Nottingham Assessment Of Functional Footcare Research Articles

Factors influencing foot care behavior among patients with type 2 diabetes mellitus who have a high-risk diabetic foot in China

Background & Aim: Foot ulceration and amputation have increased significantly among Chinese patients with type 2 diabetes mellitus. Proper foot care behavior is an important strategy for reducing the risk of diabetes-related foot issues. The current study aimed to assess foot care behavior and its influencing factors, including self-efficacy, foot care knowledge, and social support, among patients with type 2 diabetes mellitus who have a high-risk diabetic foot in Wenzhou, China.
 Methods & Materials: This research used a correlational predictive design. In total, 107 participants who were eligible for the study were randomly selected. Five self-reported questionnaires, including the demographic questionnaire, Diabetes Self-Efficacy Scale, Foot Care Knowledge questionnaire, Perceived Social Support Scale, and Chinese version of the Nottingham Assessment of Functional Footcare, were utilized. Descriptive statistical and standard multiple linear regression analyses were performed to evaluate data.
 Results: Approximately 90.7% of participants had poorly controlled diabetes (HbA1c≥ 7%), and 95.3% presented with foot deformities. Further, 51.4% of participants reported moderate foot care behavior, and 42.1% had poor foot care behavior. The multiple regression analysis revealed that self-efficacy, foot care knowledge, and social support significantly explained 31.1 % of the variability in foot care behavior. However, self-efficacy could predict foot care behavior (β= .490, p< .001).
 Conclusion: It is important to improve foot care behavior among patients with type 2 diabetes who have a high-risk diabetic foot. Nursing interventions to enhance foot care behavior should focus on improving self-efficacy and providing foot care education regularly.

Relationship of Self Efficacy with Foot Care Behavior in Diabetes Mellitus Patients

One of the main steps in saving the feet of diabetics is to take preventive measures in the form of foot care. Self-efficacy is one of the factors that can support the success of foot care in diabetics. This study aims to determine the relationship between self-efficacy and foot care behavior in patients with diabetes mellitus. The research method is quantitative with a cross-sectional approach. The sampling technique in this study is purposive sampling with a sample of 110 respondents. Data was collected using the Foot Care Confident Scale (FCCS) and Nottingham Assessment of Functional Footcare (NAFF) questionnaires. Data analysis in this study using the chi-square test. The results showed that 67 respondents (60.9%) had high self-efficacy and 43 respondents (39.1%) had low self-efficacy, 59 respondents (53.6%) had good foot care behavior, and 51 respondents (46.4%) had poor foot care behavior. The results of the chi-square test obtained a P-value of 0.000 < α = 0.05, which means that there is a relationship between self-efficacy and foot care behavior in patients with diabetes mellitus. It can be concluded that there is a positive relationship between self-efficacy and foot care behavior in diabetes mellitus patients at the Gandapura Public Health Center, Bireuen Regency. It is recommended that health workers can provide health education about foot care regularly in order to increase self-efficacy in people with diabetes mellitus.

PENGETAHUAN DAN PERILAKU PERAWATAN KAKI PADA PENDERITA DIABETES MELITUS TIPE 2 DI PUSKESMAS GONDANG SRAGEN

Type II Diabetes Mellitus due to a decrease in sensitivity to insulin (insulin resistance) or due to a decrease in the amount of insulin produced. Complications of patients with type II diabetes mellitus include diabetic foot ulcers, where diabetic ulcers can be done by doing good foot care. The purpose of this study was to describe the knowledge and behavior of foot care in patients with type II diabetes mellitus at the Gondang Health Center. The research method uses descriptive quantitative. Sampling using purposive sampling technique, with a total sample of 57 respondents. The research instrument used a Diabetic Foot Knowledge Scale (DFKS) foot care knowledge questionnaire and a Nottingham Assessment of Functional Footcare (NAFF) foot care behavior questionnaire. The analysis used is univariate analysis with frequency distribution. The results of the univariate test showed that with type II Diabetes Mellitus 37 respondents (64.9%) had poor knowledge, 41 respondents (71.9%) had poor behavior. The conclusion of the study was that the majority of respondents had poor foot care knowledge and behavior due to lack of information about diabetic foot care.

Foot Self-Care Behaviour among People with Type 2 Diabetes mellitus Living in Rural Underserved Area of North India: A Community-Based Cross-Sectional Study.

