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Jongebloed-Westra M, Exterkate SH, van Netten JJ, Kappert KDR, Koffijberg H, Bode C, van Gemert-Pijnen JEWC, Ten Klooster PM. The effectiveness of motivational interviewing on adherence to wearing orthopedic shoes in people with diabetes at low-to-high risk of foot ulceration: A multicenter cluster-randomized controlled trial. Diabetes Res Clin Pract 2023; 204:110903. [PMID: 37704109 DOI: 10.1016/j.diabres.2023.110903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
AIM To evaluate the effectiveness of motivational interviewing (MI) performed by MI-trained podiatrists in improving adherence to wearing orthopedic shoes in comparison to usual care in people with diabetes at low-to-high risk of ulceration. METHODS People with diabetes with loss of protective sensation and/or peripheral artery disease, and with orthopedic shoes prescription were allocated to receive one MI-consultation by a podiatrist randomized to MI training (n = 53) or usual care only (n = 68). Adherence was measured as the percentage of steps taken while wearing orthopedic shoes, determined using an insole temperature microsensor and wrist-worn activity tracker during one week at 3 and 6 months. RESULTS The proportion of participants ≥80 % adherent to wearing their orthopedic shoes was higher in the control group than in the MI-intervention group at 3 months (30.9 % versus 15.1 %; p = 0.044), and not significantly different at 6 months (22.1 % versus 13.2 %; p = 0.210). Average adherence was also higher in the control group than the intervention group at both 3 months (60.9 % versus 50.9 %; p = 0.029) and 6 months (59.9 % versus 49.5 %; p = 0.025). CONCLUSIONS One podiatrist-led MI-consultation in its current form did not result in higher adherence to wearing orthopedic shoes in people with diabetes 3 and 6 months after inclusion. TRIAL REGISTRATION Netherlands Trial Register NL7710 (available on the International Clinical Trials Registry Platform).
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Affiliation(s)
- M Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands.
| | - S H Exterkate
- Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands; Voetmax Orthopedie, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands
| | - J J van Netten
- Amsterdam UMC, Location University of Amsterdam, Department of Rehabilitation, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - K D R Kappert
- Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, PO Box 7600, 7600 SZ Almelo, The Netherlands
| | - H Koffijberg
- Department of Health Technology and Services Research, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - C Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - J E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - P M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
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Exterkate SH, Jongebloed-Westra M, Ten Klooster PM, Koffijberg H, Bode C, van Gemert-Pijnen JEWC, van Baal JG, van Netten JJ. Objectively assessed long-term wearing patterns and predictors of wearing orthopaedic footwear in people with diabetes at moderate-to-high risk of foot ulceration: a 12 months observational study. J Foot Ankle Res 2023; 16:60. [PMID: 37705016 PMCID: PMC10500813 DOI: 10.1186/s13047-023-00656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Orthopaedic footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Robust data on long-term wearing time of orthopaedic footwear are not available, and needed to gain more insights into wearing patterns and associated factors (i.e. participants' demographic, disease-related characteristics, and footwear usability). We aimed to objectively assess long-term wearing patterns and identify factors associated with wearing orthopaedic footwear in people with diabetes at moderate-to-high risk of ulceration. METHODS People diagnosed with diabetes mellitus type 1 and 2 with loss of protective sensation and/or peripheral artery disease and prescribed with orthopaedic footwear were included and followed for 12 months. The primary outcome was mean daily wearing time, continuously measured using a temperature sensor inside the footwear (Orthotimer®). Adherence to wearing orthopaedic footwear was calculated as percentage of wearing time of a total assumed 16 h out-of-bed daytime, where adherence < 60% was a pre-determined non-adherent threshold. Wearing time patterns were assessed by calculating participants' wearing (in)consistency. One-way analyses of variance tested for wearing time differences between subgroups, weekdays, and weekend days. Factors potentially associated with wearing time were collected by questionnaires and medical files. Univariately associated factors were included in multivariate linear regression analysis. RESULTS Sixty one participants were included (mean (SD) age: 68.0 (7.4) years; females: n = 17; type 2 diabetes mellitus: n = 54). Mean (SD) overall daily wearing time was 8.3 (6.1) hours/day. A total of 40 (66%) participants were non-adherent. Participants with a consistent wearing pattern showed higher daily wearing times than participants with an inconsistent pattern. Mean (SD) wearing times were 12.7 (4.3) vs 3.6 (4.8) hours/day, respectively (P < 0.001). Mean (SD) wearing time was significantly higher (P < 0.010) during weekdays (8.7 (6.0) hours/day) compared to Saturday (8.0 (6.1) hours/day) and Sunday (6.9 (6.2) hours/day). In the multivariate model (R2 = 0.28), "satisfaction with my wear of orthopaedic footwear" was positively associated (P < 0.001) with wearing time. The other seven multivariate model factors (four demographic variables and three footwear usability variables) were not associated with wearing time. CONCLUSIONS Only one out of three people at moderate to high risk of foot ulceration were sufficiently adherent to wearing their orthopaedic footwear. Changing people's wearing behaviour to a more stable pattern seems a potential avenue to improve long-term adherence to wearing orthopaedic footwear. Investigated factors are not associated with daily wearing time. Based on these factors the daily wearing time cannot be estimated in daily practice. TRIAL REGISTRATION Netherlands Trial Register NL7710. Registered: 6 May 2019.
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Affiliation(s)
- Stein H Exterkate
- Research & Development, Voetencentrum Wender, Hengelo, 7555 SK, The Netherlands.
| | - Manon Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Tech Med Centre, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Julia E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Josephus G van Baal
- Research & Development, Voetencentrum Wender, Hengelo, 7555 SK, The Netherlands
- Ziekenhuisgroep Twente (ZGT), ZGT Academy, Hengelo, 7555 DL, The Netherlands
- University of Cardiff, Cardiff, CF10 3AT, UK
| | - Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Hemler SL, Ntella SL, Jeanmonod K, Köchli C, Tiwari B, Civet Y, Perriard Y, Pataky Z. Intelligent plantar pressure offloading for the prevention of diabetic foot ulcers and amputations. Front Endocrinol (Lausanne) 2023; 14:1166513. [PMID: 37469988 PMCID: PMC10352841 DOI: 10.3389/fendo.2023.1166513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
The high prevalence of lower extremity ulceration and amputation in people with diabetes is strongly linked to difficulties in achieving and maintaining a reduction of high plantar pressures (PPs) which remains an important risk factor. The effectiveness of current offloading footwear is opposed in part by poor patient adherence to these interventions which have an impact on everyday living activities of patients. Moreover, the offloading devices currently available utilize primarily passive techniques, whereas PP distribution is a dynamically changing process with frequent shifts of high PP areas under different areas of the foot. Thus, there is a need for pressure offloading footwear capable of regularly and autonomously adapting to PPs of people with diabetes. The aim of this article is to summarize the concepts of intelligent pressure offloading footwear under development which will regulate PPs in people with diabetes to prevent and treat diabetic foot ulcers. Our team is creating this intelligent footwear with an auto-contouring insole which will continuously read PPs and adapt its shape in the forefoot and heel regions to redistribute high PP areas. The PP-redistribution process is to be performed consistently while the footwear is being worn. To improve adherence, the footwear is designed to resemble a conventional shoe worn by patients in everyday life. Preliminary pressure offloading and user perceptions assessments in people without and with diabetes, respectively, exhibit encouraging results for the future directions of the footwear. Overall, this intelligent footwear is designed to prevent and treat diabetic foot ulcers while enhancing patient usability for the ultimate prevention of lower limb amputations.
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Affiliation(s)
- Sarah L. Hemler
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals, Geneva, Switzerland
| | - Sofia Lydia Ntella
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Kenny Jeanmonod
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Christian Köchli
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Bhawnath Tiwari
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Yoan Civet
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Yves Perriard
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Zoltan Pataky
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals, Geneva, Switzerland
- Faculty Diabetes Centre, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Hulshof CM, van Netten JJ, Dekker MG, Pijnappels M, Bus SA. In-shoe plantar pressure depends on walking speed and type of weight-bearing activity in people with diabetes at high risk of foot ulceration. Clin Biomech (Bristol, Avon) 2023; 105:105980. [PMID: 37178550 DOI: 10.1016/j.clinbiomech.2023.105980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/16/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND In evaluating therapeutic footwear, in-shoe plantar pressure is usually obtained during mid-gait steps at self-selected walking speed in a laboratory setting. However, this may not accurately represent plantar pressures or indicate the cumulative stress experienced in daily life. We investigated the effects of walking speed and different weight-bearing activities on in-shoe plantar pressure in people with diabetes at high risk of ulceration. METHODS In a cross-sectional study including 30 participants we compared in-shoe plantar pressures between three standardized walking speeds (0.8, 0.6 and 0.4 m/s) and between walking at self-selected speed and eight other weight-bearing activities (3 components of the Timed Up and Go test, accelerating, decelerating, stair ascending and descending, and standing). Mean forefoot regional peak plantar pressure and pressure-time integral were statistically assessed per foot using linear mixed models (α < 0.05) with Holm-Bonferroni correction. FINDINGS With increasing walking speed, peak pressures increased and pressure-time integrals decreased (P ≤ 0.014). Peak pressures during standing, decelerating, stair ascending and Timed Up and Go test were lower (P ≤ 0.001), and with other activities not different to walking at self-selected speed. Pressure-time integrals during stair ascending and descending were higher (P ≤ 0.001), during standing lower (P ≤ 0.009), and with other activities not different to walking at self-selected speed. INTERPRETATION In-shoe plantar pressure depends on walking speed and type of weight-bearing activity. Only measuring pressures to evaluate footwear at self-selected walking speed in a laboratory setting may not accurately represent the stress on the foot in daily life of the high-risk patient; a more comprehensive assessment is suggested.
