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Logo for the Journal of Rehab R&D
Volume 43 Number 2, March/April 2006
Pages 227 — 238


Abstract - Personal and treatment factors associated with foot self-care among veterans with diabetes

Mark V. Johnston, PhD;1-3* Leonard Pogach, MD;1,3 Mangala Rajan, MA;1 Allison Mitchinson, MPH;4
Sarah L. Krein, PhD, RN;4-5 Kristin Bonacker;6 Gayle Reiber, MPH, PhD6-7

1Center for Healthcare Knowledge Management, Department of Veterans Affairs (VA) New Jersey Health Care System, East Orange, NJ; 2Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ; 3University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ; 4VA Health Services Research and Development (HSR&D), Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; 5Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI; 6HSR&D, VA Puget Sound Health Care System, Seattle, WA; 7Department of Health Services and Epidemiology, University of Washington, Seattle, WA
Abstract — We developed and validated a survey of foot self-care education and behaviors in 772 diabetic patients with high-risk feet at eight Department of Veterans Affairs medical centers. Principal components analysis identified six subscales with satisfactory internal consistency: basic foot-care education, extended foot-care education, basic professional foot care, extended professional foot care, basic foot self-care, and extended foot self-care (alpha = 0.77-0.91). Despite high illness burden, adherence to foot self-care recommendations was less than optimal; only 32.2% of participants reported looking at the bottom of their feet daily. Independent predictors of greater adherence to basic foot self-care practices included African-American or Hispanic background, perceived neuropathy, foot ulcers in the last year, prior amputation (beta = 0.08-0.12, p < 0.04-0.001), and provision of greater basic and extended education (beta = 0.16, p < 0.004, and beta = 0.15, p < 0.007). The survey subscales can now be used for evaluating foot care and education needs for persons with high-risk feet.
Key words: diabetes, diabetic foot, healthcare quality, health education, minority, outcome assessment, podiatry, primary healthcare, self-care, veterans.

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