURPOSE the purpose of this study was to test the effectiveness of an educational intervention to improve patients ' foot care knowledge , self-efficacy , and self-care practice s. METHODS A prospect i ve , r and omized , single center , 2-group design was used with a convenience sample of 40 home care patients from a Medicare-certified home health agency . Baseline measures of foot care knowledge , self-efficacy , and reported self-care practice s were obtained at study entry and 6 weeks later to control for foot care interventions provided during routine home care services . After obtaining the 6-week baseline measures , patients who were r and omized to the intervention group received individualized education about proper foot care . All patients were interviewed a third time 3 months after study entry to determine the effectiveness of the intervention . RESULTS The educational intervention improved patients ' knowledge , confidence , and reported foot care behaviors . CONCLUSIONS A brief , individualized educational intervention about st and ard foot care topics improved patients ' foot care knowledge and self-efficacy as well as reported self-care practice s. Incorporating such interventions into routine home care services may enhance the quality of care and decrease the incidence of lower-extremity complications Purpose The purpose s of this study were to assess the level of foot self-care performed in a rural , multiethnic population of older adults and to identify factors associated with foot self-care . Methods The Evaluating Long-term Diabetes  Self-management  Among Elder Rural Adults study included a r and om sample of 701 African American , Native American , and white adults from 2 rural North Carolina counties . Participants completed in-home interviews , 5 foot selfcare practice s from the Summary of Diabetes Self-Care Activities ( SDSCA )  , functional status measures , and measures of education and support for foot care . Results Foot care practice s/behaviors reported at least 6 days/week ranged from 35.6 % for inspecting shoes to 79.2 % for not soaking feet . Four independent predictors of the SDSCA summary foot care index score were observed : having been shown how to care for feet ( P < .0001 ) , female gender ( P= .03 ) , having had a doctor check nerves in feet in past year ( P= .02 ) , and not receiving support caring for feet ( P = .0425 ) . Conclusions These findings indicate that educating patients about foot self-care may encourage routine foot care but that those dependent on either formal or informal support to perform foot care do so less frequently than those who perform it independently This study investigated the effectiveness of a " h and s-on " foot care teaching/learning approach for adults with diabetes . By r and om assignment , the control group received a lecture presentation on foot care , while the experimental group participated in a h and s-on session on foot care in addition to the lecture presentation . Data concerning the subjects ' foot care knowledge and skills , the condition of their feet , and their level of HbA1c were gathered prior to and six months after the foot care educational sessions . No significant increases in knowledge about foot care were observed in the experimental group . The experimental group reported improvements in inspecting and washing their feet on a daily basis , and in care of the toenails . No significant differences were observed in the status of the subjects ' feet . The HbAlc readings were significantly improved for both the experimental ( t=4.10 , df=10 , p=0.002 ) and control ( t=2.25 , df=9 , p=0.051 ) groups . A h and s-on educational session may improve foot care practice s temporarily . However , long term effects need to be studied to discern overall improvement of foot care practice s and physical status of the feet PURPOSE The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer . METHODS We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program . Two sessions were conducted by a nurse diabetes educator 3 months apart . Multiple educational approaches were used to teach patients foot self-examination , foot washing , proper footwear , and encouragement in enlisting proper physician foot care . Knowledge and satisfaction with care was measured before and after each visit . RESULTS The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program . After the second session , the mean improvement over baseline was 14 % . These patients also reported improved satisfaction with foot care ; mean improvement was 33 % . CONCLUSIONS An intensive education program improved the foot care knowledge and behavior of high-risk patients . Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program . Ways to improve accessibility of education sessions must be explored The diabetic foot project was an initiative design ed to help develop a training package for community nurses and podiatrists . It also aim ed to evaluate the impact of two days ' training on the knowledge and reported practice of  nurses and podiatrists  in the management of the diabetic foot . The study used a two-group pre- and post-test design , which replicated the work of Luker and Kenrick ( 1993 ) and Nelson and Jones ( 1997 ) . The  Wilcoxon signed-rank test  was used to determine if there was a difference between the experimental and control group scores . The results reported demonstrate the positive effect of the study days on practitioners ' knowledge and reported practice , and the study has highlighted the potential to improve practitioners ' knowledge and reported practice Participants who received Pies Sanos , a 15-min intervention design ed to improve diabetes self-efficacy and foot self-care behaviors in adult patients with type 2 diabetes who lived in a predominantly Mexican American community , performed more-complete foot self-care 1 month later in their homes . Recruited when they presented for nonurgent care to the emergency department in two community hospitals near the U.S .— Mexico border , participants were r and omized into one of three groups . At follow-up , there was a significant difference in observed foot self-care behaviors between groups , F(2 , 135 ) = 2.99 , p < .05 , as well as a significant difference within the intervention , t ( 47 ) = −4.32 , p < .01 , and control group , t ( 46 ) = −2.06 , p < .05 , for baseline and follow-up self-reported foot self-care behaviors . Baseline diabetes self-efficacy was significantly and positively correlated with both baseline ( r = .335 , p < .001 ) and follow-up ( r = .174 , p < .05 ) foot self-care behaviors The purpose of this study was to evaluate the effectiveness of the activities of a podiatrist in the outpatient foot care of patients with diabetes . Patients from southwestern Finl and , ages 10 to 80 years , were selected from the national diabetes register . Those without a recent visit to a podiatrist and without any obvious need for foot care ( n=530 ) were r and omized into a podiatric care group ( individual counseling and primary prevention measures , n=267 ) and a control group ( written instructions only , n=263 ) . Knowledge of foot care and self-care habits were evaluated by means of structured interviews , and a podiatric examination  was performed at baseline and 1 and 7 years later . Compared with the baseline scores , the knowledge score was higher at the 7-year follow-up in both the podiatric and control group and similarly in men and women . Self-care score increased in men similarly in both treatment groups . The self-care score for women increased more in the podiatric group during the first year and the difference between the groups remained for up to 7 years . There were no significant differences between the groups in the podiatric findings Despite the established role of foot care education in diabetes management , reports evaluating such interventions are rare . The effectiveness of an intensive foot care intervention programme and a conventional one were therefore compared in Type 2 diabetes . The intensive group showed significantly greater improvements than the conventional group in foot care knowledge ( p less than 0.001 ) , compliance with the recommended foot care routine ( p = 0.012 ) , and compliance with the initial advice to consult  a podiatrist ( other than the project podiatrist ) for further treatment ( p = 0.008 ) . At the first follow-up visit the intensive group also showed a significantly greater reduction in the number of foot problems requiring treatment than the conventional group The objective of this study was to verify self-care guidelines together with lower limb home exercises alter ankle and foot plantar pressure and alignment in patient with Type 2 Diabetes Mellitus ( DM ) measuring health and sociodemographic factors . The health factors analyzed were sensitivity and circulation aspects , risk rating , and neuropathy symptom score , ankle and foot alignment ( photogrammetry ) , plantar pressures , and postural stability ( baropodometry ) before and after administering these guidelines and home exercises in 97 patients type 2 DM during 10 months . The self-care guidelines and exercises changed the forefoot alignment ( Right Foot – Initial vs Final , p = 0.04 ; Left Foot , P<0.01 ) , the center of the force displacement in the mediolateral ( Right Foot - Initial versus Final , p = 0.02 ; Left Foot , P<0.01 ) , and the anterior-posterior ( Right foot - Initial versus Final , p = 0.01 ) direction , and body balance ( Initial versus Final , p = 0.02 ) . There was no change in the remaining assessed parameters . Self-care associated with the guidelines for home exercises for the lower limbs in patients with type 2 DM are effective in maintaining and improving the alignment of the feet , mediolateral stability and prevention of complications . Trial Registration The Brazilian Clinical Trials Registry OBJECTIVE To evaluate the influence of podiatrist activities on the outpatient care of diabetic patients in terms of knowledge of diabetic foot care , self-care , and minor foot problems . RESEARCH DESIGN AND METHODS There were 733 patients , aged 10–79 years , identified from the national diabetes register . Patients without recent visits to a podiatrist and without an obvious need for foot care were r and omized into a podiatric care group ( education and primary