The objective of this study was to ascertain the foot self-care behaviour and its associated factors among people with type 2 diabetes mellitus (T2DM) living in the rural resource-constrained health setting of Punjab, North India. A community based cross sectional study was undertaken in the randomly selected underserved rural area of District Fatehgarh Sahib, Punjab, North India. A pre-validated Nottingham Assessment of Functional Footcare (NAFF) scale was administered to assess foot self-care behaviour, and participants were classified based on the percentage of a maximum possible score of 84 on the scale, as poor, if the score was <50%, satisfactory if score 50%-70% and >70% good foot self-care behaviour. A total of 700 participants' responses were recorded. The study results revealed that 84% (588) of the respondents had poor, 16% (112) had satisfactory, and none were following good foot self-care behaviour. An outcome of multivariable logistics regression suggested satisfactory foot self-care behaviour was significantly associated with foot self-care education, with an adjusted odds ratio (aOR) of 2.83 (95%, CI:1.62 - 4.93; p <0.01) among respondents who had received foot self-care education, literate than illiterate (aOR 2.50 95%, CI:1.31- 4.74; p <0.01) and women compared to men (aOR 1.69 95%, CI: 1.06 -2.70; p -0.26). This study revealed that foot self-care behaviours were alarmingly low among people with T2DM living in rural resource-constrained health settings of Punjab, North India, suggesting an urgent need to disseminate foot self-care education to prevent diabetes foot related complications.

A male’s foot is being shot by an ulcer, not a gunshot! The magnitude and associated factors of diabetic foot ulcer among diabetes mellitus patients on chronic care follow-up of southwestern Ethiopian hospital: A cross-sectional study

BackgroundDiabetic foot ulcer (DFU) is one of the main complications of diabetes mellitus associated with major morbidity and mortality. DFU is the major cause of infection and lower extremity amputations in diabetic patients. Despite this, there was a scanty finding on associated factors of foot ulcer among diabetes mellitus. MethodsFacility-based cross-sectional study was conducted among diabetes mellitus patients at BGH from August 1, 2021 - 30, 2021. The validated tool of the Nottingham Assessment of Functional Footcare (NAFF) was used to assess the diabetic foot self-care practice. Multivariate logistic regression was used to analyze the associations between the dependent variables and independent variables. Data were analyzed using a statistical package for social science (SPSS version 23). ResultsA total of 162 respondents with a response rate of 100% have participated in the study. Of the respondents, 88 (54.3%) were females and the mean and SD of the age were 35.8 and 12.70. The prevalence of diabetic foot ulcers in our study area was 24(14.81%). The results of the multivariable logistic regression analysis revealed that being a male (AOR = 2.143; 95% CI: 0.691–6.65), poor diabetic foot care practice (AOR = 3.761; 95CI: 1.188–11.90), and having a co-morbidity (AOR = 2.507; 95CI: 3.270–5.95)were more likely to experience a diabetic foot ulcer than their counterparts. ConclusionThe prevalence of diabetic foot ulcers among diabetic patients in BGH was found to be high. The presence of comorbidity, being a male, and foot care practice were factors that predict the occurrences of diabetic foot ulcers. Therefore, the ongoing medical education on the foot care practices should be given to diabetes mellitus patients.

IDF21-0391 Foot Self-care Practices among People Living with Type 2 Diabetes Mellitus: A Community-based Cross-sectional Study

Background: In India, the prevalence of diabetes is increasing at an alarming rate, so is the prevalence of mortality and morbidity due to its complications. Problem-related to the foot is neglected amongst complications of diabetes and the most common cause of hospitalization among people living with type 2 diabetes mellitus (T2DM). Therefore, education regarding the importance of foot care practice among people living with diabetes is very vital. Aim: The main aim of the study was to assess foot self-care practices and determine factors affecting foot self-care activity among people living with T2DM. Method: A community-based cross-sectional study was conducted among 700 people living with T2DM from July 2019 to December 2019 in the district Fatehgarh Sahib, Punjab, India. Multistage random sampling was used for the selection of the sampling area and a consecutive sampling technique was applied to recruit eligible participants from the selected areas. Pre-validated and structured questionnaires were administered based on recommendations of the International Working Group on the Diabetic Foot (IWGDF) and American Diabetes Association (ADA) along with Nottingham Assessment of Functional Footcare (NAFF) to score the foot care practices among people living with T2DM. The foot care practices were classified into three categories: if the score was <50% of the maximum possible score of 84, foot care practices was considered poor, if the score was 50%-70% of the maximum possible score of 84, then it was appraised as satisfactory foot care and if the score was >70% of the maximum possible of 84, then it was regarded as good. Results: Total 700 people living with T2DM were assessed for foot self-care practices in the study. Out of which 233 (33%) were males and 467 (67%) were females. The mean (SD) age was 55 years (± 10 years) and 2/3 of the participants were literate. The median duration (IQR) of diagnosed with T2DM was 4 years (IQR:3years -7years). Few proportions (13%) of respondents received foot care education from their treating physician, while only 6% of the participants underwent foot examination by the treating physician. Overall, diabetes foot self-care practices were poor among 84% (588) of the respondents, while 16% (112) participants have satisfactory performance and none were in the good category. Factors in multivariable logistics regression namely female gender, literate, low socioeconomic status, nuclear family, uncontrolled blood glucose level and participants who had received foot care advice from their treating physician were demonstrated significant better foot self-care practices (p-value <0.05). Discussion: The study results highlighted that foot self-care practices among people living with T2DM was alarmingly low and there is an urgent need to start a comprehensive diabetes management clinic in both primary and secondary health care levels to avert the consequences of the rapidly rising prevalence of diabetes and its related complications.

