Rural and Remote Primary Health Care Research Fellow

Peter Manuel

Title

A case control study of the effectiveness of digital wound imaging, remote consultation and podiatry offloading devices on the healing rates of chronic lower extremity wounds in remote WA

Project summary

The project incorporated a pilot study to investigate the effectiveness of digital wound imaging, remote consultation and podiatry offloading devices on the healing rates of chronic lower extremity wounds in remote regions of Western Australia.  Previous studies had demonstrated a statistically significant improvement in healing rates when digital wound imaging and expert consultation was utilised to treat chronic wounds of the lower leg and foot.  However it was proposed podiatry skills could be utilised to remove weight bearing and shear forces from these wounds to increase healing rates further.



The pilot study recruited 13 subjects from rural and remote areas (ARIA scores >3.34) over a 3 month period. The wounds were digitally photographed, assessed using the Alfred Medseed Wound Imaging Software (AMWIS) and referred to a wound consultant for expert advice.  An offloading device when needed was manufactured by a podiatrist and the treatment plan referred to the treating practitioner.  At 2 weekly intervals or similar time frames the wound was rephotographed and reassessed by AMWIS.  The size of the wound was compared to the previous image captured.  A smaller wound equalled a positive healing rate and a bigger wound a negative healing rate. 

Results of the study demonstrated an average healing rate for the cohort of 18.12% per week.  These results display a clinical improvement in healing rates although this was not proven statistically.  However the healing rates are greater than similar studies. It is proposed this form of healthcare delivery would be well served by further investigation to ascertain its effectiveness when dealing with a larger sample size. A major randomised clinical trial should be conducted to investigate the impact of this management protocol on ulcer healing rates and other relevant outcomes.

A nation such as Australia with large geographical areas, significant movement of people and limited numbers of health specialists will require effective delivery of health services remotely. The required information technology is readily available and many health services are utilising it.  It is important effective delivery of services through this means is developed.  The presented model for treatment of lower leg wounds is a management protocol the authors believe has the capability to achieve this and warrants further investigation.