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Affiliation(s)
- Chantal M Hulshof
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Jaap J van Netten
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Maartje G Dekker
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands; Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, Amsterdam, the Netherlands
| | - Mirjam Pijnappels
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands; Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, Amsterdam, the Netherlands
| | - Sicco A Bus
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands
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Jarl G, Hulshof CM, Busch-Westbroek TE, Bus SA, van Netten JJ. Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use? SENSORS (BASEL, SWITZERLAND) 2023; 23:1648. [PMID: 36772691 PMCID: PMC9919850 DOI: 10.3390/s23031648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Adherence to prescribed footwear is essential to prevent diabetes-related foot ulcers. The aim was to compare different measures of adherence and wearing time of prescribed footwear with a reference adherence measure, among people with diabetes at high risk of foot ulceration. We followed 53 participants for 7 consecutive days. A temperature sensor measured wearing time of prescribed footwear and a triaxial accelerometer assessed weight-bearing activities. Subjective wearing time was self-reported. Reference adherence measure was proportion of weight-bearing time prescribed footwear was worn. We calculated Spearman's correlation coefficients, kappa coefficients, and areas under the curve (AUC) for the association between the reference measure and other measures of adherence and wearing time. Proportion of daily steps with prescribed footwear worn had a very strong association (r = 0.96, Κ = 0.93; AUC: 0.96-1.00), objective wearing time had a strong association (r = 0.91, Κ = 0.85, AUC: 0.89-0.99), and subjective wearing time had a weak association (r = 0.42, Κ = 0.38, AUC: 0.67-0.81) with the reference measure. Objectively measured proportion of daily steps with prescribed footwear is a valid measure of footwear adherence. Objective wearing time is reasonably valid, and may be used in clinical practice and for long-term measurements. Subjective wearing time is not recommended to be used.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Chantal M. Hulshof
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
| | - Tessa E. Busch-Westbroek
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
| | - Sicco A. Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
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Béghin L, Mohammad Y, Fritot S, Letellier G, Masson S, Zagamé Y, Donskoff C, Toussaint-Thorin M, Gottrand L. Safety and adherence of pressure garment therapy in children with upper limb unilateral cerebral palsy. Results from a randomized clinical trial ancillary analysis. Front Pediatr 2023; 11:1043350. [PMID: 37025290 PMCID: PMC10071041 DOI: 10.3389/fped.2023.1043350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/10/2023] [Indexed: 04/08/2023] Open
Abstract
Background This study was conducted to assess the safety and adherence of the use of a PGT (Pressure Garment Therapy) Lycra® sleeve to treat upper limb unilateral cerebral palsy (UCP) in children. Methods This study was conducted as a prospective, placebo-controlled, double-blinded, randomized monocenter study. Included in the study were 58 UCP children, 49 of whom were analyzed. 25 children (mean age 6.6 ± 1.6 years; 12 girls) were allocated to the active group vs. 24 (mean age 6.7 ± 1.6 years; 10 girls) in the placebo group. The intervention consisted of an active PGT Lycra® arm sleeve manufactured to generate a homogeneous pressure ranging from 15 to 25 mmHg. The placebo PGT Lycra® sleeve was manufactured to generate a homogeneous pressure under 7 mmHg. The time of wearing period was set at 3 h/day at minimum and 6 h/day at maximum, over the course of 6 months. The main outcome measures were safety outcomes including the number and intensity of Adverse Events of Special Interest (AESIs). AESIs were defined as adverse events imputable to compressive therapy and Lycra® wearing. Level of adherence was expressed in percentage of number of days when the sleeve was worn for at least 3 h per day compared to length of duration in days (start and end date of wearing period). Results Frequency of AESIs were very low and no different between groups (4.12 ± 11.32% vs. 1.83 ± 3.38%; p = 0.504). There were no differences in adherence (91.86 ± 13.86% vs. 94.30 ± 9.95%; p = 0.425). Conclusion The use of PGT Lycra® arm sleeve in children with UCP is safe and well-tolerated with a very good adherence. The low rate of AESIs is promising for further randomized clinical trials on efficacy.
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Affiliation(s)
- Laurent Béghin
- CIC 1403 – Clinical Investigation Center. Lille University Hospital Inserm, Lille, France
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
- Correspondence: Laurent Beghin
| | - Yasser Mohammad
- Pediatric Physical Medicine and Rehabilitation Center APF, Creil, France
- Rehabilitation Center, Beaumont sur Oise, France
| | - Séverine Fritot
- Physical Medicine and Rehabilitation Department, CHU Amiens, Amiens, France
| | - Guy Letellier
- Pediatric Physical Medicine and Rehabilitation Center (ESEAN-APF), Nantes, France
| | - Sixtine Masson
- Physical Medicine and Rehabilitation Center APF (Centre Marc Sautelet), Villeneuve-d’Ascq, France
| | | | - Catherine Donskoff
- Physical Medicine and Rehabilitation Department, Paul Dottin Center, Ramonville-Saint-Agne, France
| | | | - Laurence Gottrand
- Pediatric Physical Medicine and Rehabilitation Center, CHU Reims, Reims, France
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Malki A, Verkerke GJ, Dekker R, Hijmans JM. Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation: A focus group study. PLoS One 2023; 18:e0280264. [PMID: 36634096 PMCID: PMC9836263 DOI: 10.1371/journal.pone.0280264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Persons with diabetes mellitus (DM) and loss of protective sensation (LOPS) due to peripheral neuropathy do not use their therapeutic footwear (TF) consistently. TF is essential to prevent foot ulceration. In order to improve compliance in using TF, influencing factors need to be identified and analyzed. Persons with a history of foot ulceration may find different factors important compared with persons without ulceration or persons who have never used TF. Therefore, the objective of this study was to determine factors perceived as important for the use of TF by different groups of persons with DM and LOPS. METHOD A qualitative study was performed using focus group discussions. Subjects (n = 24) were divided into 3 focus groups based on disease severity: ulcer history (HoU) versus no ulcer history (no-HoU) and experience with TF (TF) versus no experience (no-TF). For each group of 8 subjects (TF&HoU; TF&no-HoU; no-TF&no-HoU), an online focus group discussion was organized to identify the most important influencing factors. Transcribed data were coded with Atlas.ti. The analysis was performed following the framework approach. RESULTS The factors comfort and fit and stability/balance were ranked in the top 3 of all groups. Usability was ranked in the top 3 of group-TF&noHoU and group-noTF&noHoU. Two other factors, reducing pain and preventing ulceration were ranked in the top 3 of group-TF&noHoU and group-TF&HoU, respectively. CONCLUSION Experience with TF and a HoU influence which factors are perceived as important for TF use. Knowledge of these factors during the development and prescription process of TF may lead to increased compliance. Although the main medical reason for TF prescription is ulcer prevention, only 1 group gave this factor a high ranking. Therefore, next to focusing on influencing factors, person-centered education on the importance of using TF to prevent ulcers is also required.
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Affiliation(s)
- Athra Malki
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
- * E-mail:
| | - Gijsbertus J. Verkerke
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, Overijssel, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
| | - Juha M. Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
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Does in-shoe pressure analysis to assess and modify medical grade footwear improve patient adherence and understanding? A mixed methods study. J Foot Ankle Res 2022; 15:94. [PMID: 36564819 PMCID: PMC9789308 DOI: 10.1186/s13047-022-00600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Medical grade footwear (MGF) with demonstrated plantar-pressure reducing effect is recommended to reduce the risk of diabetes-related foot ulceration (DFU). Efficacy of MGF relies on high adherence (≥ 80%). In-shoe pressure analysis (IPA) is used to assess and modify MGF, however, there is limited evidence for the impact on patient adherence and understanding of MGF. The primary aim of this study was to determine if self-reported adherence to MGF usage in patients with previous DFU improved following IPA compared to adherence measured prior. The secondary aim was to determine if patient understanding of MGF improved following in-shoe pressure analysis. METHODS Patients with previous DFU fitted with MGF in the last 12 months were recruited. The first three participants were included in a pilot study to test procedures and questionnaires. MGF was assessed and modified at Week 0 based on findings from IPA using the Pedar system (Novel). Patients completed two questionnaires, one assessing patient adherence to MGF at Week 0 and Week 4, the other assessing patient understanding of MGF before and after IPA at week 0. Patient understanding was measured using a 5-point Likert scale (strongly disagree 1 to strongly agree 5). Patient experience was assessed via a telephone questionnaire administered between Weeks 0-1. RESULTS Fifteen participants were recruited, and all completed the study. Adherence of ≥ 80% to MGF usage inside the home was 13.3% (n = 2) pre-IPA and 20.0% (n = 3) at Week 4. Outside the home, ≥ 80% adherence to MGF was 53.3% (n = 8) pre-IPA, and 80.0% (n = 12) at Week 4. Change in scores for understanding of MGF were small, however, all participants reported that undergoing the intervention was worthwhile and beneficial. CONCLUSIONS Self-reported adherence inside the home demonstrated minimal improvement after 4 weeks, however, adherence of ≥ 80% outside the home increased by 27%, with 80% of all participants reporting high adherence at Week 4. Participants rated their learnings from the experience of IPA as beneficial.