Diabetic foot self-care practices and its predictors among chronic diabetic mellitus patients of southwestern Ethiopia hospitals: A cross sectional study

BackgroundThe prevalence of foot ulcers has increased globally due to the worldwide burden of diabetes mellitus and the poor practice of diabetic foot self-care. ObjectiveThe study aimed to identify the diabetic foot self-care practices among diabetic patients in south western Ethiopian hospitals. MethodsA cross-sectional study was conducted for a total of 387 diabetic patients at Bedele General Hospital and Mettu Karl Comprehensive Specialized Hospital. The validated tool of the Nottingham Assessment of Functional Footcare (NAFF) was used to assess the diabetic foot self-care practice. The data was collected by using face-to-face interview method. The multivariate logistic regression was employed to identify the predictors. Data was analyzed using a statistical package for social science (SPSS version 23). ResultOf the 387 patients, a total of 39.8 % of the patients had good diabetic foot self-care practice. Higher educational status (AOR = 2.901(1.213–6.937), P = 0.017), previous information about diabetic foot care (AOR = 2.46(1.90–7.719), P = 0.04) and knowledge level of diabetic foot care(AOR = 2.51(1.43–5.34), P = <0.001) were the predictors of the diabetic foot care practices. ConclusionMore than half of the study participants had poor diabetic foot self-care practice. Diabetic foot self-care practice was associated with a level of education, previous information, and the knowledge level of diabetic foot care. Therefore, the hospital should provide continuous diabetic foot care education to enhance their foot care practices.

Ankle Proprioception in Patients with Type 2 Diabetes Mellitus.

Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications. Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer. Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P < .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P < .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P > .05). Educational level and disease duration were found to be correlated with NAFF scores. Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.

Summary Guidance for Daily Practices on Glycemic Control and Foot Care Behavior

Introduction: The Prevalence of Diabetes Foot Ulcers (DFU) in Indonesia is increasing every year. Summary Guidance for Daily Practice (SGFDP) is a media used to discuss and share knowledge to prevent foot ulcer in patients with Type 2 Diabetes Mellitus (T2DM). The aim was to know the influence of applying SGFDP on glycemic control (fasting blood glucose levels) and foot care behavior.Methods: The study was quasi-experimental utilizing a pretest-post-test with a control group design. The sample obtained was 232 respondents through consecutive sampling. The variables were SGFDP, glycemic control, and foot care behavior. The intervention was conducted for three weeks meeting. The data collected using observation sheets and the Nottingham Assessment of Functional Footcare (NAFF) questionnaire. The results were analyzed using the Wilcoxon and Mann-Whitney tests.Results: Most of respondents were elderly aged 41-50 years old. Respondents showed significant progressed of foot care behavior on before and after treatment. The results showed a significant influence from SGFDP on foot care behavior (p=0.001).Conclusion: The application of SGFDP as an approach to prevent foot ulcers among adults T2DM was significantly affected. It was conducted by discussing and sharing knowledge and utilizing a foot ulcer prevention simulation with foot exercises. Sharing information and the attention given by the nurses in the form of regular meetings can increase patient knowledge and induce behavior changes among adult T2DM.

Pengetahuan Berpengaruh Terhadap Kepatuhan Dalam Perawatan Kaki Pada Klien Diabetes Melitus Tipe II

Background: An increasing number of people with diabetes mellitus will increase the risk of chronic complications, one of which is neuropathy. Diabetic neuropathy can cause disability and even death. Management of Diabetes Mellitus is intended to prevent the occurrence of complications by educating clients about foot care. it aims to improve the knowledge and adherence of people with diabetes mellitus. The purpose of this study was to determine the relationship of the knowledge level of foot care with adherence in performing foot care in patients with Type II Diabetes Mellitus. Research Methods. this study was quantitative research using descriptive-analytic method through a cross-sectional study approach. Data analysis used Chi-Square. This research questionnaire used Nottingham Assessment of Functional Footcare (NAFF) to measure knowledge Rnd Diabetic Foot Care Behavior (DFCB) to measure compliance. Results showed a significant relationship between the level of knowledge with patient compliance in performing foot care (p = 0.001). Conclusion, Based on these results can be concluded that people with diabetes mellitus who have good knowledge will tend to increase adherence in performing foot care.

