Background: The Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter‐rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system.Methods: This was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45) and a standardised measurement protocol.Results: The mean intra‐class correlation for intra‐rater reliability for toe systolic pressures was 0.87 (95% LOA: ‐25.97 to 26.06 mmHg) and the mean intra‐class correlation for Toe Brachial Indices was 0.75 (95% LOA: ‐0.22 to 0.28). The intra‐class correlation for inter‐rater reliability was 0.88 for toe systolic pressures (95% LOA: ‐22.91 to 29.17.mmHg) and 0.77 for Toe Brachial Indices (95% LOA: ‐0.21 to 0.22).Conclusion: Despite the reasonable intra‐class correlation results, the range of error (95% LOA) was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.

Background: People with diabetes and peripheral neuropathy often do not implement the foot‐care behavioural strategies that are suggested by many health professionals. The concept of self‐efficacy has been shown to be an effective predictor of behaviour in many areas of health. This study investigated the relationships between foot‐care self‐efficacy beliefs, self‐reported foot‐care behaviour and history of diabetes‐related foot pathology in people with diabetes and loss of protective sensation in their feet.Methods: Ninety‐six participants were included in this cross‐sectional study undertaken in a regional city of Australia. All participants had diabetes and clinically diagnosed loss of protective sensation in their feet. The participants completed a self‐report pen‐paper questionnaire regarding foot‐care self efficacy beliefs (the “Foot Care Confidence Scale”) and two aspects of actual foot‐care behaviour‐preventative behaviour and potentially damaging behaviour. Pearson correlation coefficients were then calculated to determine the association between foot‐care self‐efficacy beliefs and actual reported foot‐care behaviour. Multiple analysis of variance was undertaken to compare mean self‐efficacy and behaviour subscale scores for those with a history of foot pathology, and those that did not.Results: A small positive correlation (r = 0.2, p = 0.05) was found between self‐efficacy beliefs and preventative behaviour. There was no association between self‐efficacy beliefs and potentially damaging behaviour. There was no difference in self‐efficacy beliefs in people that had a history of foot pathology compared to those that did not.Conclusion: There is little association between foot‐care self‐efficacy beliefs and actual foot‐care behaviour. The usefulness of measuring foot‐care self‐efficacy beliefs to assess actual self foot‐care behaviour using currently available instruments is limited in people with diabetes and loss of protective sensation.

Background: Smart insole technologies that provide biofeedback on foot health can support foot‐care in adults with diabetes. However, the factors that influence patient uptake and acceptance of this technology are unclear. Therefore, the aim of this mixed‐methods study was to use an established theoretical framework to determine a model of psychosocial factors that best predicts participant intention to use smart insoles.Methods: Fifty‐three adults with diabetes from regional Australia completed the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the psychosocial factors that best predict behavioural intention to adopt a smart insole. Additionally, a focus group was conducted and thematic analysis was performed to explore barriers and enablers to adopting this technology.Results: The multiple regression model that best predicted intention to adopt the smart insole (adjusted R² = 0.51, p < 0.001) identified that self‐efficacy (β = 0.67, p = 0.001) and attitude (β = 0.72, p < 0.001) were significant predictors of behavioural intention, while effort expectancy (β = − 0.52, p = 0.003) and performance expectancy (β = − 0.40, p = 0.040) were moderating factors. Thematic analysis illustrates the importance of attitude and self‐efficacy on participants' behavioural intentions, influenced by participant's belief in the device's clinical efficacy and anticipated effort expectancy.Conclusions: This mixed‐methods study demonstrates that attitude, self‐efficacy, performance expectancy and effort expectancy combine to predict intention to adopt smart insole technology. Clinicians should consider these psychosocial factors when they prescribe and implement smart soles with patients at high risk of foot ulceration.

Background: The health‐related quality of life (HRQoL) of people with diabetes‐related foot complications has been increasingly reported, mostly from studies of people with a foot ulcer. The aim of this study was to assess HRQoL and determine factors associated with HRQoL in people with diabetes at high risk of foot ulceration.Methods: In all, 304 participants enrolled in the Diabetic Foot Temperature Trial (DIATEMP) were included in the cross‐sectional analysis. HRQoL was measured by the RAND® 36‐Item Short Form Health Survey (SF‐36) at baseline. Potential factors associated with HRQoL were analysed using multiple linear regression analyses for the eight domains of the SF‐36.Results: Participants were predominantly male (72%), mean age 64.6 (±10.5) years, 77% type 2 diabetes and mean duration of diabetes 20 (±14) years. Mean SF‐36 domain scores for the General Health (49.2 ± 20.1), Role Physical (50.9 ± 44.7), Physical Function (58.5 ± 27.9) and Vitality domains (59.8 ± 21.6) were lower compared to the Mental Health (78.4 ± 18.0), Social Functioning (75.3 ± 24.2), Role Emotional (73.5 ± 38.9) and Bodily Pain (67.0 ± 27.0) domains. HRQoL was lower than Dutch population‐based and general diabetes samples, but higher than in samples with an ulcer. Use of a walking aid was associated with lower HRQoL across all 8 SF‐36 domains (β range − 0.20 to − 0.50), non‐Caucasian descent was associated with lower HRQoL in 5 domains (β range − 0.13 to − 0.17). Not working, higher BMI and younger age were associated with lower HRQoL in 3 domains.Conclusions: People at high risk of diabetes‐related foot ulceration have reduced HRQoL that varies across domains, with the physical domains most affected. Assessing mobility, ethnicity, BMI and job status may be useful in daily practice to screen for people who might benefit from interventions targeting HRQoL.Trial registration: Netherlands Trial Registration: NTR5403. Registered on 8 September 2015.

Background: The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre.Methods: This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data.Results: Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context.Conclusions: This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.