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Keukenkamp R, van Netten JJ, Busch-Westbroek TE, Nollet F, Bus SA. Users' needs and expectations and the design of a new custom-made indoor footwear solution for people with diabetes at risk of foot ulceration. Disabil Rehabil 2022; 44:8493-8500. [PMID: 34846977 DOI: 10.1080/09638288.2021.2003878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess users' needs and expectations regarding custom-made indoor footwear, and to design such footwear with similar biomechanical efficacy and better usability compared to regular custom-made footwear in people with diabetes at risk for foot ulceration. MATERIALS AND METHODS Multidisciplinary systematic design approach. Needs and expectations regarding indoor footwear were evaluated via a questionnaire in 50 high foot ulcer risk people with diabetes using custom-made footwear. We systematically designed indoor footwear, and manufactured this for nine participants. Primary requirement was similar plantar pressure compared to participants' regular custom-made footwear. RESULTS Eighty-two percent of participants expressed a need for custom-made indoor footwear and 66% expected such footwear to increase their adherence. The custom-made indoor footwear had the same bottom construction as participants' regular custom-made footwear, but with softer and more light-weight upper materials. Peak pressures were similar or lower, while qualitative evaluation showed better usability and lower costs for indoor footwear. CONCLUSIONS People with diabetes at risk of foot ulceration expressed a clear need for custom-made indoor footwear, and expected such footwear to increase their adherence. Our indoor footwear design provides adequate pressure relief, with better usability, and can be produced at lower costs compared to regular custom-made footwear.Implications for rehabilitationPeople with diabetes at risk of foot ulceration express a need for special indoor footwear.We developed indoor footwear with similar offloading capacity as regular custom-made footwear.The indoor footwear is lighter in weight, easier to don/doff and lower in costs.At-risk people with diabetes expect this footwear to increase their footwear adherence.
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Affiliation(s)
- Renske Keukenkamp
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap J van Netten
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa E Busch-Westbroek
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sicco A Bus
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Racaru S, Bolton Saghdaoui L, Roy Choudhury J, Wells M, Davies AH. Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading. Diabetes Metab Syndr 2022; 16:102493. [PMID: 35468484 DOI: 10.1016/j.dsx.2022.102493] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS To identify measurement methods, proportions of adherent participants, factors affecting adherence, and concordance promoting interventions. METHODS A systematic scoping review was conducted by searching Medline, CINAHL, PubMed, EMBASE, and EMCARE databases. RESULTS Twenty-four trials were identified from 1001 citations. Only 25% of the included studies used objective methods to quantify adherence. The proportion of adherent participants (≥80% of daily steps/time) ranged from 28% to 60%. Psychosocial factors are the most common influencers of adherence. However, interventions for improving compliance are lacking. CONCLUSION There is a need to accurately quantify and optimize adherence to foot offloading in people with diabetes.
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Affiliation(s)
- Simona Racaru
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK; Diabetes Education Centre, 1st Floor, Mint Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| | - Layla Bolton Saghdaoui
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK
| | - Jaya Roy Choudhury
- Section of Vascular Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Mary Wells
- Nursing Directorate, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK
| | - Alun H Davies
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK; Section of Vascular Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
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11
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Menz HB, Bonanno DR. Footwear comfort: a systematic search and narrative synthesis of the literature. J Foot Ankle Res 2021; 14:63. [PMID: 34876192 PMCID: PMC8650278 DOI: 10.1186/s13047-021-00500-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To provide a narrative synthesis of the research literature pertaining to footwear comfort, including definitions, measurement scales, footwear design features, and physiological and psychological factors. METHODS A systematic search was conducted which yielded 101 manuscripts. The most relevant manuscripts were selected based on the predetermined subheadings of the review (definitions, measurement scales, footwear design features, and physiological and psychological factors). A narrative synthesis of the findings of the included studies was undertaken. RESULTS The available evidence is highly fragmented and incorporates a wide range of study designs, participants, and assessment approaches, making it challenging to draw strong conclusions or implications for clinical practice. However, it can be broadly concluded that (i) simple visual analog scales may provide a reliable overall assessment of comfort, (ii) well-fitted, lightweight shoes with soft midsoles and curved rocker-soles are generally perceived to be most comfortable, and (iii) the influence of sole flexibility, shoe microclimate and insoles is less clear and likely to be more specific to the population, setting and task being performed. CONCLUSION Footwear comfort is a complex and multifaceted concept that is influenced not only by structural and functional aspects of shoe design, but also task requirements and anatomical and physiological differences between individuals. Further research is required to delineate the contribution of specific shoe features more clearly, and to better understand the interaction between footwear features and individual physiological attributes.
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Affiliation(s)
- Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Daniel R Bonanno
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
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12
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Jongebloed-Westra M, Bode C, van Netten JJ, Ten Klooster PM, Exterkate SH, Koffijberg H, van Gemert-Pijnen JEWC. Using motivational interviewing combined with digital shoe-fitting to improve adherence to wearing orthopedic shoes in people with diabetes at risk of foot ulceration: study protocol for a cluster-randomized controlled trial. Trials 2021; 22:750. [PMID: 34711263 PMCID: PMC8551942 DOI: 10.1186/s13063-021-05680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background Diabetic foot ulcers have a high impact on mobility and daily functioning and lead to high treatment costs, for example, by hospitalization and amputation. To prevent (re)ulcerations, custom-made orthopedic shoes are considered essential. However, adherence to wearing the orthopedic shoes is low, and improving adherence was not successful in the past. We propose a novel care approach that combines motivational interviewing (MI) with a digital shoe-fitting procedure to improve adherence to orthopedic shoes. The aim of this trial is to assess the (cost-)effectiveness of this novel care approach compared to usual care (no MI and casting-based shoe-fitting) in promoting footwear adherence and ulcer prevention. Methods The trial will include people with diabetes, with IWGDF Risk categories 1–3, who have been prescribed orthopedic shoes. Participants will be randomized at the level of the podiatrist to the novel care approach or usual care. The primary outcome is the proportion of participants who adhere to the use of their orthopedic shoes, that is, who take at least 80% of their total daily steps with orthopedic shoes. A temperature microsensor will be built into the participants’ orthopedic shoes to measure wearing time continuously over 12 months. In addition, daily activity will be measured periodically using log data with an activity monitor. Data from the temperature microsensor and activity monitor will be combined to calculate adherence. (Re-)experienced complications after receiving orthopedic shoes will be registered. Questionnaires and interviews will measure the experiences of participants regarding orthopedic shoes, experiences of podiatrists regarding motivational interviewing, care consumption, and quality of life. Differences in costs and quality of life will be determined in a cost-effectiveness analysis. Discussion This trial will generate novel insights into the socio-economic and well-being impact and the clinical effectiveness of the novel care approach on adherence to wearing orthopedic shoes. Trial registration Netherlands Trial Register NL7710. Registered on 6 May 2019
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Affiliation(s)
- M Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands.
| | - C Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
| | - J J van Netten
- Department of Rehabilitation, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ,, Amsterdam, The Netherlands.,Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, PO Box 7600, 7600 SZ,, Almelo, The Netherlands
| | - P M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
| | - S H Exterkate
- Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK,, Hengelo, The Netherlands.,Voetmax Orthopedie, Sabina Klinkhamerweg 10, 7555 SK,, Hengelo, The Netherlands
| | - H Koffijberg
- Department of Health Technology and Services Research, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
| | - J E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
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13
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Kwak H, Oh H, Cha B, Kim JM. The assessment of usability of pain medical device by physiatrists and physiotherapists: A Delphi survey. Medicine (Baltimore) 2021; 100:e27245. [PMID: 34559126 PMCID: PMC8462558 DOI: 10.1097/md.0000000000027245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/26/2021] [Indexed: 01/05/2023] Open
Abstract
When developing a new medical device, it is essential to assess the usability of such a device through various stakeholders.This study assessed the usability of pain medical devices through a Delphi survey administered to physiatrists and physiotherapists.A Delphi survey was conducted on the problems and improvements in hardware and software for a panel consisting of 10 physiatrists and 10 physiotherapists. A total of 3 rounds of surveys were conducted, and the third round of survey was confirmed through a Likert scale (1 = strongly agree to 5 = strongly disagree).The 2 groups generally had a common perception of the problems and improvements in pain medical devices. However, the physiatrist group mostly identified problems such as linking patient information, whereas the physiotherapist group deemed hardware problems such as device weight or connection cables as being more important (mean [standard deviation]; physiatrist, hardware 2.90 [0.93], software 2.28 [0.91] / physiotherapist, hardware 3.04 [0.84], software 3.03 [1.13]).To date, analysis has not been conducted by dividing the focus of various stakeholders using pain medical devices. The difference in view of the usability of these 2 stakeholder groups should be considered when improving the hardware or software of pain medical devices in the future. Further research is warranted to investigate other stakeholders such as patients and device developers to improve the devices.
