Diabetic Foot, Diabetic Foot Ulcer
Conditions
Keywords
Patient education, Prevention, Smart phone application
Brief summary
The purpose of this study is to compare foot care knowledge, behaviour and glycaemic control in patients at increased risk of diabetic foot ulcers. Participants will receive either usual diabetic foot care education and follow-up as per evidence-based guidelines or usual care and follow-up, supplemented with an educational video and weekly foot alerts via a phone application.
Detailed description
It is recommended that patients who are at moderate or high risk of diabetic foot ulcer (DFU) are seen by a healthcare professional for foot review every 2-6 months. Yet, diabetic foot ulcers remain the leading cause of non-traumatic lower limb amputation with an amputation occurring every 20 secs. This suggests that additional information and prompts, as well as regular follow-up, are required. Additionally, long term diabetic foot complications including loss of protective pain sensation are related to poor glycaemic control. This single blinded randomised study aims to determine if weekly foot alerts (a total of 12 alerts cycled over 12-months), delivered by the MyU phone application in combination with usual education routes and follow-up, improves patient foot care behaviour and foot care knowledge. Using standardized questionnaires at baseline and 12-months. Furthermore, does the frequency of viewing/engaging in foot alert content influence foot care knowledge and behaviour. Secondary objectives are to determine: 1) if individuals who receive 7-foot review appointments in a 12-month period have better foot care knowledge and behaviour when compared to those seen less frequently regardless of educational route. 2) Baseline and 12-months HbA1c blood test will be measured to establish if any changes occurred between the two groups. Expected results: The investigators hypothesized that participants randomised to the intervention group (Phone app) will have improved foot care knowledge and foot health behaviours. Sample size: 100 patients with a 1:1 ratio Quality Assurance: A standard operating procedure based on established diabetic foot screening tools will be used to ensure the inter-rater reliability of foot assessment. Educational material will go through back translation to ensure the accuracy of the content. Feedback on content, meaning and usability of the English and Arabic documents from a sample of 10 participants will be sought. To maintain investigator blinding the participants will be escorted to the video viewing room by a research coordinator.
Interventions
DEVICEPhone application
Weekly foot alerts and educational video
OTHERUsual care
Usual routine of diabetic foot education
Sponsors
Kuwait Foundation for the Advancement of Sciences
Dasman Diabetes Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Caregiver, Investigator)
Intervention model description
Parallel assignment
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or female 21 yrs or * Type 2 Diabetes Mellitus or Type 1 Diabetes Mellitus greater than 5-yrs * At least one diabetic foot risk factor (i.e Loss of Pain Sensation Peripheral Arterial Disease etc) * Ability to understand Arabic or English to a skill listening level 3 and speaking level +2 (Interagency Language Roundtable). * Own a smartphone and access to the internet * The ability to understand the study procedures and to comply with them for the entire length of the study * Resident in Kuwait
Exclusion criteria
* Chronic kidney disease stage 3 or above * Cognitive impairment * Acute psychiatric illness * Hearing or visual impairment that would mean the intervention would not be understood * phone application inaccessible for more than 4 continuous weeks * Refusal to give written informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in foot care knowledge as measured by the adapted foot care knowledge test | 12 months | Change in the adapted Diabetic Foot Care Knowledge test (Pollock et al. 2004 and Rheeder et al. 2008) score between baseline and 12-months in the two groups This 12-question test has a maximum score of 12, and a minimum score of 0. Each correct answer is given one point, where a low score denotes low knowledge and high score denotes high knowledge. For each group a mean will be calculated and significance of differences will be tested using the students two tailed unpaired T-Test. |
| Change in foot care behaviour as measured by the SDSCA | 12 months | SDCS questionnaire includes a number of domains which evaluate different aspects of patient behaviour performed during the previous week. Each domain has one or more questions that are marked between 0-7. The domains are: 1. Foot care: total of 9 questions with maximum score 9x7 = 63, the greater the score the better the behaviour 2. Diabetes Management: 4 questions in diabetes management, maximum score 4x7 = 28, the greater the score the better the behaviour 3. Smoking habits: number of cigarettes per day, the greater the number the worse the behaviour These measures allow formulation of a composite reflection in changes in the patient's behaviour between baseline and 12-months in the two groups. Differences will be tested using the students two-tailed unpaired T-Test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in HbA1c from baseline | 12 months | Change in HbA1c measurement taken from venous blood supply at baseline and 12-months between intervention and control group. |
| Proportion of participants who developed a new diabetic foot ulcer | 12 months | Case report form. Diabetic foot ulcer is defined as a wound below the ankle in someone with diabetes and will be classified using the University of Texas Wound classification System. |
Countries
Kuwait
Contacts
Primary ContactKay Scarsbrook Khan, BSc
Outcome results
None listed