prevention measures , n = 267 ) and a control group ( written instructions only , n = 263 ) . The patients were examined by an independent study podiatrist at baseline and after 1 year . RESULTS Patients in the podiatrist group had greater improvement in knowledge of diabetic foot care ( P = 0.004 ) and self-care ( P < 0.001 ) scores compared with control subjects . The prevalence of callosities in regions other than the calcaneal region decreased more ( P = 0.009 ) in the podiatrist group ( from 54.5 to 39.5 % ) than in the control group ( from 51.3 to 48.2 % ) , and the size of the callosities decreased more ( P < 0.001 ) in the podiatrist group than in the control group . Reduction in the prevalence of callosities was associated with younger age ( < 50 years ) . CONCLUSIONS Education and primary preventive measures provided individually by a podiatrist result in significant improvements in knowledge and foot self-care scores and in improvements in the prevalence of some minor foot problems . Long-term studies are needed to evaluate whether the intervention of podiatrists starting at an early phase would lead to a reduction in major foot problems AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced A cohort of Medicare beneficiaries with diabetes was identified from inpatient and outpatient cl aims data and their risk for foot complications was estimated based on cl aims reflecting services for recent foot problems . A telephone survey of a r and om sample from this cohort was conducted to assess their foot care practice s , barriers , and perceptions of risk . Eight percent of respondents reported a history of foot ulcers and 7 % a history of lower extremity amputation . Based on cl aims data , 30 % of respondents were at high risk for future foot complications . Compared to those at low risk , those at high risk were more likely to report having an  annual foot exam , using protective footwear , and perceiving themselves to be high risk for future foot complications . However , 50 % of those with cl aims indicating a high risk perceived themselves to be at low risk for future foot complications . Overall , 20 % of respondents seldom checked their feet daily for sores or irritations . Among this group , 60 % felt that it was unimportant and 9 % reported they were limited by poor vision or physical problems . Our findings suggest that strategies are needed to improve the delivery of preventive foot care services to older persons with diabetes . Additionally , emphasis is needed to help individuals underst and their risk and seek and perform appropriate preventive foot care OBJECTIVE To examine the prevalence and predictors of foot disease , self-care and clinical monitoring in adults with type 2 diabetes in Alberta , Canada . METHOD Baseline data from a prospect i ve cohort of adults with type 2 diabetes were used . Assessment of foot disease included self-reported peripheral neuropathy , peripheral vasculopathy , foot or leg ulcer/infection or gangrene/amputation . Foot self-care  was assessed using the Summary of Diabetes Self-Care Activities , and clinical monitoring using patients ' reports of having feet checked for lesions or sensory loss . RESULTS The mean age of respondents ( N=2040 ) was 64 ( SD 10.7 ) years ; 45 % were female , and 91 % were Caucasian . Peripheral neuropathy was reported by 18 % of the respondents , peripheral vasculopathy by 28 % , ulcer/infection by 6 % and gangrene/amputation by 1.4 % . Only 14 % of respondents performed foot self-care  behaviours ≥6 days per week , and only 41 % and 34 % had their feet clinical ly checked for lesions or sensory loss , respectively . Predictors of foot disease included longer duration of diabetes , smoking , depressive symptoms , low self-efficacy and a history of cardiovascular diseases . Predictors of good self-care included older age , female sex , longer duration of diabetes and no report of hyperlipidemia . Predictors of clinical monitoring included female sex , current smoking , residing in urban areas , longer duration of diabetes , and histories of heart disease or hyperlipidemia . CONCLUSIONS Peripheral neuropathy and vasculopathy were the most common reported foot problems in this population . Foot self-care is generally infrequent , and clinical monitoring is performed for less than half of these patients , with significant variations by patient demographics and clinical presentation Associations between specific foot-care behaviors and  foot lesions in patients with non-insulin-dependent diabetes mellitus were prospect ively investigated . Data from a r and omized controlled trial for preventing diabetic foot lesions were analyzed as a prospect i ve cohort using logistic regression . Independent variables included  foot-care behaviors , patient self-foot examination , going barefoot , availability of foot-care assistance , and visits to health-care providers .  