Consensus-based physiotherapy interventions for the treatment of diabetic foot ulcers: a Delphi study

Introduction: Diabetic foot ulcers are a common complication that occurs in patients with diabetes mellitus. The literature describes the treatment as multidisciplinary and also the benefits of physiotherapy as an adjuvant therapy in the treatment of diabetic foot ulcers. Objective: To investigate physiotherapeutic interventions for the management of foot ulceration in people with diabetes. Methods: Exploratory and descriptive study using the Delphi method. The interventions resulted from a systematic review of the literature that was submitted to a panel of experts for analysis. The panel consisted of 12 experts in the field of wound care, and two rounds of analysis were carried out. Quantitative analysis was carried out for the agreement of the answers, and qualitative analysis was used on the experts' comments. Results: In the first round, the expert’s analysis had consensus between 66.7% to 100% within the answers, and in the second round, it ranged from 85.7% to 100%. Two of the interventions in the first round needed to be adjusted. In the second round, all interventions obtained at least 80% consensus. Conclusion: Physiotherapy can help as an adjuvant therapy in the treatment of diabetic foot ulcers. The intervention includes therapeutic exercise (active mobilization exercises) and the use of assistive technologies (removable or non-removable offloading devices). Physiotherapeutic interventions are an adjuvant therapy to a specific local treatment of the wound and pressure relief. Keywords: assistive technologies; Delphi survey; neuropathic ulcer; physiotherapy; therapeutic exercise