Instruments for measuring diabetic foot self-care behavior: a systematic review of measurement properties

Aims: To synthesize and critically evaluate the psychometric properties of patient-reported outcome measures (PROMs) designed to assess diabetic foot self-care behaviors. Methods: A systematic search was conducted in PubMed, EMBASE, CINAHL, and Cochrane databases up to February 2024. Eligible studies included adults (≥18 years) with diabetes who could independently perform daily foot care, and only instruments assessing self-reported foot care practices were included. Studies were excluded if diabetes was not the primary condition, instruments were unrelated, or full-text data were unavailable. The methodological quality and measurement properties of these instruments were assessed using the COSMIN checklist and a modified GRADE approach. Results: Seven self-report instruments for assessing diabetic foot self-care were identified across 16 studies. The review found considerable variability in the methodological quality and psychometric robustness of the included PROMs. The Diabetic Foot Self-Care Questionnaire (DFSQ) consistently showed adequate content validity, structural validity, and internal consistency, and was validated across several cultural context. Conclusion: Despite generally adequate psychometric properties, the evidence is limited by small and variable sample sizes, lack of longitudinal data, incomplete cross-cultural representation, and potential publication bias. Overall, the DFSQ demonstrated the most robust psychometric properties and recommended as a reliable and valid tool for assessing diabetic foot self-care behaviors in both research and clinical practice.