Dosing Activity and Returning to Pre-Ulcer Function in Diabetic Foot Remission: Patient Recommendations and Guidance from the Limb Preservation Consortium at USC and The National Rehabilitation Center at Rancho Los Amigos

2021 ◽  
Author(s):  
Malindu E Fernando ◽  
Stephanie L Woelfel ◽  
Diana Perry ◽  
Bijan Najafi ◽  
Tanzim Khan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Foot Ulcer ◽  
Position Statement ◽  
Moderate Intensity ◽  
Foot Ulcers ◽  
Recurrent Ulcer ◽  
Moderate Intensity Exercise ◽  
Walking Activity ◽  
Foot Reconstruction

Diabetes-related foot ulcers are a leading cause of global morbidity, mortality and healthcare costs. People with a history of foot ulcers have a diminished quality of life attributed to limited walking and mobility, decreased moderate intensity exercise when compared to people with diabetes without ulcers. One of the largest concerns is ulceration recurrence. Approximately 40% of patients with ulcerations will have a recurrent ulcer in the year following healing and the majority occurs in the first three months following wound healing. Hence this period after ulceration is called "remission" due to this risk for re-ulceration. Promoting and fostering mobility is an integral part of everyday life and is important for maintaining good physical health and health related quality of life for all people living with diabetes. In this short perspective, we provide recommendations on how to safely increase walking activity and facilitate appropriate offloading and monitoring in people with a recently healed foot ulcer, foot reconstruction or partial foot amputation. Interventions include monitored activity training, dosed out in steadily increasing increments and coupled with daily skin temperature monitoring which can identify dangerous "hot spots" prone to recurrence. By understanding areas at risk, it empowers patients to maximize ulcer-free days and to enable an improved quality of life. There is a current absence of high-quality evidence and standardized clinical algorithms for the post-ulcerative period. This perspective outlines this institution's unified strategy to treat patients in the remission period after ulceration. This approach utilizes the available evidence, identifies patient preferences, and relies on good clinical judgement for the best long-term outcomes for this patient population. Hence this position statement aims to provide clinicians with appropriate patient recommendations based on best available evidence and expert opinion to educate their patient to ensure a safe transition to footwear and return to activity.

scholarly journals Treatment strategies for chemotherapy-induced peripheral neuropathy: potential role of exercise

2011 ◽  
Vol 4 (2) ◽  
pp. 117
Author(s):  
Karen Y. Wonders ◽  
Beverly S. Reigle ◽  
Daniel G. Drury
Keyword(s):  
Quality Of Life ◽  
Peripheral Neuropathy ◽  
Cancer Patients ◽  
Lifestyle Modification ◽  
Treatment Strategies ◽  
Moderate Intensity ◽  
Moderate Intensity Exercise ◽  
Exercise Rehabilitation

Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting effect of cancer therapy that often has negative implications on a patient’s quality of life. The pain associated with CIPN has long been recognized as one of the most difficult types of pain to treat. Historically, much effort has been made to explore pharmacological therapies aimed at reducing symptoms of CIPN. While many of these agents provide a modest relief in the symptoms of peripheral neuropathy, many have been shown to have additional negative side effects for cancer patients. Therefore, the authors suggest exercise rehabilitation as one lifestyle modification that may positively impact the lives of patients with CIPN. To our knowledge, there are currently no published clinical trials examining the role of exercise in preserving neurological function following chemotherapy. However, investigations using low-to-moderate intensity exercise as an intervention in patients with diabetic peripheral neuropathy and hereditary motor and sensory neuropathies have produced promising results. Given that cancer patients appear to tolerate exercise, it seems plausible that exercise rehabilitation could be used as an effective strategy to minimize CIPN-induced detriments to quality of life.

scholarly journals Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marjolein M. Iversen ◽  
Jannicke Igland ◽  
Hilde Smith-Strøm ◽  
Truls Østbye ◽  
Grethe S. Tell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Foot Ulcer ◽  
Well Being ◽  
Foot Ulcers ◽  
Control Group ◽  
Patient Reported ◽  
Reported Health

Abstract Background Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. Methods The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. Results In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. Conclusions There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life. Trial registration Clinicaltrials.gov, NCT01710774. Registered October 19th, 2012.

scholarly journals Quality of Life of Diabetic Foot Ulcer Patients with Hyperbaric Oxygen Therapy

2019 ◽  
Vol 55 (2) ◽  
pp. 127
Author(s):  
Kusnanto Kusnanto ◽  
Dismalyansa Dismalyansa ◽  
Retnayu Pradanie ◽  
Hidayat Arifin
Keyword(s):  
Quality Of Life ◽  
Hyperbaric Oxygen ◽  
Diabetic Foot ◽  
Intervention Group ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Rank Test ◽  
Control Group ◽  
Signed Rank Test