Factors Affecting Foot Self-Care Practices in Individuals with Diabetes Mellitus Living in an Asian Population - A Quantitative Study

Category: Diabetes Introduction/Purpose: Diabetic foot complications and subsequent lower limb amputations commonly occur in diabetic patients due to poor foot care. We aimed to understand the extent of proper footcare practices and to identify the factors which influence these among diabetic patients in a multi-ethnic Asian population. Methods: A cross-sectional multi-centre quantitative study was performed. Inclusion criteria was all patients attending hospital outpatients clinics for diabetes. Patients were only excluded if they were unable to understand basic English. Demographic information, medical history (including formal assessment for peripheral neuropathy) and Nottingham Assessment of Functional Footcare (NAFF) scoreswere collected. All data was analysed using SPSS Version 21. Results: 350 valid responses were obtained. The mean NAFF score was 49.6±7.19. Univariate analysis revealed that ethnically non-Chinese patients had significantly better scores than did Chinese patients. After linear regression analysis, a statistically significant correlation with better foot care practices was found for patients with higher education levels, active employment and the presence of previous diabetic foot complications. Conclusion: The mean NAFF scores in our study were lower than those published in other populations which may in part account for the huge burden of diabetic foot disease in Singapore. Patients appear to start to look after their feet better only after suffering a complication.Cultural and financial factors probably account for the differences in our risk factor findings and those published in other populations. Future studies should i evaluate the effectiveness of targeted interventions for the specific groups that we have identified who have poorer NAFF scores.

Study on the reliability and validity of the Chinese version of the Nottingham Assessment of Functional Footcare

Objective The study aimed to explore the reliability and validity of the Chinese version of the Nottingham Assessment of Functional Footcare (NAFF) in investigating the footcare behavior's level in patients with high risk of diabetic foot. Methods According to Bradley's principle, NAFF was converted into the Chinese version scale, then it was applied to 211 cases of patients with high risk of type 2 diabetic foot, and the reliability and validity of foot care behavior scores were analyzed. Results In the Chinese version scale, the Cronbach's alpha coefficient was 0.77, test-retest reliability was 0.74. Content validity, I-CVI was 0.80 to 1.00, S-CVI/Ave was 0.96, and the adjusted value of kappa was 0.75 to 1.00. Conclusions The questionnaire has been tested to have good reliability and validity. The NAFF possesses certain value in the clinical application and could be suitable for Chinese patients with high risk of type 2 diabetic foot. Key words: Diabetic foot; Care; Scale; Reliability; Validity

The relationship between self-efficacy and diabetic foot self-care

AimsResearch has shown that the ongoing rate of diabetes-related amputations remains significant despite the existence of prevention methods and that amputation in most cases can be prevented. The purpose of the study was to assess the relationship between the level of self-efficacy and performance of foot self-care in those with diabetes as they relate to the prevention of lower extremity amputation (LEA). MethodsA descriptive correlational study was conducted using the theoretical framework of Bandura's social cognitive theory. The Foot Care Confidence Scale (FCCS) and the Nottingham Assessment of Functional Footcare (NAFF) survey instruments were distributed to individuals over 18 years old with diabetes Type 1 and 2 in the lower peninsula of Michigan (N = 223). ResultsNo significant correlation was identified between the level of self-efficacy and performance of foot self-care behaviors. Statistical significance was found between foot self-care behaviors and gender with males scoring higher than females. ConclusionsThis study adds to the body of knowledge regarding self-efficacy and diabetic foot self-care behaviors. Further research is needed to explore the relationship of gender, diabetes education attendance, and foot self-care behaviors as influencing factors in LEA prevention.

A comparison of two methods of foot health education: The Fremantle Diabetes Study Phase II

AimsTo compare the effectiveness of two different methods of education on foot health, behaviours and attitudes in patients with type 2 diabetes. MethodsCommunity-based patients were consecutively allocated to written education (Group A) or an interactive educator-led session (Group B). A quantitative Foot Score (maximum 90 points score based on severity of treatable pathology), the Nottingham Assessment of Functional Foot Care (NAFFC) survey score (maximum 30 points reflecting frequency of foot care behaviours) and a 6-question survey of attitudes to foot complications were administered at baseline and 3 months. Results154 patients (mean±SD age 68±10 years, 59.7% males, median [interquartile range] diabetes duration 11.5 [5.6–18.9] years) were recruited. There was a greater change (Δ) in Foot Score from baseline to 3 months in Group A (8.3±3.6, Δ−1.8 (95% CI: −2.4 to −1.2) vs Group B (6.8±2.6, Δ−0.1 (−0.7 to 0.4); P<0.001), but no change in NAFFC survey score in either group (P=0.13). In the attitudes survey, Group B felt they better understood how to prevent foot complications than Group A after education (P=0.031). ConclusionsWritten information was more effective at improving foot health while interactive education improved confidence in undertaking preventive measures, suggesting that the most effective foot care education should include both components.

Psychometric Properties of the Nottingham Assessment of Functional Footcare (NAFF)

Aims: The Nottingham Assessment of Functional Footcare (NAFF) was developed to assess the foot care behaviour of people with diabetes. The aim was to check the reliability and validity of the measure. Methods: Patients attending outpatient clinics were asked to complete the NAFF. A sample of respondents was asked to complete the NAFF again two weeks later. There were 86 participants, 60 (69.8%) of whom had current foot problems. Findings: The distribution of item responses indicated all four response categories were used on most items. Internal consistency was 0.61. Re-test data was available from 24 of 39 respondents who agreed to complete the NAFF a second time (61.5%). There was a significant correlation between test and retest (r = 0.91, p &lt; 0.001). Conclusions: The NAFF was internally consistent and reliable over time. Patients with foot problems performed significantly more foot care behaviours that those without. A cut-off score of 50 is suggested to indicate further evaluation of foot care behaviour is needed.

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

This observer-blind, randomised controlled trial was designed to determine the effect of a foot care education programme in the secondary prevention of foot ulcers. People with newly healed foot ulcers attending one of three specialist clinics were allocated to receive either targeted, one-to-one education or usual care, using a computer-generated random allocation sequence that had been prepared in advance but which was concealed from the clinical researcher. The primary outcome was ulcer incidence at 12 months. Secondary outcomes were ulcer incidence at 6 months and incidence of amputation, mood (Hospital Anxiety and Depression Scale) and quality of life (Diabetic Foot Ulcer Scale) at 6 and 12 months. Protective foot care behaviours (Nottingham Assessment of Functional Footcare) were assessed at 12 months. There were 87 (mean [SD] age 63.5 [12.1] years) patients in the intervention group and 85 control patients (mean [SD] age 64.9 [10.9] years). The groups were comparable at baseline. No significant differences (p > 0.05) were observed between groups in ulcer incidence at either 6 months (intervention 30%, control 21%) or 12 months (intervention 41%, control 41%). Recommended foot care behaviours at 12 months were better in the intervention than in the control group (p = 0.03), but education had no significant (p > 0.05) effect on mood, quality of life or amputations. Even though the intervention was associated with improved foot care behaviour, there was no evidence that this programme of targeted education was associated with clinical benefit in this population when compared with usual care. The usefulness and optimal delivery of education to such a high-risk group requires further evaluation. ClinicalTrials.gov NCT00729456 FUNDING: Diabetes UK project grant RD02/0002535.

Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF)

AbstractThere are no measures available to document footcare practice among people with diabetes and yet such measures are needed as a surrogate marker in studies designed to determine the effectiveness of footcare education. We have therefore developed such a measure, the Nottingham Assessment of Functional Footcare (NAFF), and have assessed its reliability and validity.A pilot questionnaire was distributed to people with diabetes and healthy controls, before being revised and shortened. The revised version was assessed for internal consistency and reliability.The pilot 51‐item questionnaire was determined in 100 out‐patients with diabetes and 61 healthy controls. The internal consistency was 0.46 in people with diabetes and 0.39 in healthy volunteers. Twenty‐eight items showed significant differences between those with and without diabetes. The internal consistency and test–retest reliability of a revised version were determined in people with diabetes. The measure was further refined to a 29‐item version, which had an internal consistency of 0.53. There was a significant correlation (rs 0.83; p&lt;0.001) and no significant difference (p = 0.85) between scores in the test–retest study. Respondents with neuropathy scored significantly higher than those without (p&lt;0.01).We conclude that the NAFF could act as an outcome measure in the prospective trials which are needed to establish the place of education programmes in clinical practice. The measure could also be used in routine care to identify those whose usual foot care might put their feet at risk of future ulceration. Copyright © 2007 John Wiley &amp; Sons.