Objectives: Assess the evidence supporting the impact of patient foot-care education on self-efficacy, self-care behaviour and self-care knowledge in individuals with diabetes.
Design: Systematic review registered prospectively on the PROSPERO database (CRD42019106171).
Materials and Methods: Ovid EMBASE and MEDLINE databases were searched from 1946 to end of March 2019, using search terms related to the domains diabetic foot, patient education, self-efficacy, self-care behaviour and self-care knowledge. All included studies were prospective, randomised controlled trials that assessed foot-care education interventions in individuals with diabetes and recorded an outcome related to self-efficacy, self-care behaviour and/or self-care knowledge.
Results: 13 randomised controlled trials were included, reporting on a total of 3,948 individuals. The risk of bias was high or unclear in 11 of the 13 included studies, and low in 2 studies. Both the education-interventions delivered, and the outcome assessment tools used were heterogenous across included studies: meta-analysis was therefore not performed. Eight of 11 studies identified significantly better foot self-care behaviour scores in individuals randomised to education compared with controls. Self-efficacy scores were significantly better in education groups in four of five studies reporting this primary outcome. Foot-care knowledge was significantly better in intervention versus control in three of seven studies. In general, studies assessing secondary end-points including quality of life and ulcer/amputation incidence tended not to identify significant clinical improvements.
Conclusion: The available evidence is of inadequate quality to reliably conclude that foot-care education has a positive impact on foot self-care behaviour and self-efficacy in individuals with diabetes. Quality data supporting accompanying benefits on quality of life or ulcer/amputation incidence are also lacking and should be considered as an important outcome measure in future studies.