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Purpose: Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers (DFU). Characteristics and considerations associated with the use of offloading devices are discussed.
Methods: A DFU management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of DFU in each center.
Results: Of the 895 respondents that treat DFU, shoe modifications (41.2%, p<0.03) were the most common form of pressure mitigation while total contact casts (TCC) were used by only 1.7% of the centers.
Conclusions: This study reports the usage and characteristics of offloading devices in the care of DFU in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the "gold standard" (TCC) for treating the majority of DFU.
Press release: Study Indicates Clinical Practice Standards in Lower-Extremity Care of Diabetes Not Being Met Nationwide
Quote:
Researchers at The University of Arizona College of Medicine participated in a groundbreaking study of clinical practice patterns in lower-extremity care of diabetes that suggests standards of quality care are not being met nationwide.
The Southern Arizona Limb Salvage Alliance (SALSA), the Department of Veterans Affairs, and Rosalind Franklin University of Medicine in Chicago also participated in the study, published Aug. 11 (ahead of print) in the online edition of the journal Diabetes Care.
“I think the bottom line is that clinicians, for a variety of reasons, are not practicing what is preached,” said the study’s senior author David G. Armstrong, DPH, PhD, professor and director of SALSA in the UA Department of Surgery and the Southern Arizona VA Healthcare System.
"The simple task of using the right technique to take pressure off of the bottom of the feet is being practiced in the majority of cases by fewer than 2 percent of the reporting centers. In a time when every 30 seconds someone loses a limb due to diabetes, this is unacceptable." Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers, the authors stress.
The three-year study evaluated nearly 900 diabetic foot clinics across the nation. Stephanie Wu, DPM, MSc, assistant professor of surgery at Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University and the first author of the study, voiced similar sentiments.
"We must marry effective reimbursement with effective care. Right now, most insurance plans will pay for an amputation, but not for the boot or cast that would heal the wound and prevent the amputation."
Offloading: Do we practice what we preach?
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