The dependent variable was a foot wound on each foot at follow-up . In the final multivariate model , patients who rarely lubricated their feet had an increased risk of foot lesions . Increasing patient use of emollients may be key to preventing foot lesions BACKGROUND While lower-extremity amputation ( LEA ) is a frequent complication of diabetes , effective strategies for the prevention of LEA in primary care setting s have not been extensively studied . METHODS This prospect i ve study of American Indians with diabetes in a rural primary care clinic was divided into three periods : the st and ard care period ( 1986 to 1989 ) , during which patients received foot care at the discretion of the primary care provider ; the public health period ( 1990 to 1993 ) , during which patients  were screened for foot problems and high-risk individuals received foot care education and protective footwear ; and the Staged Diabetes Management ( SDM ) period ( 1994 to 1996 ) , during which comprehensive guidelines for diabetic foot management were adapted by the primary care clinicians to their practice s and were systematic ally implemented . RESULTS A total of 639 individuals contributed 4322 diabetic person-years during the three periods of observation . Patient sex distribution , mean age , and mean duration of diabetes were similar i the three periods . The average annual LEA incidence was 29/1000 diabetic person-years for the st and ard care period ( n = 42 ) , 21/1000 for the public health period ( n = 33 ) , and 15/1000 for the SDM period ( n = 20 ) , an overall 48 % reduction ( P = .016 ) . Overall , the incidence of a first amputation declined from 21/1000 to 6/1000 ( P < .0001 ) . CONCLUSIONS The customization and systematic implementation of practice guidelines by local primary care providers was associated with improved diabetic foot care outcomes . SDM has relevance to primary care organizations seeking to improve outcomes for patients with diabetes Purpose The purpose of this study is to test the feasibility of conducting a community-based r and omized controlled trial evaluating a culturally tailored community-based group diabetes self-management education ( DSME ) program among rural African Americans . Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study design ed to test the effectiveness of the “ Taking Care of Sugar ” DSME program for the 2-year follow-up . Participants were selected from rural central Virginia . Primary outcomes variables included average blood sugar levels , cardiovascular risk factors , and general physical and mental health . These outcomes were assessed at baseline , 3 months , 6 months , and 12 months post baseline . Results From baseline to 3-month follow-up assessment , participants exhibited significant improvement on several physiological and behavioral measures . Given the small sample size , hypothesis testing was limited . Results show change from baseline over time , illustrating that the primary outcome of A1C decreased , although not significant . Additionally , participants reported more knowledge about diabetes self-management and personal care skills ( ie , exercise and foot care ) that persisted over time . The feasibility of the culturally tailored DSME was established , and participation with the program was high . Conclusions A community-based group DSME program using storytelling is feasible . This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population . If such a program is carried out , we can improve knowledge , reduce complications , and improve quality of life among rural African Americans AIMS To assess whether a programme of nurse education increased the frequency with which nurses conducted foot checks on people with diabetes undergoing haemodialysis and to evaluate whether this influenced self-reported foot care behaviour . METHODS A non-r and omized stepped-wedge design was used to evaluate a nurse education programme implemented in four UK National Health Service dialysis units . People with diabetes undergoing haemodialysis were invited to complete a question naire on the frequency of foot examination by health professionals , on the presence of foot problems and on their own foot care behaviour , using the Nottingham Assessment of Functional Foot-care ( NAFF ) . An education session for nurses , including procedures for foot examination , was conducted sequentially in each of four haemodialysis units . The question naire was repeated at 2-monthly intervals . RESULTS The education session result ed in a significant increase in the reported number of foot examinations by nurses ( P = 0.007 ) . There was also a significant improvement in reported foot care behaviour ( P < 0.001 ) , but this occurred between the first and second 2-monthly assessment s and was unrelated to the timing of the intervention . CONCLUSIONS A single education session can improve the routine checking of the feet of people with diabetes undergoing haemodialysis . The administration of the Nottingham Assessment of Functional Foot-care question naire was associated with improved self-reported foot care behaviour , reflecting greater awareness of risk in this population
Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practice s. Conclusion Preventing these complications , underst and ing the risk factors , and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program .
Introduction The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions .