Byron Perrin

The reliability of toe systolic pressure and the toe brachial index in patients with diabetes

BackgroundThe Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system.MethodsThis was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45) and a standardised measurement protocol.ResultsThe mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 (95% LOA: -25.97 to 26.06 mmHg) and the mean intra-class correlation for Toe Brachial Indices was 0.75 (95% LOA: -0.22 to 0.28). The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures (95% LOA: -22.91 to 29.17.mmHg) and 0.77 for Toe Brachial Indices (95% LOA: -0.21 to 0.22).ConclusionDespite the reasonable intra-class correlation results, the range of error (95% LOA) was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.

The Behavior and Psychological Functioning of People at High Risk of Diabetes-Related Foot Complications

PURPOSE The purpose of this review was to propose a model that describes the influences on the behavior and psychological functioning of people at risk for diabetes-related foot complications. METHODS A literature search was conducted in Medline (1950-2005), CINAHL (1982-2005), and PsycInfo (1967-2005) databases and in reference lists of journal articles and relevant books. The search focused on published literature in the English language that was related to concepts such as diabetes-related foot complications, behavior, and psychology. RESULTS The literature reviewed was arranged to reflect the reciprocal relationship between the personal, environmental, and behavioral factors of people at risk of diabetes-related foot complications. The model proposed uses the concept of reciprocal determinism to illustrate how these factors interact and influence the development of diabetes-related foot complications. CONCLUSION The concept of reciprocal determinism may be useful when developing further investigation into educational and behavioral interventions in this clinical population.

Cognitive representations of peripheral neuropathy and self-reported foot-care behaviour of people at high risk of diabetes-related foot complications.

The aim of this study was to explore the cognitive representations of peripheral neuropathy and self‐reported foot‐care behaviour in an Australian sample of people with diabetes and peripheral neuropathy.

Diabetic Foot Australia guideline on footwear for people with diabetes

BackgroundThe aim of this paper was to create an updated Australian guideline on footwear for people with diabetes.MethodsWe reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations.ResultWe recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate- or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers.ConclusionsThis guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.

Enablers and barriers to using two-way information technology in the management of adults with diabetes: A descriptive systematic review:

Background This systematic review aimed to explore the enablers and barriers faced by adults with diabetes using two-way information communication technologies to support diabetes self-management. Methods Relevant literature was obtained from five databases using search strategies combining four major constructs: adults with diabetes, biomedical technology, communication technology and patient utilisation. Results Of 8430 unique articles identified, 48 were included for review. Risk of bias was assessed using either the Newcastle–Ottowa or Cochrane risk of bias assessment tools. Seventy-one percent of studies were of cohort design with the majority of studies assessed at high or unclear risk of bias. Consistently identified barriers included poorly designed interfaces requiring manual data entry and systems that lacked functionalities valued by patients. Commonly cited enablers included access to reliable technology, highly automated data entry and transmission, graphical display of data with immediate feedback, and supportive health care professionals and family members. Conclusions People with diabetes face a number of potentially modifiable barriers in using technology to support their diabetes management. In order to address these barriers, end users should be consulted in the design process and consideration given to theories of technology adoption to inform design and implementation. Systems should be designed to solve clinical or behavioural problems that are identified by patients as priorities. Technology should be as automated, streamlined, mobile, low cost and integrated as possible in order to limit the burden of usage for the patient and maximise clinical usefulness.

The foot-health of people with diabetes in a regional Australian population: a prospective clinical audit

BackgroundThere is limited understanding of the foot-health of people with diabetes in Australian regional areas. The aim of this study was to document the foot-health of people with diabetes who attend publically funded podiatric services in a regional Australian population.MethodsA three month prospective clinical audit was undertaken by the publically-funded podiatric services of a large regional area of Victoria, Australia. The primary variables of interest were the University of Texas (UT) diabetic foot risk classification of each patient and the incidence of new foot ulceration during the study period. Age, gender, diabetes type, duration of diabetes and the podiatric service the patients attended were the other variables of interest.ResultsFive hundred and seventy six patients were seen during the three month period. Over 49% had a UT risk classification at a level at least peripheral neuropathy or more serious diabetes-related foot morbidity. Higher risk at baseline was associated with longer duration of diabetes (F = 31.7, p < 0.001), male gender (χ2 = 40.3, p < 0.001) and type 1 diabetes (χ2 = 37.3, p < 0.001). A prior history of foot pathology was the overwhelming predictor for incident ulceration during the time period (OR 8.1 (95% CI 3.6 to 18.2), p < 0.001).ConclusionsThe publically funded podiatric services of this large regional area of Australia deal with a disproportionally large number of people with diabetes at high risk of future diabetes-related foot complications. These findings may be useful in ensuring appropriate allocation of resources for future public health services involved in diabetic foot health service delivery in regional areas.

The relationship between cognitive and emotional representations of peripheral neuropathy and incident diabetes-related foot ulceration

Methods One-hundred and twenty-one people with diabetes and peripheral neuropathy were recruited into this one-year prospective cohort study. At baseline, the participants completed two questionnairesthe Patients’ Interpretation of Neuropathy questionnaire and a short questionnaire asking about preventative foot-care behaviour. Basic diabetes and demographic information was also collected. Sequential logistic regression was used to investigate the influence of cognitive and emotional representations of peripheral neuropathy as measured by the PIN and the development of incident foot ulceration.

The foot-health of adult diabetics in regional Australia: baseline findings from an epidemiological study

Background There is limited epidemiological research that reports on the foot-health of people with diabetes within Australian regional settings. This study reports on the baseline characteristics of a large prospective cohort study. The objective of this baseline analysis is to explore the relationship between demographic, socio-economic and diabetesrelated variables with diabetes-related foot morbidity in people residing in regional and rural Australia.

Pathway to ending avoidable diabetes-related amputations in Australia

A new Australian strategy should finally reduce the significant national burden of diabetes‐related foot disease Diabetes‐related foot disease (DFD) is “common, complex, and costly” and underappreciated in Australia. With DFD not even rating a footnote mention in recent national chronic disease strategies, it is arguably Australias least known major health problem. If Australia is to reduce avoidable amputations, major improvements in the way we approach DFD are urgently needed.

From Noordwijkerhout to Bendigo: lessons learnt in developing a high risk foot clinic in regional Australia

Methods On establishment, the overarching goal of the DFC was to provide the best evidence-based care possible to those at the highest risk of developing diabetes-related foot problems in the region. To achieve this, the DFC undertook a ten-year process of continual quality improvement activities that included a series of retrospective clinical audits. This paper describes the results of these audits.