Clinician assessment tools for patients with diabetic foot disease: A systematic review

The amputation rate in patients with diabetes is 15 to 40 times higher than in patients without diabetes. To avoid major complications, the identification of high-risk in patients with diabetes through early assessment highlights as a crucial action. Clinician assessment tools are scales in which clinical examiners are specifically trained to make a correct judgment based on patient outcomes that helps to identify at-risk patients and monitor the intervention. The aim of this study is to carry out a systematic review of valid and reliable Clinician assessment tools for measuring diabetic foot disease-related variables and analysing their psychometric properties. The databases used were PubMed, Scopus, SciELO, CINAHL, Cochrane, PEDro, and EMBASE. The search terms used were foot, ankle, diabetes, diabetic foot, assessment, tools, instruments, score, scale, validity, and reliability. The results showed 29 validated studies with 39 Clinician assessment tools and six variables. There is limited evidence on all of the psychometric characteristics of the Clinician assessment tools included in this review, although some instruments have been shown to be valid and reliable for the assessment of diabetic neuropathy (Utah Early Neuropathy Scale or UENS); ulceration risk (Queensland High Risk Foot Form or QHRFF); diabetic foot ulcer assessment, scoring, and amputation risk (Perfusion, extent, depth, infection and sensation scale or PEDIS and Site, Ischemia, Neuropathy, Bacterial Infection, and Depth score or SINBAD); and diabetic foot ulcer measurement (Leg Ulcer Measurement Tool LUMT). © 2020 by the authors. Licensee MDPI, Basel, Switzerland.No hubo financiación extern

Instruments of choice for assessment and monitoring diabetic foot: A systematic review

Diabetic foot is the most frequent disorder among the chronic complications of diabetes, happening in 25% of patients. Objective clinical outcome measures are tests or clinical instruments that provide objective values for result measurement. The aim of this study was to carry out a systematic review of specific objective clinical outcome measures focused on the assessment and monitoring of diabetic foot disorders. The databases used were PubMed, CINAHL, Scopus, PEDro, Cochrane, SciELO and EMBASE. Search terms used were foot, ankle, diabet*, diabetic foot, assessment, tools, instruments, objective outcome measures, valid*, reliab*. Because of the current published evidence, diabetic neuropathy assessment via sudomotor analysis, cardiovascular autonomic neuropathy and peripheral vascular disease detection by non-invasive electronic devices, wound 3D dimensional measurement, hyperspectral imaging for ulcer prediction and the probe-to-bone test for osteomyelitis diagnosis were highlighted in this study. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.No hubo financiación extern

Development and validation of a new questionnaire for the assessment of patients with diabetic foot disease: The Diabetic Foot Questionnaire (DiaFootQ)

Background The epidemiology data and global burden of diabetic foot disease underscores the need for effective prevention strategies, which requires an early diagnosis. Patient-reported outcome measures are instruments based on a simple format, which favours their application. Currently, there is an absence of instruments with a broad enough scope to capture the diverse aspects involved in diabetic foot disease. Objectives To develop a questionnaire for the assessment of patients with diabetic foot disease and carry out an analysis of its validity and reliability. Methods The study was developed in two stages. Stage 1: the Delphi Panel was composed of 22 experts. The questionnaire is made up of 25 questions selected, after three rounds, from an initial sample of 68 questions. Stage 2: A validation study was performed. With a sample of 273 subjects, an exploratory factor analysis and an analysis of internal consistency, items response, and validity were carried out using the Diabetes Quality of Life, SF-12v2, Foot Function Index and EuroQol EQ5D questionnaires. Measurements of error and sensitivity to change were also analyzed. Results A 25-item questionnaire (DiaFootQ) was developed. It comprised two dimensions: 1) lifestyle and function; and 2) footwear and foot self-care. Sample (n=273) mean age was 69.77 years (±11.08). The internal consistency of DiafootQ was α=0.916, and item response values were ICC=0.862–0.998. External validity correlation levels ranged from r=0.386 to r=0.888. Conclusion DiaFootQ was developed. Integrating the main aspects involved in diabetic foot disease could help to detect more accurately the risk or severity of these patients. DiaFootQ is a well-structured, valid, and reliable tool whose use should be promoted in clinical and research settings.Funding for open access charge: Universidad de Málaga / CBU

