Role of telehealth in diabetic foot ulcer management - A systematic review.

OBJECTIVES: To review the use of telehealth in subjects with diabetic foot ulcer; evaluating its clinical outcomes, diagnostic accuracy, cost-effectiveness and behavioural perceptions.

DESIGN: Systematic review.

SETTING: Selected studies were conducted in Australia, USA, the Netherlands, Denmark, Poland and UK.

PARTICIPANTS: A total of 948 identified studies were evaluated against the inclusion criteria. Eleven eligible studies were included for review. Patients with diabetic foot ulcer had to have telehealth guided management.

MAIN OUTCOME MEASURES: Telehealth systems were evaluated against at least one of the following: clinical implications on ulcer healing and disease prognosis; diagnostic accuracy; cost-effectiveness; behavioural perceptions among health professionals or patients.

RESULT: Eleven eligible studies were included for review. Studies that evaluated telehealth against clinical outcomes were underpowered by study design, sample sizes and short duration follow-up. Telehealth systems demonstrated good intra- and inter-observer reproducibility, high diagnostic accuracy and agreement with live assessments. Authors rationalised the cost-effectiveness of their respective telehealth systems, but could not support this with long-term cost analysis. Both patient and health professionals responded positively towards telehealth in surveys and face-to-face interviews.

CONCLUSION: Telehealth yields high diagnostic accuracy, reproducibility and positive behavioural perceptions. However, it is not clear if telehealth use in diabetic foot management has favourable clinical and economic outcomes. More long-term prospective controlled trials on larger populations are needed to further characterise our findings.