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mHealth Study Gives Smartphones a Failing Grade on Foot Ulcer Care

Australian researchers say an mHealth platform that uses a smartphone camera to evaluate diabetic foot ulcers is unreliable on eight of nine characteristics used to treat those patients.

Source: ThinkStock

By Eric Wicklund

- Australian researchers have found that an mHealth platform that relies on photographs taken by a smartphone isn’t enough to properly treat a diabetic foot ulcer.

Roughly 3.4 percent of those diagnosed with diabetes around the world develop foot ulcers, with 1.5 percent eventually requiring amputation. Those developing ulcers often require weekly treatment in clinics, along with remote monitoring at home in between those visits.

While telehealth platforms with medical grade cameras are appropriate for remote monitoring, they’re expensive and cumbersome. As a result, providers looking to improve outcomes and boost patient engagement are turning to smartphones.

According to this analysis, however, those devices are unreliable.

The study of 50 patients with foot ulcers, conducted at the Queensland University of Technology and the Wound Management Innovation Cooperative Research Center, found that smartphone cameras can’t capture enough data about the ulcer to enable providers to treat patients effectively. Researchers said doctors couldn’t, for instance, accurately diagnose an infection, measure the level of exudate or determine whether the wound needs to be debrided.  

In the study, five independent investigators were brought in to evaluate nine characteristics of a foot ulcer based on photographs taken by an iPhone 4. Only one of those nine characteristics could be accurately measured through the smartphone.

“With the exception of the treatment decision of peri-wound debridement, no other item resulted in strong validity or adequate reliability,” said Japp J. van Netten, PhD, of Queensland University's School of Clinical Sciences, lead author of the study, posted this past August in Nature.

“Clinicians who use mobile phone images in daily clinical practice should obtain as much additional information as possible when making treatment decisions based on these images, and be cautious of the low diagnostic accuracy,” he added. “Evidence-based clinical assessment by a trained health professional commonly includes assessment of presence of peripheral neuropathy, peripheral artery disease, infection, wound size and depth and, if available, results from radiological or microbiological assessments. When combined with such additional clinical information, mobile phone images become part of a more comprehensive telemedicine system.”

In the study, van Netten and his researchers did point out that smartphones may someday become sophisticated enough to be used in remote monitoring programs. Some are equipped with infrared sensors and artificial intelligence systems that can better analyze the image, they said.

But they aren’t there yet, the researchers added. And with some three-quarters of the world’s population now using a smartphone, healthcare providers – ranging from hospitals to clinics to home health programs – may find the urge to use them irresistible.

“It is important for these negative outcomes to be reported, as mobile phone images are, in our experience, already widely used in daily clinical practice for the assessment of diabetic foot ulcers and wounds in general,” the study reported. “Mobile phone images are often used in addition to verbal descriptions of diabetic foot ulcers when a patient, carer or home care nurse seeks remote assistance from a specialized team. And even though these images may tell more than the words used to describe the ulcer, the low diagnostic values found for both diagnosis of clinical characteristics and for treatment decisions are an important warning that caution is needed when clinicians remotely assess such images.”

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