Diabetic foot ulcer (DFU) is a disabling complication of diabetes mellitus associated with delayed healing, reduced quality of life, and increased risk of lower-limb amputation. Nursing-led interventions integrating self-care education with rehabilitation may improve outcomes, but evidence for combined approaches remains limited.To evaluate the effects of nursing-led self-care education and rehabilitation interventions on clinical, functional, and behavioral outcomes in adults with DFU.
Methods: This systematic review followed PRISMA 2020. PubMed, Embase, Scopus, Web of Science, Cochrane Library, ProQuest, Ovid, Google Scholar, SID, and Magiran were searched for English and Persian studies from 1 January 2015 to 20 May 2025. Quantitative studies evaluating nursing-led education-focused, combined education–rehabilitation, or telehealth/ digital interventions in adults with DFU were included. Quality was appraised using Joanna Briggs Institute (JBI) checklists. Due to heterogeneity, meta-analysis was not performed and findings were synthesized narratively.
Results: We identified 4,241 records (2,891 databases; 1,350 registers). After removing 1,095 duplicates, 3,146 records were screened; 66 full texts were assessed; and 16 studies were included. Participants totaled 1,208 (34–182 per study). Seven studies examined combined interventions, five education-focused interventions, and four telehealth/digital approaches. Combined interventions tended to show broader improvements in wound-related indicators, perfusion, pain, and quality of life. Education-focused interventions most consistently improved knowledge, self-care behaviors, self-efficacy, and adherence.
Conclusion: Nursing-led DFU interventions appear beneficial, with combined education–rehabilitation approaches tending to yield broader improvements than education-focused strategies alone. Standardized trials with longer follow-up are needed.