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Affiliation(s)
- Hyunseok Kwak
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyunjung Oh
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Byoungwoo Cha
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Rehabilitation and Regeneration Research Center, CHA University, Seongnam, Korea
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14
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Matthias EC, Banwell HA, Arnold JB. Methods for assessing footwear comfort: a systematic review. FOOTWEAR SCIENCE 2021. [DOI: 10.1080/19424280.2021.1961879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elsa C. Matthias
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Helen A. Banwell
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - John B. Arnold
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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15
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Van Netten JJ, Jarl G, Postema K, Williams AE. A toolkit for prosthetists and orthotists to facilitate progress in professional communication over the next 50 years. Prosthet Orthot Int 2020; 44:408-415. [PMID: 33045902 PMCID: PMC7689560 DOI: 10.1177/0309364620962325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In this celebratory issue of Prosthetics and Orthotics International, we review professional communication skills in the field of prosthetics and orthotics. OBJECTIVE We aim to reflect on communication skills in the past 50 years, to discuss developments in the coming 50 years, and to create a toolkit and research agenda to facilitate progress in professional communication in the next 50 years. RESULTS Despite being a key area in prosthetics and orthotics training programmes, we found no studies on professional communication with an experimental design published in Prosthetics and Orthotics International. As an alternative, we provide clinical reflections on the changes in professional communication in the past 50 years, and we discuss questionnaire-based and qualitative studies that provide evidence for the importance of communication in pedorthic footwear provision. In the coming 50 years, professional communication in the field of prosthetics and orthotics may be impacted by aging populations, global mobility, information technology, technological advances and emphasis on prevention. We discuss each of these topics. To facilitate progress in professional communication, we have created a toolkit with resources for prosthetics and orthotics professionals, prosthetics and orthotics students and other interested professionals. CONCLUSIONS We hope this toolkit will inspire others to use, extend and implement it in their daily practice. As a research agenda, we strongly recommend undertaking research on interventions to improve professional communication and to study its effect on clinically meaningful outcomes.
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Affiliation(s)
- Jaap J Van Netten
- Department of Rehabilitation Medicine and Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Jaap J Van Netten, Department of Rehabilitation Medicine and Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Klaas Postema
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Anita E Williams
- Directorate of Allied and Public Health, School of Health and Society, University of Salford, Salford, UK
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16
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Ploeger HE, Bus SA, Brehm MA, Nollet F. Use and usability of custom-made dorsiflexion-restricting ankle-foot orthoses for calf muscle weakness in polio survivors: a cross-sectional survey. Eur J Phys Rehabil Med 2020; 56:575-584. [DOI: 10.23736/s1973-9087.20.06020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Jarl G, Tranberg R, Johansson U, Alnemo J, Lundqvist LO. Predictors of adherence to wearing therapeutic footwear among people with diabetes. J Foot Ankle Res 2020; 13:45. [PMID: 32660610 PMCID: PMC7359292 DOI: 10.1186/s13047-020-00413-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Aims People at increased risk of developing diabetic foot ulcers often wear therapeutic footwear less frequently than is desirable. The aims were to identify patient groups prone to nonadherence to wearing therapeutic footwear and modifiable factors associated with adherence. Materials and methods A questionnaire was mailed to 1230 people with diabetes who had been fitted with therapeutic footwear. Independent variables were categorized into five domains. For each domain, variables that were associated with adherence in a univariate regression analysis were entered into a multiple regression analysis. Results A total of 429 (34.9%) questionnaires were analyzed. Multiple regression analyses showed significant associations (p < 0.05) between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear, and a belief that therapeutic footwear promotes ulcer healing. The five multivariate models explained 2–28% of the variance in adherence, with the strategies for footwear use domain explaining the most. Conclusions Patients without paid employment or without foot ulcer experience are more prone to nonadherence. To improve adherence, clinicians should advise patients to store therapeutic footwear in a visible place at home and put conventional footwear away and encourage patients’ self-efficacy and habitual use of therapeutic footwear. Future studies should investigate this topic further and explore ways to promote changes in habits. A study limitation was that all variables were self-reported.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ulf Johansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - John Alnemo
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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18
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Zwaferink JBJ, Custers W, Paardekooper I, Berendsen HA, Bus SA. Optimizing footwear for the diabetic foot: Data-driven custom-made footwear concepts and their effect on pressure relief to prevent diabetic foot ulceration. PLoS One 2020; 15:e0224010. [PMID: 32324739 PMCID: PMC7179916 DOI: 10.1371/journal.pone.0224010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/03/2019] [Indexed: 01/22/2023] Open
Abstract
Aims To assess the effect of data-driven custom-made footwear concepts on plantar pressure relief to prevent diabetic foot ulceration. Methods Twenty-four neuropathic diabetic patients at high risk of foot ulceration were measured for in-shoe plantar pressures during walking in four data-driven custom-made footwear conditions, an athletic shoe and an off-the-shelf non-therapeutic shoe. Two evidence-based footwear conditions (Shoe-A; Insole-A) follow a scientific-based design protocol, are handmade, and use in-shoe plantar pressure guided optimization. One evidence-based insole condition (Insole-B) uses a barefoot plantar pressure and 3D foot shape-based computer-assisted design and manufacturing (CADCAM) routine. And one insole condition (Insole-C) uses a barefoot and in-shoe plantar pressure and 3D foot shape-based CADCAM design and optimization routine. Patient satisfaction was scored on walking comfort, shoe fit, weight and appearance. Results All data-driven footwear conditions significantly reduced metatarsal head peak pressure compared with the non-therapeutic shoe (17–53% relief). Shoe-A and Insole-A showed the lowest metatarsal head peak pressures (mean 112–155 kPa, 90–98% of cases <200 kPa), significantly lower than for Insole-B and Insole-C (mean 119–199 kPa, 52–100% <200 kPa). Patient satisfaction was not significantly different between footwear concepts. Conclusions This study proves the offloading efficacy of a scientific-based, handmade, and in-shoe plantar pressure data-driven approach to custom-made footwear design, and advocates its implementation to optimize diabetic footwear for plantar foot ulcer prevention.
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Affiliation(s)
- Jennefer B. J. Zwaferink
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | | | - Heleen A. Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Sicco A. Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- * E-mail:
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19
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Yalla SV, Crews RT, Patel NA, Cheung T, Wu S. Offloading for the Diabetic Foot: Considerations and Implications. Clin Podiatr Med Surg 2020; 37:371-384. [PMID: 32146989 DOI: 10.1016/j.cpm.2019.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Offloading the diabetic foot remains the major consideration for ulceration prevention and healing. This narrative literature review presents a brief overview of current guidelines for offloading the diabetic foot and discusses the implications that come with offloading treatment modalities and their effects on the kinetic chain of the lower extremity. We also present the latest innovative studies from the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science that advance the knowledge in this field and provide avenues for future research opportunities.
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Affiliation(s)
- Sai V Yalla
- Podiatric Surgery and Applied Biomechanics, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Ryan T Crews
- Podiatric Surgery and Applied Biomechanics, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Niral A Patel
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine & Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Timothy Cheung
- School of Graduate and Postdoctoral Studies, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine & Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Stephanie Wu
- Podiatric Surgery and Applied Biomechanics, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
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20
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van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3270. [PMID: 31957213 DOI: 10.1002/dmrr.3270] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022]
Abstract
Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non-controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot-related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight-bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non-existent for the prevention of a first foot ulcer and non-plantar foot ulcer.
