Where do we stand? The availability and efficacy of diabetes related foot health programs for Aboriginal and Torres Strait Islander Australians: a systematic review

Review Open Access Open Peer Review Where do we stand? The availability and efficacy of diabetes related foot health programs for Aboriginal and Torres Strait Islander Australians: a systematic review Vivienne Chuter1, 2Email authorView ORCID ID profile, Matthew West1, Fiona Hawke1 and Angela Searle1 Journal of Foot and Ankle Research201912:17 https://doi.org/10.1186/s13047-019-0326-1 ©  The Author(s). 2019 Received: 6 December 2018Accepted: 1 March 2019Published: 18 March 2019 Open Peer Review reports Abstract Background Aboriginal and Torres Islander Australians experience considerably higher rates of diabetes and diabetes related foot complications and amputations than non-Indigenous Australians. Therefore there is a need to identify aspects of Aboriginal and Torres Islander focussed foot health programs that have had successful outcomes in reducing diabetes related foot complications. Wider knowledge and implementation of these programs may help reduce the high burden of diabetes related foot disease experienced by Aboriginal and Torres Islander Australians. Methods PubMeD, Informit Indigenous collection, CINAHL, SCOPUS, the Cochrane Library and grey literature sources were searched to 28th August 2018. We included any published reports or studies of stand-alone diabetes related foot care interventions, programs, services, educational resources or assessment of these interventions, designed for Aboriginal and Torres Strait Islander Australians. Results Thirteen studies detailing interventions in the Northern Territory, New South Wales, Queensland and Western Australia met the inclusion criteria. Five reports described delivery of podiatry services while the other eight investigated educational and training programs. Half of the reports related to aspects of the Indigenous Diabetic Foot program which provides culturally appropriate foot education and training workshops for health care providers. One article reported quantitative data related to clinical patient outcome measures. Conclusions No state- or nation-wide foot health programs for prevention of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians were identified. One program achieved high adherence to the national guidelines regarding timing of podiatry review treatments through use of an evidence based foot risk classification tool and provision of services in a culturally appropriate centre. Keywords Aboriginal and Torres Strait islanderIndigenousFootDiabetesProgramPrevention Background Diabetes mellitus is one of the fastest growing chronic diseases in the world [1]. Aboriginal and Torres Islander Australians experience four times the rate of diabetes compared to non-Indigenous Australians, with an overall incidence of 13% [2], and rates as high as 42% reported in some remote communities [3]. As the leading cause of lower limb amputation, and with high rates of associated mortality, diabetes related foot complications are a major but poorly recognised health care burden in Australia, estimated to cost in excess of $1.6 billion annually [4, 5]. Evidence demonstrates Aboriginal and Torres Islander Australians have a three to six fold increased risk of diabetes related foot complications including neuropathy, foot ulcer and lower limb amputation compared to non-Indigenous Australians [6, 7]. Consequently the National Health and Medical Research Council Guidelines for the prevention of foot complications in diabetes state that ‘Until adequately assessed all Aboriginal and Torres Strait Islander people with diabetes are considered to be at high risk of developing foot complications and therefore will require foot checks at every clinical encounter and active follow-up’ [8]. International guidelines suggest that up to 85% of diabetes related amputations could be prevented with early detection of problems and appropriate treatment [9]. Despite the evident need for effective preventative foot care in this population, available data indicate poor engagement with existing preventative care services in contrast to high rates of related hospitalisation and amputation [6, 7, 10]. A number of examples of culturally safe services for Aboriginal and Torres Strait Islander communities in Australia have increased access to combined diabetes care services and improved patient outcomes [11–17]. These share common characteristics, including community consultation in the development, implementation and ongoing management of the service; involvement of Aboriginal Health Workers (AHW); and a focus on self-management and patient participation in health through improved health literacy. There is an obvious and urgent need to identify similarly successful stand-alone foot health programs for the prevention of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians. Methods An electronic database search of PubMeD (using Lit.search https://www.lowitja.org.au/litsearch from the Lowitja Institute which was developed as a search tool for Aboriginal and Torres Strait Islander health articles), Informit Indigenous collection, CINAHL, SCOPUS, and the Cochrane Library was conducted from database inception to 28th August 2018. Additional hand searches of grey literature sources were also conducted including of the Lowitja Institute, Menzies School of Health Research, Australian Indigenous HealthInfoNet (www.healthinfonet.ecu.edu.au), Services for Australian Rural and Remote Allied Health (www.sarrah.org.au), and the Australia Institute of Health and Welfare (http://www.aihw.gov.au/). Reference lists of included studies, clinical guidelines and review articles were also searched. Authors of included studies and reports were contacted where intentions of further evaluation was stated, and, where information was provided, it has been included in this review. The PubMed search strategy as generated from the Lowitja Institute is detailed in Additional file 1. Inclusion criteria were any published reports of stand-alone diabetes related foot care interventions, programs, services, educational resources or assessment of these interventions, designed for Aboriginal and Torres Strait Islander Australians. Interventions were excluded if foot care was embedded within a broader health program due to likelihood of variability in the extent and reporting of the foot care component, and, the confounding effect of the broader health care program on foot specific outcomes. Foot care programs not designed specifically for Aboriginal and Torres Strait Islander Australians were also excluded. One reviewer conducted the electronic searches (AS). Titles and abstracts were independently assessed by two reviewers (AS and VC). Disagreements were resolved by consensus and a third reviewer where necessary (MW). Extraction of the study data and assessment of the methodological quality of the included studies was conducted by two authors (AS an (...truncated)