Reducing Lower Extremity Amputations via Peer Support Interventions: A Scoping Review

Patients with diabetes and/or peripheral artery disease (PAD) are at risk for lower limb amputation and a subsequently higher mortality risk. Peer support interventions have been shown to increase diabetes self-management and glycemic control. This scoping review aims to synthesize the current literature on peer support interventions in reducing lower limb amputations. A PubMed search was conducted in June of 2023, excluding publications prior to 2000, focusing on two themes: (1) peer support and (2) the patient population of interest (i.e., individuals with diabetic foot disease and/or PAD). Studies were included if they addressed the population of interest, involved a peer support intervention to improve lower extremity health, and had outcomes pertaining to the health of the lower extremities or programmatic metrics such as participant satisfaction or program adherence. Out of 1730 publications initially identified, six met the inclusion criteria. These six studies were categorized as group foot care education studies (n = 4) or group cognitive behavioral studies (n = 2). The group foot care education studies showed mixed results, which varied from no effect to significant improvements in foot care, self-management, and complications. There was a trend of improvement in self-management behaviors and physical activity in cognitive behavioral interventions. Despite showing promise in other settings, there have been limited investigations of peer support interventions to improve lower extremity outcomes and avert amputations in persons with diabetes and/or PAD. Further studies are required to conclusively determine the efficacy of peer support interventions to reduce lower extremity amputation rates.