Patient education for preventing diabetic foot ulceration - A systematic review
Patient education for preventing diabetic foot ulceration - A systematic review
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DOI：
10.1016/s0889-8529(02)00021-x
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发表时间：
2002-09-01
影响因子：
4.5
通讯作者：
Assendelft, WJJ
中科院分区：
文献类型：
--
作者：
Valk, GD;Kriegsman, DMW;Assendelft, WJJ
足部溃疡是糖尿病患者的一个主要健康问题，可能导致四肢丧失和死亡。本综述的目的是评估患者教育预防糖尿病足溃疡的有效性。我们对随机对照试验（rct）进行了系统回顾，评估了糖尿病患者预防足部溃疡的教育计划。我们使用共基因“Wounds Group”的标准搜索方法。两名评论者独立工作提取数据并评估研究质量。纳入的8项随机对照试验的方法学质量较差。各rct的内部效度评分（0 ~ 10分）在2 ~ 4分之间。四项试验比较了强化教育干预与简短教育干预的效果；其中2个报告了临床终点。一项涉及高风险患者的研究报告，1年后溃疡发生率（OR 0.28, 95%可信区间[95% CI] 0.13-0.59）和截肢率（OR 032, 95% Cl 0.14-0.71）降低。另一项随机对照试验在7年随访后没有发现效果。两项试验显示，受试者的足部护理知识随着教育的提高而显著提高。在一项试验中，尽管足部护理行为显著改善，但6个月时足部护理知识明显变差。一项将患者足部护理教育作为普通糖尿病教育项目的一部分与常规护理进行比较的随机对照试验显示，足部溃疡的风险没有降低。在一项随机对照试验中，患者教育作为针对糖尿病患者和医生的复杂干预的一部分，降低了1年后严重足部病变的患病率（OR 0.41, 95% Cl 0.16-1.00），并改善了足部护理行为。来自两项随机对照试验的证据比较了除常规护理外为患者量身定制的教育的效果，结果相互矛盾。证据表明，由于方法质量差和结果矛盾，患者教育可能对患者的足部护理知识和行为产生积极但短暂的影响，并可能减少足部溃疡和截肢，特别是在高危患者中。需要高质量的随机对照试验来确定患者教育预防糖尿病足溃疡的有效性。
Ulceration of the feet, which can result in loss of limbs and death, is a major health problem for people with diabetes mellitus. The objective of this review was to assess the effectiveness of patient education to prevent diabetic foot ulcers. We conducted a systematic review of randomized controlled trials (RCTs) that evaluated educational programs for the prevention of foot ulcers in people with diabetes mellitus. We used standard search methods of the Co-chranes "Wounds Group". Two reviewers working independently extracted data and assessed study quality. The methodologic quality of the 8 included RCTs was poor. The internal validity score (range 0-10) of individual RCTs ranged from 2 to 4. Four trials compared the effect of intensive with brief educational interventions; 2 of these reported clinical endpoints. One study involving high-risk patients reported a reduction in ulcer incidence (OR 0.28, 95% confidence interval [95% CI] 0.13-0.59) and amputation rate (OR 032, 95% Cl 0.14-0.71) after I year. The other RCT did not find an effect after 7 years of follow-up. Two trials showed that participants' foot care knowledge significantly improved with education. In one trial, foot care knowledge was significantly worse at 6 months, although foot care behavior improved significantly. One RCT, which compared patient foot care education as part of a general diabetes education program to usual care, showed no reduction in the risk of foot ulceration. In one RCT, patient education as part of a complex intervention targeted at both people with diabetes and doctors reduced the prevalence of serious foot lesions at 1 year (OR 0.41, 95% Cl 0.16-1.00) and improved foot care behavior. Evidence from two RCTs comparing the effect of patient-tailored education in addition to usual care was conflicting. Evidence, limited by poor methodologic quality and conflicting results, suggests that patient education may have positive but short-lived effects on foot care knowledge and behavior of patients and may reduce foot ulceration and amputations, especially in high-risk patients. High-quality randomized controlled trials are needed to establish the efficacy of patient education to prevent diabetic foot ulcerations.