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Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS - Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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21
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Zwaferink JBJ, Hijmans JM, Schrijver CM, Schrijver LK, Postema K, van Netten JJ. Mechanical Noise Improves the Vibration Perception Threshold of the Foot in People With Diabetic Neuropathy. J Diabetes Sci Technol 2020; 14:16-21. [PMID: 30328708 PMCID: PMC7189161 DOI: 10.1177/1932296818804552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mechanical noise may improve somatosensation at the dorsal side of the foot, but the effect at the plantar side of the foot, the side most at risk for foot ulceration, is unknown. Moreover, techniques used in research so far have several problems that limit applicability in daily practice. Piezoelectric actuators may provide mechanical noise with better clinical applicability. We assessed the effects of piezoelectric actuators generating mechanical noise on the vibration perception threshold (VPT) at the plantar side of the foot in people with diabetic neuropathy. METHODS Double-blind within-subjects design in a controlled laboratory setting including participants with diabetic neuropathy (N = 40; 18 male; mean age 69.6 years; mean duration of diabetes 14.1 years; mean BMI 30.5). VPT was measured at three plantar foot locations with and without mechanical noise applied via piezoelectric actuators. RESULTS Mechanical noise improved VPT at metatarsophalangeal joint (MTP) 1 (left 39.3V vs 43.5V; right 39.0 vs 42.6 V), MTP5 (left 37.5V vs 41.7V; right 34.5V vs 40.8V) and the heel (left 40.0V vs 44.0V; right 39.3V vs 41.0V), all P < .001. CONCLUSIONS Mechanical noise improves VPT at the plantar side of the foot in people with diabetic neuropathy. This is an important step for further development of insoles using mechanical noise that may have the potential to improve VPT and decrease the risk of foot ulceration.
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Affiliation(s)
- Jennefer B. J. Zwaferink
- Ziekenhuisgroep Twente, Almelo and
Hengelo, The Netherlands
- Amsterdam UMC, Department of
Rehablitation Medicine, University of Amsterdam, Amsterdam Movement Sciences, The
Netherlands
- Jennefer B. J. Zwaferink, Department of
Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam
Movement Sciences, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - Juha M. Hijmans
- Department of Rehabilitation Medicine,
University of Groningen, University Medical Center Groningen, The Netherlands
| | | | | | - Klaas Postema
- Department of Rehabilitation Medicine,
University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jaap J. van Netten
- Ziekenhuisgroep Twente, Almelo and
Hengelo, The Netherlands
- Amsterdam UMC, Department of
Rehablitation Medicine, University of Amsterdam, Amsterdam Movement Sciences, The
Netherlands
- School of Clinical Sciences, Queensland
University of Technology, Brisbane, Australia
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22
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Kossioris A, Tentolouris N, Loupa CV, Tyllianakis M. The role of amputative and non-amputative foot deformities severity in the risk for diabetic ulceration classification systems building: a cross-sectional and case-control pilot investigation. Pan Afr Med J 2019; 33:103. [PMID: 31489081 PMCID: PMC6711698 DOI: 10.11604/pamj.2019.33.103.17684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/27/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Foot deformities and amputations are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of "foot deformities" and "amputations" in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU. Methods The objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature's established risk factors was performed, as well as for two versions of the "amputative and non-amputative foot deformities severity" variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out. Results From the MLRA, only PAD (peripheral arterial disease) was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories amputative and non-amputative foot deformities severity variable, had the greatest area under the ROC curve (0.763, P<0.001). Conclusion A united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.
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Affiliation(s)
- Aristomenis Kossioris
- Department of Neurology, General Hospital of Athens "G. Gennimatas"; School of Medicine, University of Patras, Rio, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Chariclia V Loupa
- "Demetrios Voyatzoglou" Diabetic Foot Clinic, "A. Fleming" General Hospital, Athens, Greece
| | - Minos Tyllianakis
- Department of Orthopaedics, School of Medicine, University of Patras, Rio, Greece
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23
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Jorgetto JV, Gamba MA, Kusahara DM. Evaluation of the use of therapeutic footwear in people with diabetes mellitus - a scoping review. J Diabetes Metab Disord 2019; 18:613-624. [PMID: 31890687 DOI: 10.1007/s40200-019-00428-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Foot ulcers are one of the major complications of Diabetes Mellitus and are associated with increasing rates of morbidity and mortality. It is estimated that 2% of diabetic patients present lesions in the feet, with relapse rates between 30% and 40% in the first year after healing of the first ulcerations. Therapeutic footwear is one of the main strategies to prevent foot ulceration. OBJECTIVES To identify in the literature aspects related to the recommendation of health professionals and the use of therapeutic footwear by patients with Diabetes Mellitus. MATERIALS AND METHODS Scoping review of literature in the Scopus, Scielo, Pubmed and Cochrane databases, using diabetic foot crosswords and therapeutic footwear. RESULTS Twenty-six articles were included in this review. The majority was systematic reviews (46.15%) with published date from 2016 (38.5%). Of the 26 articles included, 10 (38.5%) referred to adherence to the use of footwear, 10 (38.5%) the difficulty to evaluate the effectiveness of the intervention and 6 (23.0%) to changes in the balance and biomechanics patterns In the studies, the use of therapeutic footwear is linked to the reduction of the risk of ulceration or its recurrence in people with diabetes who already have diabetic neuropathy as chronic complication of the disease. CONCLUSIONS Therapeutic footwear for diabetics was able to produce significant reductions of peak plantar pressure in static and dynamic analysis, being more efficient than a common footwear, and could contribute to the prevention of injuries associated with diabetic foot.
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Affiliation(s)
- Juliana Vallim Jorgetto
- 1Department of Public Health in the Collective Dimension, Paulista School of Nursing, Federal University of São Paulo - UNIFESP, Octávio Parreira Street, 100, Jardim das Paineiras, CEP: 13, São João da Boa Vista-SP, 874-720 Brazil
| | - Mônica Antar Gamba
- 2Department of Administration Applied to Nursing and Collective Health, School of Nursing, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Denise Miyuki Kusahara
- 3Department of Pediatric Nursing of the Paulista School of Nursing, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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24
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van Netten JJ, Seng L, Lazzarini PA, Warnock J, Ploderer B. Reasons for (non-)adherence to self-care in people with a diabetic foot ulcer. Wound Repair Regen 2019; 27:530-539. [PMID: 31107578 DOI: 10.1111/wrr.12728] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
Abstract
We aimed to explore reasons for (non-)adherence to self-care among people with diabetic foot ulcers, as well as barriers and solutions to improving their self-care adherence. We performed a qualitative study, recruiting people with a diabetic foot ulcer from a community diabetic foot clinic. Semistructured interviews were held with participants. Data saturation occurred after 9 and was confirmed after 11 participant interviews. Interviews were audio-taped, transcribed verbatim and analyzed using the framework approach. Findings were mapped and the World Health Organization's (WHO) adherence dimensions were applied to themes identified. The key themes identified were (1) participants performed recommended practices in self-care; (2) participants relied heavily on care support; (3) motivations for self-care came from "staying well"; and (4) there was a disparity between self-care knowledge and understanding. Barriers identified included poor mobility and visibility, difficulty wearing offloading devices or using wound dressings, and frustration with lack of progress. Solutions to improve adherence included integrating self-care as routine, improved education, more external help and improving visibility. All five WHO adherence dimensions played a role in (non-)adherence to diabetic foot ulcer self-care. We conclude that adherence to recommended diabetic foot ulcer self-care was limited at best, and reasons for nonadherence were multidimensional. Based on the factors related to (non-)adherence and the barriers and solutions described, we suggest clinicians obtain a broad view of a person's situation when aiming to improve self-care adherence.
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Affiliation(s)
- Jaap J van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Leonard Seng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Australia
| | - Jason Warnock
- Podiatry Service, Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Australia
| | - Bernd Ploderer
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, Australia
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25
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Tan S, Horobin H, Tunprasert T. The lived experience of people with diabetes using off-the-shelf prescription footwear in Singapore: a qualitative study using interpretative phenomenological analysis. J Foot Ankle Res 2019; 12:19. [PMID: 30949242 PMCID: PMC6429698 DOI: 10.1186/s13047-019-0329-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/06/2019] [Indexed: 12/30/2022] Open
Abstract
Background Diabetic foot ulceration (DFUs) is increasingly prevalent in Singapore. Appropriate management is important since DFU brings with it an associated risk for lower limb amputations, high morbidity rates and costs. Footwear prescription has been a part of clinical guidelines to manage DFUs. However, adherence to prescription footwear is typically poor amongst patients. Reasons for this have been explored in Northern American and Western European studies, but not in Singapore’s context. As cultural and climate differences limit transferability of findings from existing studies to individuals in Singapore, this study aims to explore the lived experiences of participants with diabetes using prescription footwear in Singapore. Methods This was a qualitative study using interpretative phenomenological analysis (IPA) to understand some people’s personal experience of using off the shelf prescription footwear. A total of 8 people with diabetes who received prescription footwear as part of their diabetic foot management were recruited. All participants provided written consent and took part in a semi-structured interview lasting up to an hour. Interviews were digitally recorded, transcribed and analysed using an IPA approach. Findings and discussion The analysis identified the super-ordinate themes of 1) security and 2) acceptance with sub-themes of 1.1) risk and 1.2) protection and 2.1) personal and social acceptance and 2.2) social and cultural acceptance respectively that inter-related to influence how participants’ made footwear decisions. This process of evaluation was portrayed to be a fluctuant one, making it difficult to predict yet necessary to understand. A modified seesaw model of adherence is suggested to explain this decision-making process. Conclusions The complex manner by which participants grappled with security and acceptance is often overlooked when footwear is prescribed, highlighting a need for a more collaborative clinician-patient partnership for these issues to surface in clinical practice. Furthermore, prescription footwear should be seen more holistically. Empowering patients with choice to select from a range of therapeutic yet normalised footwear could increase the level of security and acceptance they experience with its use.
