Summary:
In patients with diabetic foot ulcers (DFUs) receiving home healthcare, telemedicine-based home healthcare interventions focusing on wound management and patient self-care education significantly promoted wound healing and improved self-management behaviour compared to conventional outpatient face-to-face care in clinical settings, though it was associated with no major reported adverse effects, with suggestions for further app development to optimize care delivery.
| PICO | Description |
|---|---|
| Population | Patients diagnosed with diabetic foot ulcers (DFUs) receiving home healthcare, representing individuals requiring ongoing wound management who may face barriers to frequent clinic visits. |
| Intervention | Telemedicine-based home healthcare interventions incorporating remote wound assessment, patient self-care education, and ongoing clinical guidance through digital platforms. |
| Comparison | Conventional outpatient face-to-face care in clinical settings for DFU management, requiring regular in-person visits for wound assessment and treatment. |
| Outcome | Telemedicine showed comparable efficacy in wound healing and significantly enhanced patient self-management behaviours. No major adverse effects were reported. The study suggests promising development prospects for telemedicine applications including smartphone app usage for wound care. |
Clinical Context
Diabetic foot ulcers represent one of the most costly and debilitating complications of diabetes mellitus, affecting approximately 15-25% of patients with diabetes during their lifetime. These chronic wounds require intensive, ongoing management that traditionally involves frequent clinic visits for wound assessment, debridement, dressing changes, and patient education. For many patients—particularly those with mobility limitations, transportation barriers, or living in rural areas—maintaining the recommended visit frequency poses significant challenges that can compromise wound healing outcomes.
The COVID-19 pandemic accelerated telemedicine adoption across healthcare, but its application to complex wound care presents unique considerations. Unlike many telehealth applications that rely primarily on patient-reported symptoms and verbal consultation, DFU management requires visual wound assessment, evaluation of infection signs, and hands-on guidance for dressing changes. The question of whether remote wound monitoring and education can match in-person care quality has significant implications for healthcare delivery models and patient access to specialized wound care.
Home healthcare for DFU patients offers potential advantages beyond convenience: patients receive care in their actual living environment where self-management occurs, potentially enabling more relevant and practical education. Healthcare providers can observe home conditions, footwear practices, and daily routines that affect wound healing. This study examined whether telemedicine-enhanced home healthcare could achieve wound healing outcomes comparable to traditional clinic-based care while improving patient self-management capabilities.
Clinical Pearls
1. Self-Management Improvement Is the Key Differentiator: While wound healing rates were comparable between groups, telemedicine significantly enhanced patient self-management behaviours. This finding suggests that the educational and engagement components of telemedicine—rather than the wound care itself—may drive its unique value proposition for DFU management.
2. Non-Inferiority in Healing Validates Remote Assessment: The comparable wound healing outcomes between telemedicine and in-person care demonstrate that visual remote wound assessment, when properly implemented, can guide effective treatment decisions. This validates telemedicine as a viable option rather than a compromise when in-person care is unavailable.
3. Technology Development Opportunities Remain: The study authors noted potential for smartphone app development to further optimize telemedicine wound care. Features such as standardized wound photography protocols, AI-assisted wound measurement, automated healing trajectory tracking, and integrated patient education modules could enhance both care quality and scalability.
4. Safety Profile Supports Broader Implementation: The absence of major adverse effects associated with telemedicine-based care addresses a key concern about remote management of potentially serious wounds. This safety signal supports consideration of telemedicine for appropriate DFU patients, though proper patient selection and escalation protocols remain essential.
Practical Application
Consider telemedicine-enhanced home healthcare for DFU patients who face barriers to regular clinic attendance, including those with mobility limitations, transportation challenges, work schedule constraints, or geographic distance from wound care specialists. Establish clear protocols for wound photography that ensure consistent image quality for remote assessment—including standardized lighting, ruler placement for size reference, and multiple angles.
Maintain defined escalation criteria for conversion to in-person evaluation: signs of spreading infection, exposed bone or tendon, rapidly deteriorating wounds, or patient concerns requiring hands-on assessment. Telemedicine should augment rather than replace clinical judgment about when physical examination is necessary. Consider hybrid models combining periodic in-person visits with more frequent telemedicine check-ins.
Leverage the self-management benefits by incorporating structured education into telemedicine encounters: footwear assessment, daily foot inspection techniques, glucose management review, and offloading compliance. The home environment visibility that telemedicine provides creates natural opportunities for practical, contextual patient education.
Broader Evidence Context
This study adds to growing evidence supporting telemedicine for chronic wound management. Previous studies have demonstrated feasibility and patient satisfaction with remote wound monitoring, but comparative effectiveness data against standard in-person care has been limited. The finding of comparable healing outcomes with enhanced self-management aligns with the broader telehealth literature suggesting that patient engagement benefits often accompany remote care delivery.
International guidelines increasingly recognize telemedicine as an appropriate component of diabetic foot care, particularly for surveillance and patient education between in-person assessments. The integration of telemedicine into multidisciplinary diabetic foot teams is evolving, with various models ranging from asynchronous store-and-forward wound photography to real-time video consultations with wound care specialists.
Study Limitations
Sample size and single-center design may limit generalizability. The study population receiving home healthcare may differ from general DFU populations in terms of wound severity, comorbidities, or social support. Long-term outcomes including ulcer recurrence, amputation rates, and sustained self-management behaviours were not reported. Technology platform specifics and implementation details affect reproducibility in other settings.
Bottom Line
Telemedicine-based home healthcare achieves wound healing outcomes comparable to conventional clinic-based care for diabetic foot ulcers while significantly improving patient self-management behaviours, supporting its use for appropriate patients facing barriers to in-person care.
Source: Yu Hai-Ping, et al. “Application of telemedicine in home healthcare for patients with diabetic foot ulcers: a randomised controlled study.” Read article
