Education of health professionals for preventing diabetic foot ulceration: a systematic review

ABSTRACT

OBJECTIVE: To investigate the effects of education of healthcare professional as an intervention for preventing diabetic foot ulceration. DESIGN AND METHODS: A Cochrane systematic review with comprehensive search for randomized controlled trials (RCTs) and quasi-experimental studies was carried out. Independent screening for inclusion/exclusion, risk of bias assessment and synthesis was done. Primary and secondary outcomes included the incidence of foot ulcers, amputations, infections, behaviour and knowledge change in healthcare professional. RESULTS: The search identified 183 studies, of which three met the inclusion criteria. There was no significant improvement in nurses’ knowledge compared to controls when exposed to a specialized foot care training session. In a controlled before and after study, a foot care education intervention for healthcare staff had no risk reduction benefits to patient’s incidence of foot ulceration (RR 1.17; 95%CI 0.96, 1.43); amputations, (RR 0.88; 95%CI 0.57, 1.38). However, patients treated in the foot care education clinic had lower risk of infections (RR 0.72; 95%CI 0.55, 0.97) compared to control clinic. A multi-component diabetes care education package was effective in increasing the likelihood of foot examination among physicians compared to controls who did not receive education (OR13.47; 95%CI7.51, 24.15). CONCLUSIONS: This review found that studies on education of healthcare professional for preventing diabetic foot ulceration are limited and inadequate to determine whether such interventions resulted in clinically important benefits. Further evidence from well conducted RCTs is still needed.