DM with ulcer can result in a decrease in the quality of life of patients and need to reduce the intensity of pain and odor on the ulcer, preventing amputation and Hyperbaric Oxygen as an adjuvant therapy in accelerating wound healing. This study aims to explain the effect of HBO on the quality of life of patients with diabetic foot ulcers at RSAL Dr. Ramelan Surabaya. Methods: The research used quasi-experimental design with a non-equivalent control group design approach. The samples were 70 patients from population of all diabetes patients who suffered from diabetic foot ulcers at RSAL Dr. Ramelan. Data were collected by WHOQOL-BREF questionnaire. Analyzed byWilcoxon signed rank test and Mann Whitney U test. Result: Mann Whitney in the post test, the physical p-value domain (0.000), psychological domain (0.012), social domain (0.003), and environmental domain (0,001), where the intervention group has a better value than the control group. Wilcoxon signed rank test results on the physical domain (0,000), psychological (0,012), social (0,003), and environmental (0,001), meaning there were significant differences between pre post test in intervention group. Discussion: Diabetes mellitus patients with foot ulcers given hyperbaric oxygen showed improvement on wound condition, thus reducing pain and medical needs. This makes patients motivated, reduce anxiety, and improve interpersonal support and confidence. Therefore, it is necessary to socialize the effect of HBO on DM patients with foot ulcer, as a treatment option in improving the quality of life of DM patients with foot ulcers.

An integrated approach for the management of diabetic foot ulcer: a case report

2019 ◽  
Vol 16 (3) ◽  
Author(s):  
Madan Bhandari ◽  
Prasanna N. Rao ◽  
Gopikrishna B J ◽  
Duradundi Gudasi
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Integrated Approach ◽  
Foot Ulcers ◽  
Combined Effects ◽  
Diabetic Foot Ulcers ◽  
History Of

Abstract Diabetic foot ulcers (DFUs) are the results of the combined effects of diabetes-related vascular disease and neuropathy. DFUs are responsible for more hospitalizations than any other complication of diabetes. It can impair patients’ quality of life and affect social participation and livelihood. It is one of the big challenges for podiatric surgeons to salvage the foot upto optimum. A case of DFU of a patient of 70 years of age with repeated history of Ray’s Amputation was managed by an integrated approach (Ayurveda and Allopathy medications and procedures).

scholarly journals Quality of Life of Diabetic Foot Ulcer Patients with Hyperbaric Oxygen Therapy

2021 ◽  
Vol 55 (2) ◽  
pp. 127
Author(s):  
Kusnanto Kusnanto ◽  
Dismalyansa Dismalyansa ◽  
Retnayu Pradanie ◽  
Hidayat Arifin
Keyword(s):  
Quality Of Life ◽  
Hyperbaric Oxygen ◽  
Diabetic Foot ◽  
Intervention Group ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Rank Test ◽  
Control Group ◽  
Signed Rank Test

DM with ulcer can result in a decrease in the quality of life of patients and need to reduce the intensity of pain and odor on the ulcer, preventing amputation and Hyperbaric Oxygen as an adjuvant therapy in accelerating wound healing. This study aims to explain the effect of HBO on the quality of life of patients with diabetic foot ulcers at RSAL Dr. Ramelan Surabaya. Methods: The research used quasi-experimental design with a non-equivalent control group design approach. The samples were 70 patients from population of all diabetes patients who suffered from diabetic foot ulcers at RSAL Dr. Ramelan. Data were collected by WHOQOL-BREF questionnaire. Analyzed byWilcoxon signed rank test and Mann Whitney U test. Result: Mann Whitney in the post test, the physical p-value domain (0.000), psychological domain (0.012), social domain (0.003), and environmental domain (0,001), where the intervention group has a better value than the control group. Wilcoxon signed rank test results on the physical domain (0,000), psychological (0,012), social (0,003), and environmental (0,001), meaning there were significant differences between pre post test in intervention group. Discussion: Diabetes mellitus patients with foot ulcers given hyperbaric oxygen showed improvement on wound condition, thus reducing pain and medical needs. This makes patients motivated, reduce anxiety, and improve interpersonal support and confidence. Therefore, it is necessary to socialize the effect of HBO on DM patients with foot ulcer, as a treatment option in improving the quality of life of DM patients with foot ulcers.

scholarly journals Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: Secondary outcomes from a cluster randomized controlled trial (DiaFOTo)

2020 ◽  
Author(s):  
Marjolein Memelink Iversen ◽  
Jannicke Igland ◽  
Hilde Smith-Strøm ◽  
Truls Østbye ◽  
Grethe Seppola Tell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Foot Ulcer ◽  
Well Being ◽  
Foot Ulcers ◽  
Control Group ◽  
Patient Reported ◽  
Reported Health

Abstract BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life.

