Date of Graduation

Summer 8-8-2015

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson, PA-C, MPH

Second Advisor

Annjanette Sommers

Abstract

Background: At least 60% of nontraumatic lower limb amputations are due to diabetic foot disease. Furthermore, this carries a five-year mortality risk of 50% after one major amputation. A foot ulcer precedes the majority of amputations. One strategy for the management of patients with diabetic foot disease is to introduce a multidisciplinary approach and address the multifactorial processes involved in diabetic foot ulcers. The purpose of this review is to examine how a multidisciplinary approach can affect the rate of amputation in patients with diabetic foot disease.

Methods: An exhaustive search was made available using medical literature via Medline-OVID, CINAHL, Web of Science and Google Scholar using the keywords diabetic foot, amputation and patient care team. Relevant articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation criteria.

Results: Two studies met the inclusion criteria and were included in this systematic review. The first study was a retrospective observational study that reviewed medical records of 74 patients who were hospitalized and treated in a multidisciplinary foot clinic at a university hospital in Turkey between January 1, 2002 and December 31, 2007. From 2002 through 2007, the overall amputation rate was 21.6%, which was lower than the prior rates from 1992 to 1996 and 2000 to 2002, 36.7% and 39.4% respectively. The second study was a retrospective observational study that reviewed 574 patients who were admitted to a university hospital in Turkey between January 1999 and January 2008. A multidisciplinary diabetic foot clinic was established in January 2002. There was a statistically significant reduction in major amputations after initiating the diabetic foot clinic (20.4% vs. 12.6%, p=0.026). However, there was no statistical significance in overall or minor amputations.

Conclusion: A multidisciplinary approach to treat patients with diabetic foot disease delays the rate of amputations via early identification and intervention. The studies in the United States are limited, as are studies with diverse populations; however, based on the above results, it may not be necessary to conduct further studies if all patients with diabetic foot disease are treated aggressively with a multidisciplinary approach.

Keywords: diabetic foot, amputation and patient care team

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