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Affiliation(s)
- Sheena Tan
- 1Podiatry Department, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Hazel Horobin
- 2University of Brighton, School of Health Professions, 49 Darley Road, Eastbourne, BN20 7UR UK
| | - Thanaporn Tunprasert
- 3University of Brighton, School of Health Professions, 49 Darley Road, Eastbourne, BN20 7UR UK
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26
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Jarl G, Alnemo J, Tranberg R, Lundqvist LO. Gender differences in attitudes and attributes of people using therapeutic shoes for diabetic foot complications. J Foot Ankle Res 2019; 12:21. [PMID: 30976327 PMCID: PMC6440011 DOI: 10.1186/s13047-019-0327-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/04/2019] [Indexed: 01/22/2023] Open
Abstract
Background Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications. Methods A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women’s and men’s answers were compared using t-tests, Mann–Whitney U tests and chi-square tests with Fischer’s exact tests. P-values < 0.05 were considered statistically significant. Results Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women (p < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes’ efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support. Conclusions Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients’ concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.
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Affiliation(s)
- Gustav Jarl
- 1Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden.,2University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
| | - John Alnemo
- 3Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roy Tranberg
- 4Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lars-Olov Lundqvist
- 2University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
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27
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Binning J, Woodburn J, Bus SA, Barn R. Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration. Diabetes Metab Res Rev 2019; 35:e3105. [PMID: 30513132 DOI: 10.1002/dmrr.3105] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 11/06/2022]
Abstract
Diabetic foot ulceration is a major complication associated with high morbidity. Little evidence exists on which interventions are effective at preventing ulceration. Participants who are adherent to self-care behaviours have significantly better outcomes. Motivational interviewing is an intervention that has been used successfully for conditions where adherence is important, such as reduction of obesity and HbA1c levels. A systematic review was conducted to determine whether motivational interviewing is effective at improving adherence for the prevention of Diabetic Foot Ulceration. Electronic searches were run without date or language restrictions in MEDLINE (viaEBSCOhost), CINAHL (viaEBSCOhost), ProQuest (Health and Medical Collection, Nursing and Allied Health Database, PsycINFO, Psychology, PsychArticles), AMED, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, and Web of Science Core Collections. Papers were included if participants had or were at risk of diabetic foot ulceration. Studies required motivational interviewing or a motivational approach as the sole intervention or as a component. Randomised controlled trials and quasi-experimental studies were included if ulceration and/or at least one behavioural outcome was measured before and after the intervention. Five studies met the inclusion criteria. Heterogeneity prevented the pooling of data. One study used motivational interviewing as the sole intervention. This study found a short-term positive effect on footwear adherence. The remaining four studies had a motivational component within their interventions. Two of these studies showed the intervention to be effective but both were at a high risk of bias. This review demonstrates an evidence gap. More research is needed.
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Affiliation(s)
- Jodi Binning
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jim Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sicco A Bus
- Department of Rehabilitation, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, The Netherlands
| | - Ruth Barn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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28
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Jarl G. Methodological considerations of investigating adherence to using offloading devices among people with diabetes. Patient Prefer Adherence 2018; 12:1767-1775. [PMID: 30254428 PMCID: PMC6143128 DOI: 10.2147/ppa.s175738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Foot ulcers are a diabetic complication associated with significant morbidity, mortality, and amputation risk. Offloading devices prevent and heal foot ulcers, but adherence to using these devices is low. The reasons for nonadherence are unclear, and study results are difficult to compare due to methodological heterogeneity. This paper explores aspects of investigating adherence to using offloading devices among people with diabetes and provides recommendations for future studies, focusing on study designs, definitions of adherence, measurement methods, and conceptual frameworks. Most studies use a cross-sectional observational study design, limiting the potential to establish the temporal sequence between predictors and adherence, rule out confounding factors, and establish causality. Studies defining adherence as the length of time the device is worn have often used self-report to measure adherence, which may be unreliable. Studies using activity monitors to measure adherence have defined adherence as the number of steps taken with the device, which excludes weight-bearing activities where no steps are taken. Conceptual frameworks are not made explicit in the current quantitative research. It is concluded that future studies should use a longitudinal design with observational studies to identify patient groups prone to nonadherence and factors that influence adherence and experimental studies to evaluate interventions to improve adherence, focusing on these patient groups and factors. Furthermore, adherence should be defined in terms of relative adherence to using offloading devices during all weight-bearing activities, and objective measurement of adherence (using accelerometers and temperature monitors) should be used whenever possible. Clearly defined conceptual frameworks should guide the choice of factors to include in the study and the analysis of their interactions. By implementing these recommendations, research could provide a stronger evidence base in the future, supporting interventions to increase adherence and thereby improve outcomes for people with diabetic foot complications.
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Affiliation(s)
- Gustav Jarl
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,
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29
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Jadali F, Nemati H, Jadali P, Jadali P. Comparison of Diabetic Foot Care with Other Diabetic Preventive Care Services. J Am Podiatr Med Assoc 2018; 108:362-369. [PMID: 29320218 DOI: 10.7547/17-081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetes is a major chronic disease with high morbidity and mortality. Diabetic preventive care services are essential in the management and outcome of the disease. More than other preventive diabetic care services, preventive care of diabetic retinopathy has been emphasized and recommended by practitioners and insurance companies. We investigated the status of preventive care in the diabetic population. METHODS Information was collected from 420 outpatients aged 30 to 80 years. The patients were divided into two groups: those with well-controlled blood sugar levels (hemoglobin A1c [HbA1c] level ≤7%) and those with uncontrolled blood sugar levels (HbA1c level >7%). RESULTS Data analysis indicated that for both groups, 93% of the participants were seen for diabetic eye care at least once and 78% were getting an annual eye examination regularly. In the controlled and uncontrolled blood sugar groups, 26% and 32% of patients, respectively, had ever seen a nephrologist and 38% and 49%, respectively, had ever seen a cardiologist. In the controlled and uncontrolled blood sugar groups, 32% and 38% of patients, respectively, had visited a podiatric physician. For statistical analysis and comparison of results between the two groups, we applied the χ2 test and calculated 95% confidence intervals. There were some significant differences regarding the complications of diabetes mellitus and preventive care. CONCLUSIONS There is a need for greater engagement by podiatric physicians and health-care providers to promote regular visits for the diabetic population to podiatric medical clinics.
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30
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Crews RT, Candela J. Decreasing an Offloading Device's Size and Offsetting Its Imposed Limb-Length Discrepancy Lead to Improved Comfort and Gait. Diabetes Care 2018; 41:1400-1405. [PMID: 29666111 PMCID: PMC6014548 DOI: 10.2337/dc17-2584] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patient adherence is a challenge in offloading diabetic foot ulcers (DFUs) with removable cast walkers (RCWs). The size and weight of an RCW, changes to gait, and imposed limb-length discrepancies may all discourage adherence. This study sought to determine whether RCW size and provision of a contralateral limb lift affected users' comfort and gait. RESEARCH DESIGN AND METHODS Twenty-five individuals at risk for DFUs completed several 20-m walking trials under five footwear conditions: bilateral standardized shoes, a knee-high RCW with shoe with or without an external shoe lift contralaterally, and an ankle-high RCW with shoe with or without an external shoe lift contralaterally. Perceived comfort ratings were assessed through the use of visual analog scales. Spatial and temporal parameters of gait were captured by an instrumented walkway, and plantar pressure was measured and recorded using pedobarographic insoles. RESULTS The bilateral shoes condition was reported to be most comfortable; both RCW conditions without the lift were significantly less comfortable (P < 0.01). In contrast to the ankle-high RCW, the knee-high RCW resulted in significantly slower walking (5.6%; P < 0.01) but greater offloading in multiple forefoot regions of the offloaded foot (6.8-8.1%; P < 0.01). Use of the contralateral shoe lift resulted in significantly less variability in walking velocity (52.8%; P < 0.01) and reduced stance time for the offloaded foot (2.6%; P = 0.01), but it also reduced offloading in multiple forefoot regions of the offloaded foot (3.7-6.0%; P < 0.01). CONCLUSIONS Improved comfort and gait were associated with the ankle-high RCW and contralateral limb lift. Providing this combination to patients with active DFUs may increase offloading adherence and subsequently improve healing.