Development and validation of a new questionnaire for the assessment of patients with diabetic foot disease : the diabetic foot questionnaire (DiaFootQ)

Background: The epidemiology data and global burden of diabetic foot disease underscores the need for effective prevention strategies, which requires an early diagnosis. Patient-reported outcome measures are instruments based on a simple format, which favours their application. Currently, there is an absence of instruments with a broad enough scope to capture the diverse aspects involved in diabetic foot disease.Objectives: To develop a questionnaire for the assessment of patients with diabetic foot disease and carry out an analysis of its validity and reliability.Methods: The study was developed in two stages. Stage 1: the Delphi Panel was composed of 22 experts. The questionnaire is made up of 25 questions selected, after three rounds, from an initial sample of 68 questions.Stage 2: A validation study was performed. With a sample of 273 subjects, an exploratory factor analysis and an analysis of internal consistency, items response, and validity were carried out using the Diabetes Quality of Life, SF-12v2, Foot Function Index and EuroQol EQ5D questionnaires. Measurements of error and sensitivity to change were also analyzed.Results: A 25-item questionnaire (DiaFootQ) was developed. It comprised two dimensions: 1) lifestyle and function; and 2) footwear and foot self-care. Sample (n=273) mean age was 69.77 years (±11.08). The internal consistency of DiafootQ was α=0.916, and item response values were ICC=0.862–0.998. External validity correlation levels ranged from r=0.386 to r=0.888.Conclusion: DiaFootQ was developed. Integrating the main aspects involved in diabetic foot disease could help to detect more accurately the risk or severity of these patients. DiaFootQ is a well-structured, valid, and reliable tool whose use should be promoted in clinical and research settings.peer-reviewe

Management of the Diabetic Foot according to Clinical Practice Guidelines and its evaluation using Patient-Reported Outcome Measures (PROMs)

Una vez alcanzados los objetivos propuestos para esta tesis, las principales conclusiones alcanzadas son las siguientes: A pesar de la heterogeneidad de los niveles de evidencia de las GPC, las intervenciones más recomendables para el manejo del pie diabético son el desbridamiento (nivel de evidencia muy alto y muy recomendado) y evaluación del pie (nivel de evidencia moderado y bastante recomendado); mientras que los PROM más recomendados para evaluar pacientes con pie diabético son Diabetic foot self-care questionnaire (DFSQ-UMA) y Questionnaire for Diabetes Related Foot Disease (Q-DFD).La Diabetes Mellitus (DM) se trata de una de las patologías más importantes en la actualidad y que ocasiona un mayor impacto económico, sanitario y social. Esta enfermedad está asociada con el desarrollo de complicaciones propias debido al progreso de la enfermedad. El pie diabético es considerado una de las complicaciones más costosas de la diabetes, destinándose a esta complicación más del 33% de los presupuestos totales destinados a la diabetes, por lo que la prevención y diagnóstico precoz de esta enfermedad resulta fundamental para evitar las complicaciones desarrolladas por la enfermedad. El propósito de esta tesis doctoral es el abordaje del Pie Diabético (PD) y para ello se realizó un análisis para identificar los mecanismos de acción focalizados en la prevención, diagnóstico y manejo del PD en base a las Guías de Práctica Clínica (GPC); identificar cuáles son las estrategias/herramientas de evaluación específicas del pie diabético más recomendadas por la comunidad científica y analizar los niveles de evidencia y grados de recomendación de las GPC focalizadas en el pie diabético. Los siguientes objetivos propuestos fueron analizar las medidas de resultado informadas por el paciente (PROM) específicas para la evaluación del pie diabético y analizar las características estructurales y psicométricas con la finalidad de identificar cuáles son los PROM con mejores propiedades psicométricas.