The Model and Efficacy of Online Nurse-led on the Clinical Outcome of Diabetic Foot Ulcers: A Systematic Review of Randomized Controlled Trials

Background: The most frequent consequence for those with diabetes mellitus is diabetic foot ulcers. Diabetic ulcer treatment must be done properly and on time. The development of online-based intervention by nurses, such as messaging health, may improve the clinical outcome of diabetic foot ulcers by providing easier access, more convenience, and cost-effectiveness, especially for patients in rural areas. Objective: This study aimed to perform a systematic review and meta-analysis the models and efficacy of online nurse-led intervention on clinical outcomes of diabetic foot ulcers. Methods: Randomized Controlled Trials were searched by using PubMed, Scopus, and Google Scholar. The final inclusion study analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed risk of bias by using RoB 2.0. The study used Mantel Haenszel method. Results: Five randomized controlled trials with 1399 total number of participants were included. There are three studies with some concerns and two studies with low risk of bias. The nurse-led model for diabetic foot ulcer care consists of phone and web-based that conducted by nurse (community nurses and clinical nurses) and doctor specialists are involved in the service. The meta-analysis for amputation outcome showed that telehealth has more favor amputation number with RR 0.6 (95 % CI 0.43 - 0.84; p = 0.003). For healing wounds and mortality outcome, telehealth with RR 1.07 (95% CI 0.99 - 1.16; p = 0.11) and RR 1.37 (95 % CI 0.78 - 2.40; p =0.28), respectively. Conclusions: Phone and web-based may improve clinical outcome of diabetic foot ulcers in terms of amputation outcome, but standard care still more favor in higher wound healing outcome and significantly lower mortality rate.