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Affiliation(s)
- Ryan T Crews
- Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University, Chicago, IL
| | - Joseph Candela
- Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University, Chicago, IL
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31
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Keukenkamp R, Merkx MJ, Busch-Westbroek TE, Bus SA. An Explorative Study on the Efficacy and Feasibility of the Use of Motivational Interviewing to Improve Footwear Adherence in Persons with Diabetes at High Risk for Foot Ulceration. J Am Podiatr Med Assoc 2018; 108:90-99. [PMID: 29111785 DOI: 10.7547/16-171] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear. METHODS Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie, <80% of steps taken in prescription footwear) were randomly assigned to standard education (ie, verbal and written instructions) or to standard education plus two 45-min sessions of motivational interviewing. Adherence was objectively measured over 7 days using ankle- and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability. RESULTS Median (range) baseline, 1-week, and 3-month adherence at home was 49% (6%-63%), 84% (5%-98%), and 40% (4%-80%), respectively, in the motivational interviewing group and 35% (13%-64%), 33% (15%-55%), and 31% (3%-66%), respectively, in the standard education group. Baseline, 1-week, and 3-month adherence away from home was 91% (79%-100%), 97% (62%-99%) and 92% (86%-98%), respectively, in the motivational interviewing group and 78% (32%-97%), 91% (28%-98%), and 93% (57%-100%), respectively, in the standard education group. None of the differences were statistically significant. Interviewer proficiency was good, and the protocol could be successfully executed in the given time frame. CONCLUSIONS Footwear adherence at home increases 1 week after motivational interviewing to clinically relevant but not statistically significant levels (ie, 80%) but then returns over time to baseline levels. Away from home, adherence is already sufficient at baseline and remains so over time. The use of motivational interviewing seems feasible for the given purpose and patient group. These findings provide input to larger trials and provisionally suggest that additional or adjunctive therapy may be needed to better preserve adherence.
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Affiliation(s)
- Renske Keukenkamp
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten J. Merkx
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; HSK Group B.V., Arnhem, The Netherlands
| | - Tessa E. Busch-Westbroek
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sicco A. Bus
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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32
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Crews R, King A, Yalla S, Rosenblatt N. Recent Advances and Future Opportunities to Address Challenges in Offloading Diabetic Feet: A Mini-Review. Gerontology 2018; 64:309-317. [DOI: 10.1159/000486392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
Diabetic foot ulcers (DFU) are a substantial dilemma for geriatric individuals with diabetes. The breakdown in tissue associated with DFU is typically a result of repetitive cycles of physical stress placed on the feet during weight-bearing activity. Accordingly, a key tenet in healing as well as preventing DFU is the use of offloading footwear to redistribute physical stress away from high stress locations such as bony prominences. Over the last several years there has been a substantial amount of effort directed at better understanding and implementing the practice of offloading. A review of this work as well as relevant technological advances is presented in this paper. Specifically, we will discuss the following topics in association with offloading diabetic feet: achieving optimal offloading, dosing activity/physical stress, thermal monitoring to detect preulcerative tissue damage, adherence with offloading devices, and optimizing the user experience. In addition to presenting progress to date, potential directions for further advancement are discussed.
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van Netten JJ, Lazzarini PA, Armstrong DG, Bus SA, Fitridge R, Harding K, Kinnear E, Malone M, Menz HB, Perrin BM, Postema K, Prentice J, Schott KH, Wraight PR. Diabetic Foot Australia guideline on footwear for people with diabetes. J Foot Ankle Res 2018; 11:2. [PMID: 29371890 PMCID: PMC5769299 DOI: 10.1186/s13047-017-0244-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes. Methods We reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations. Result We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate- or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers. Conclusions This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.
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Affiliation(s)
- Jaap J van Netten
- 1School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia
| | - Peter A Lazzarini
- 1School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD Australia
| | - David G Armstrong
- 5Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ USA
| | - Sicco A Bus
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Robert Fitridge
- Diabetic Foot Australia, Brisbane, QLD Australia.,7Vascular Surgery, The University of Adelaide, Adelaide, South Australia Australia
| | - Keith Harding
- 8University Dean of Clinical Innovation, Professor of Wound Healing Research, Cardiff University, Cardiff, UK
| | - Ewan Kinnear
- Diabetic Foot Australia, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD Australia
| | - Matthew Malone
- Diabetic Foot Australia, Brisbane, QLD Australia.,9High Risk Foot Service, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW Australia
| | - Hylton B Menz
- 10Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC Australia
| | - Byron M Perrin
- Diabetic Foot Australia, Brisbane, QLD Australia.,11La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC Australia
| | - Klaas Postema
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jenny Prentice
- Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Consultant, Trojan Health, Perth, WA Australia
| | - Karl-Heinz Schott
- 14School of Health and Human Sciences (Pedorthics) Southern Cross University Gold Coast Campus, Bilinga, QLD Australia
| | - Paul R Wraight
- Diabetic Foot Australia, Brisbane, QLD Australia.,15Diabetic Foot Unit, Royal Melbourne Hospital, Melbourne, VIC Australia
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Vileikyte L, Crews RT, Reeves ND. Psychological and Biomechanical Aspects of Patient Adaptation to Diabetic Neuropathy and Foot Ulceration. Curr Diab Rep 2017; 17:109. [PMID: 28942488 DOI: 10.1007/s11892-017-0945-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to elucidate how psychological and biomechanical factors interrelate in shaping patients' experience with diabetic symmetric polyneuropathy (DSPN) and its sequela-diabetic foot ulceration (DFU). RECENT FINDINGS Recent findings emphasize the importance not only of neuropathic pain but also of other DSPN symptoms, such as unsteadiness. We highlight the negative spiral between unsteadiness, falls, and psychological distress. Moreover, unsteadiness is a key determinant of non-adherence to offloading resulting in the delayed DFU healing. While depression is an established predictor of incident DFU, findings linking depression and DFU healing remain inconclusive. Examination of physical activity in DFU development and healing represents the most recent application of research to this field. Research evidence indicates that DSPN markedly impairs physical and emotional functioning and suggests that there is an unmet need for the development of multifaceted interventions that address both psychological distress and biomechanical challenges experienced by patients with this debilitating complication of diabetes.
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Affiliation(s)
- Loretta Vileikyte
- Department of Medicine, University of Manchester, Manchester, M13 9WL, UK.
| | - Ryan T Crews
- William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA
| | - Neil D Reeves
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK
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Holtkamp F, Verkerk M, van Hoof J, Wouters E. Mapping user activities and user environments during the client intake and examination phase: An exploratory study from the perspective of ankle foot orthosis users. ACTA ACUST UNITED AC 2017. [DOI: 10.3233/tad-160452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F.C. Holtkamp
- Institute of Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - M.J. Verkerk
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Arts and Social Sciences, Maastricht University, Maastricht, The Netherlands
| | - J. van Hoof
- Institute of Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - E.J.M. Wouters
- Institute of Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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Crews RT, Schneider KL, Yalla SV, Reeves ND, Vileikyte L. Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes Metab Res Rev 2016; 32:791-804. [PMID: 27155091 PMCID: PMC5466070 DOI: 10.1002/dmrr.2817] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/24/2016] [Accepted: 04/21/2016] [Indexed: 02/06/2023]
Abstract
Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers. While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ryan T Crews
- Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
| | - Kristin L Schneider
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Sai V Yalla
- Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Neil D Reeves
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Crews RT, Shen BJ, Campbell L, Lamont PJ, Boulton AJM, Peyrot M, Kirsner RS, Vileikyte L. Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation. Diabetes Care 2016; 39:1371-7. [PMID: 27271185 PMCID: PMC4955934 DOI: 10.2337/dc15-2373] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/09/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Studies indicate that off-loading adherence is low in patients with diabetic foot ulcers (DFUs), which may subsequently delay healing. However, there is little empirical evidence for this relationship or the factors that influence adherence. RESEARCH DESIGN AND METHODS This prospective, multicenter, international study of 79 (46 from the U.K. and 33 the U.S.) persons with type 2 diabetes and plantar DFUs assessed the association between off-loading adherence and DFU healing over a 6-week period. Additionally, potential demographic, disease, and psychological determinants of adherence were examined. DFUs were off-loaded with a removable device (77% a removable cast walker). Off-loading adherence was assessed objectively by activity monitors. Patient-reported measures included Hospital Anxiety and Depression Scale (HADS), Neuropathy and Foot Ulcer Quality of Life (NeuroQoL) instrument, and Revised Illness Perception Questionnaire (IPQ-R). RESULTS Off-loading adherence was monitored for 35 ± 10 days, and devices were used during 59 ± 22% of subjects' activity. In multivariate analyses, smaller baseline DFU size, U.K. study site, and better off-loading adherence predicted smaller DFU size at 6 weeks (P < 0.05). Better off-loading adherence was, in turn, predicted by larger and more severe baseline DFUs, more severe neuropathy, and NeuroQoL foot pain (P < 0.05). In contrast, greater NeuroQoL postural instability predicted worse off-loading adherence (P < 0.001). HADS and IPQ-R measures were not significantly associated with off-loading adherence. CONCLUSIONS Off-loading adherence is associated with the amount of DFU healing that occurs, while postural instability is a powerful predictor of nonadherence. Clinicians should take this neuropathic symptom into consideration when selecting an off-loading device, as off-loading-induced postural instability may further contribute to nonadherence.