Body Image as a Mediator Between Gender and Quality of Life Among Patients With Diabetic Foot Ulcers in Indonesia

2021 ◽  
pp. 104365962199285
Author(s):  
Ni Made Manik Elisa Putri ◽  
Deni Yasmara ◽  
Miao-Fen Yen ◽  
Shin-Chen Pan ◽  
Su-Ying Fang
Keyword(s):  
Quality Of Life ◽  
Body Image ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The Body ◽  
Foot Ulcers ◽  
Care Providers ◽  
The Relationship

Introduction: Foot ulcers cause women in Indonesia to lose opportunities to participate in religious and cultural activities due to the inability to wear certain footwear. This study examined body image as a mediator in the relationship between gender and quality of life (QoL) among patients with diabetic foot ulcer (DFU) in Indonesia. Method: A cross-sectional design with convenience sampling was used to recruit participants at the Surgical Outpatient Department and Wound Care Clinic in Bali, Indonesia. The Diabetic Foot Ulcer Scale–Short Form and the body image domain of the Body Investment Scale were administered. Results: We found gender differences in participants’ ( n = 201) QoL and body image ( p < .05). Body image fully mediated the effect of the relationship between gender and QoL (B = 6.68; 95% confidence interval [3.14, 10.52]) and explained 39.13% of the variance. Discussion: Health care providers should consider patients’ religious beliefs in DFU education and consider women’s body image issues. Diabetes foot ulcer may prevent women from performing religious rituals, thus, influencing their QoL. Protective strategies to prevent DFU among women in Indonesia warrant further development.

Quality of Life with Diabetes-associated Foot Complications: Comparison Between Lower-limb Amputation and Chronic Foot Ulceration

2008 ◽  
Vol 29 (11) ◽  
pp. 1074-1078 ◽  
Author(s):  
David Boutoille ◽  
Alexis Féraille ◽  
Dominique Maulaz ◽  
Michel Krempf
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Foot Complications ◽  
Sf 36 ◽  
Physical Limitations

Background: Diabetic foot complications result in huge costs for both society and individual patients. Because our team performs numerous amputations each year for complicated diabetic foot ulcers, we conducted a study comparing the quality of life of diabetic amputees with a non-amputee group experiencing a diabetic foot ulcer. The aim of this study was to get better comprehension of the influence of amputation on physical and social aspects of our patients' quality of life. Materials and Methods: This study evaluated the influence of amputation for a diabetic foot ulcer on quality of life. We compared patients having experienced an amputation for a diabetic foot ulcer at least 1 year before the study, and outpatients experiencing regular visits for a current foot ulcer with no previous history of amputation. Quality of life was reported using the Medical Outcome Study Short Form 36 item health survey (MOS SF-36). Results: Most of the chronic ulcers were neuroischemic (8/9). Except for the bodily pain, which was significantly higher in the ulcer group, no difference was found between the amputee and the ulceration-group, when considering the different items of the MOS-SF 36 scales. The ulceration-group had significantly more physical limitations and pain than the toe-or-transmetatarsal-amputation-group, whereas physical limitations were identical between the transtibial-amputation-group and the ulceration-group. Median scores were quite low in both groups, reflecting strong social and psychological consequences of diabetic foot ulcers. Global prognosis was bad with 56% of the amputees having experienced another major cardiovascular event within 20 months after amputation. Conclusion: Better understanding of the consequences of diabetic foot complications is important for the general population and especially general practitioners. Psychological evaluation and support is important before and after amputation since it is a traumatic step for patients. Level of Evidence: III, Retrospective Case Control Study

scholarly journals Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: Secondary outcomes from a cluster randomized controlled trial (DiaFOTo)

2020 ◽  
Author(s):  
Marjolein Memelink Iversen ◽  
Jannicke Igland ◽  
Hilde Smith-Strøm ◽  
Truls Østbye ◽  
Grethe Seppola Tell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Foot Ulcer ◽  
Well Being ◽  
Foot Ulcers ◽  
Control Group ◽  
Patient Reported ◽  
Reported Health ◽  
Cluster Randomized

Abstract BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life. Trial registration: clinicaltrials.gov, NCT01710774. Registered October 19th, 2012https://clinicaltrials.gov/ct2/show/NCT01710774?term=iversen+marjolein&draw=2&rank=1

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