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Affiliation(s)
- Ryan T Crews
- Center for Lower Extremity Ambulatory Research at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University, Chicago, IL
| | - Biing-Jiun Shen
- Division of Psychology, Nanyang Technological University, Singapore
| | - Laura Campbell
- The Healing Foundation Centre, Faculty of Life Sciences, University of Manchester, Manchester, U.K
| | - Peter J Lamont
- Department of Medicine, University of Manchester, Manchester, U.K
| | | | | | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL
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Bettoni E, Ferriero G, Bakhsh H, Bravini E, Massazza G, Franchignoni F. A systematic review of questionnaires to assess patient satisfaction with limb orthoses. Prosthet Orthot Int 2016; 40:158-69. [PMID: 25428901 DOI: 10.1177/0309364614556836] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assessment of patient satisfaction with orthosis is a key point for clinical practice and research, requiring questionnaires with robust psychometric properties. OBJECTIVES To identify which validated questionnaires are used to investigate patient satisfaction with orthosis in limb orthotics and to analyse (1) their main fields of clinical application, (2) the orthosis-related features analysed by the questionnaires and (3) the strength of their psychometric properties. STUDY DESIGN Systematic review. METHODS A literature search using MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases for original articles published within the last 20 years was performed. RESULTS A total of 106 papers pertaining to various clinical fields were selected. The main features of patient satisfaction with orthosis analysed were as follows: aesthetic, ease in donning and doffing the device, time of orthotic use and comfort. CONCLUSION Of the questionnaires used to investigate patient satisfaction with orthosis, only four are adequately validated for this purpose: two for generic orthotic use (Quebec User Evaluation of Satisfaction with assistive Technology 2.0 and Client Satisfaction with Device of Orthotics and Prosthetic Users' Survey) and two for specific application with orthopaedic shoes (Questionnaire for the Usability Evaluation of orthopaedic shoes and Monitor Orthopaedic Shoes). Further development, refinement and validation of outcome measures in this field are warranted. CLINICAL RELEVANCE Given the importance of analysing patient satisfaction with orthosis (PSwO), appropriate instruments to assess outcome are needed. This article reviews the currently available instruments and reflects on how future studies could be focused on the development, refinement and validation of outcome measures in this field.
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Affiliation(s)
| | - Giorgio Ferriero
- Scientific Institute of Veruno, Fondazione Salvatore Maugeri, Veruno, Italy
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Bus SA, van Netten JJ. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable. Diabetes Metab Res Rev 2016; 32 Suppl 1:195-200. [PMID: 26452160 DOI: 10.1002/dmrr.2738] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/20/2015] [Accepted: 09/20/2015] [Indexed: 12/20/2022]
Abstract
Diabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on healing. In this article, we argue that a shift in priorities is needed. For the prevention of a first foot ulcer, we need more insight into the effect of interventions and practices already applied globally in many settings. This requires systematic recording of interventions and outcomes, and well-designed randomized controlled trials that include analysis of cost-effectiveness. After healing of a foot ulcer, the risk of recurrence is high. For the prevention of a recurrent foot ulcer, home monitoring of foot temperature, pressure-relieving therapeutic footwear, and certain surgical interventions prove to be effective. The median effect size found in a total of 23 studies on these interventions is large, over 60%, and further increases when patients are adherent to treatment. These interventions should be investigated for efficacy as a state-of-the-art integrated foot care approach, where attempts are made to assure treatment adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art integrated foot care is implemented, the majority of problems with foot ulcer recurrence in diabetes can be resolved. It is therefore time to act and to set a new target in diabetic foot care. This target is to reduce foot ulcer incidence with at least 75%.
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Affiliation(s)
- Sicco A Bus
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Jaap J van Netten
- Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
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Bus SA, van Deursen RW, Armstrong DG, Lewis JEA, Caravaggi CF, Cavanagh PR. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 Suppl 1:99-118. [PMID: 26342178 DOI: 10.1002/dmrr.2702] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment. METHODS We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006. RESULTS We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches. CONCLUSIONS Sufficient evidence of good quality supports the use of non-removable offloading to heal plantar neuropathic forefoot ulcers and therapeutic footwear with demonstrated pressure relief that is worn by the patient to prevent plantar foot ulcer recurrence. The evidence base to support the use of other offloading interventions is still limited and of variable quality. The evidence for the use of interventions to prevent a first foot ulcer or heal ischemic, infected, non-plantar, or proximal foot ulcers is practically non-existent. High-quality controlled studies are needed in these areas.
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Affiliation(s)
- S A Bus
- Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R W van Deursen
- School of Health Care Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - D G Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, Arizona, USA
| | - J E A Lewis
- Cardiff and Vale University Health Board and Cardiff School of Health Science, Cardiff Metropolitan University, Cardiff, UK
| | - C F Caravaggi
- University Vita Salute San Raffaele and Diabetic Foot Clinic, Istituto Clinico Città, Studi, Milan, Italy
| | - P R Cavanagh
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Centre, Seattle, WA, USA
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Jarl G, Lundqvist LO. Adherence to wearing therapeutic shoes among people with diabetes: a systematic review and reflections. Patient Prefer Adherence 2016; 10:1521-8. [PMID: 27540284 PMCID: PMC4982499 DOI: 10.2147/ppa.s112275] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Therapeutic shoes are prescribed to prevent diabetic foot ulcers, but adherence to wearing the shoes is often poor. AIM The aim of this study was to review the literature on factors that are associated with adherence to wearing therapeutic shoes and construct a model of adherence to aid future research and development in the field. METHODS We conducted a systematic search in PubMed, CINAHL, and PsycINFO for quantitative studies on factors associated with adherence to wearing therapeutic shoes among people with diabetes. RESULTS Six studies were included in the review. The studies focused mainly on patient-, therapy-, and condition-related adherence factors. There is some evidence (three to five studies) that sex, diabetes duration, and ulcer history are not associated with adherence. The evidence for or against the other factors was weak (only one or two studies) or conflicting. CONCLUSION There is no conclusive evidence for using any factor to predict adherence to wearing therapeutic shoes, but there is some evidence against using certain factors for predicting adherence. Future studies should include a broader range of factors, including health system and social/economic factors, and they should investigate perceived costs and benefits of wearing therapeutic shoes in comparison with other shoes or no shoes. A seesaw model is presented illustrating the complex phenomenon of adherence. Further research is needed to identify factors associated with adherence to wearing therapeutic shoes, to enable the development of interventions to improve adherence and thereby reduce ulceration rates among people with diabetic foot complications.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Correspondence: Gustav Jarl, Department of Prosthetics and Orthotics, University Hospital Örebro, S-701 85 Örebro, Sweden, Tel +46 19 602 5875, Fax +46 19 12 2010, Email
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Bus SA, Armstrong DG, van Deursen RW, Lewis JEA, Caravaggi CF, Cavanagh PR. IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev 2016; 32 Suppl 1:25-36. [PMID: 26813614 DOI: 10.1002/dmrr.2697] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S A Bus
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D G Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - R W van Deursen
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - J E A Lewis
- Cardiff and Vale University Health Board and Cardiff School of Health Science, Cardiff Metropolitan University, Cardiff, UK
| | - C F Caravaggi
- Vita-Salute San Raffaele University, Milan, Italy
- Diabetic Foot Clinic, Istituto Clinico Città Studi, Milan, Italy
| | - P R Cavanagh
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
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Demina AG, Bregovskiy VB, Karpova IA. The use of orthopaedic shoes in patients with diabetes at high risk of foot amputation and Charcot arthropathy. DIABETES MELLITUS 2015. [DOI: 10.14341/dm7186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aim. To evaluate the use of orthopaedic shoes in patients with diabetes with foot ulcers and/or previous minor amputations or Charcot arthropathy (CA) and factors influencing this use.Patients and methods. One hundred twenty-one patients with diabetes (55 men and 66 women; 36 in the inactive stage of CA) were included. A questionnaire based on footwear was used to evaluate patients’ compliance. Daily activity and the severity of the foot deformities were recorded. Further, foot geometry and forefoot and midfoot circumferences were measured.Results. Fifty-eight patients did not use orthopaedic shoes. Users and non-users did not differ in terms of gender and type of diabetes. The causes of refusal included ill-fitting shoes (56%), ugly appearance (11%), traumatisation with shoes (11%), inability to walk (5%) and other causes (17%). The percentages of patients in each category of deformity severity were mild (41.2%), moderate (37%) and severe (54%. Frequency of refusal of CA vs non-CA patients: 72.2% and 43.5%; with severe deformities,70.8% vs 34%; with moderate deformities, 83.3% vs 57.2% (p 0.05 for all). In patients with CA, the only significant parameter was the difference in the circumference of the midfoot between the affected and non-affected foot; in CA users and non-users, this parameter was 1.93 ± 1.25 vs 0.70 ± 0.83 cm, respectively (р = 0.01).Conclusions. The high frequency of refusing to wear orthopaedic shoes is related to severe foot deformities and the inability to accommodate them in off-the-shelf footwear. Most of the patients used orthopaedic shoes for outdoor use, but the frequency of use was low. Shoe compliance did not depend on gender but increased with ageing, low levels of daily activity and in patients with severe deformities. Patients with CA are characterised with extremely low compliance. In this group, foot parameters and other objective parameters did not rely on footwear compliance.
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