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Mohsin F, Javaid S, Tariq M, Mustafa M. Molecular immunological mechanisms of impaired wound healing in diabetic foot ulcers (DFU), current therapeutic strategies and future directions. Int Immunopharmacol 2024; 139:112713. [PMID: 39047451 DOI: 10.1016/j.intimp.2024.112713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/02/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
Diabetic foot ulcer (DFU) is a foremost cause of amputation in diabetic patients. Consequences of DFU include infections, decline in limb function, hospitalization, amputation, and in severe cases, death. Immune cells including macrophages, regulatory T cells, fibroblasts and other damage repair cells work in sync for effective healing and in establishment of a healthy skin barrier post-injury. Immune dysregulation during the healing of wounds can result in wound chronicity. Hyperglycemic conditions in diabetic patients influence the pathophysiology of wounds by disrupting the immune system as well as promoting neuropathy and ischemic conditions, making them difficult to heal. Chronic wound microenvironment is characterized by increased expression of matrix metalloproteinases, reactive oxygen species as well as pro-inflammatory cytokines, resulting in persistent inflammation and delayed healing. Novel treatment modalities including growth factor therapies, nano formulations, microRNA based treatments and skin grafting approaches have significantly augmented treatment efficiency, demonstrating creditable efficacy in clinical practices. Advancements in local treatments as well as invasive methodologies, for instance formulated wound dressings, stem cell applications and immunomodulatory therapies have been successful in targeting the complex pathophysiology of chronic wounds. This review focuses on elucidating the intricacies of emerging physical and non-physical therapeutic interventions, delving into the realm of advanced wound care and comprehensively summarizing efficacy of evidence-based therapies for DFU currently available.
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Affiliation(s)
- Fatima Mohsin
- KAM School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan.
| | - Sheza Javaid
- KAM School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan.
| | - Mishal Tariq
- KAM School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan.
| | - Muhammad Mustafa
- KAM School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan.
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Ng GW, Gan KF, Liew H, Ge L, Ang G, Molina J, Sun Y, Prakash PS, Harish KB, Lo ZJ. A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies. INT J LOW EXTR WOUND 2024:15347346241233962. [PMID: 38377963 DOI: 10.1177/15347346241233962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies. METHODS Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies. RESULTS Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts. CONCLUSION Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.
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Affiliation(s)
- Gwyneth Wy Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith F Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lixia Ge
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Gary Ang
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Joseph Molina
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Yan Sun
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Prajwala S Prakash
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Zhiwen Joseph Lo
- Department of Surgery, Woodlands Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Dragoi II, Popescu FG, Bowling FL, Bondor CI, Ionac M. Patients' Buying Behavior for Non-Reimbursed Off-Loading Devices Used in Diabetic Foot Ulcer Treatment-An Observational Study during COVID-19 Pandemic from a Romanian Physical Therapy Unit. J Clin Med 2023; 12:6516. [PMID: 37892654 PMCID: PMC10607790 DOI: 10.3390/jcm12206516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic foot ulcer non-reimbursed treatment depends on multiple factors, including the patient's buying behaviors. Factors affecting buying behaviors for the removable off-loading devices are not completely understood. The aim of this study was to investigate the patients' buying behaviors of the removable off-loading devices and their influence on the DFU treatment outcomes remotely monitored during the COVID-19 pandemic. In this prospective observational study, 45 patients affected by diabetic peripheral neuropathy, with/without peripheral arterial disease, with foot ulcers treated with removable devices were remotely monitored. Prefabricated removable cast walkers, insoles, and therapeutic footwear were the proposed off-loading methods. Patients affected by high blood pressure (p = 0.018), peripheral arterial disease (p = 0.029), past amputations (p = 0.018), and ulcer on the left foot (p = 0.007) bought removable cast walkers. Rural provenience (p = 0.011) and male (p = 0.034) did not buy a removable walker. The healing rate was 69.4%, while the median healing time was 20 weeks. High blood pressure negatively influenced healing time (p = 0.020). Patients who bought the most efficient treatment method for DFUs were females from urban provenience, with amputation in the past, with peripheral arterial disease, and with high blood pressure.
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Affiliation(s)
- Iulia Iovanca Dragoi
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
| | - Florina Georgeta Popescu
- Discipline of Occupational Health, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Frank L. Bowling
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
- Department of Surgery & Translational Medicine, Faculty of Medical and Human Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK
| | - Cosmina Ioana Bondor
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8 Victor Babeș, 400000 Cluj-Napoca, Romania;
| | - Mihai Ionac
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
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4
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Cortes-Penfield NW, Armstrong DG, Brennan MB, Fayfman M, Ryder JH, Tan TW, Schechter MC. Evaluation and Management of Diabetes-related Foot Infections. Clin Infect Dis 2023; 77:e1-e13. [PMID: 37306693 PMCID: PMC10425200 DOI: 10.1093/cid/ciad255] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
| | - David G Armstrong
- Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Meghan B Brennan
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Maya Fayfman
- Division of Endocrinology and Metabolism, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Marcos C Schechter
- Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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Ababneh A, Finlayson K, Edwards H, Armstrong DG, Najafi B, van Netten JJ, Lazzarini PA. The Validity and Reliability of Self-Reported Adherence to Using Offloading Treatment in People with Diabetes-Related Foot Ulcers. SENSORS (BASEL, SWITZERLAND) 2023; 23:4423. [PMID: 37177627 PMCID: PMC10181495 DOI: 10.3390/s23094423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Adherence to using offloading treatment is crucial to healing diabetes-related foot ulcers (DFUs). Offloading adherence is recommended to be measured using objective monitors. However, self-reported adherence is commonly used and has unknown validity and reliability. This study aimed to assess the validity and reliability of self-reported adherence to using removable cast walker (RCW) offloading treatment among people with DFUs. Fifty-three participants with DFUs using RCWs were included. Each participant self-reported their percentage adherence to using their RCW of total daily steps. Participants also had adherence objectively measured using dual activity monitors. After one week, a subset of 19 participants again self-reported their percentage adherence to investigate test-retest reliability. Validity was tested using Pearson's r and Bland-Altman tests, and reliability using Cohen's kappa. Median (IQR) self-reported adherence was greater than objectively measured adherence (90% (60-100) vs. 35% (19-47), p < 0.01). There was fair agreement (r = 0.46; p < 0.01) and large 95% limits of agreement with significant proportional bias (β = 0.46, p < 0.01) for validity, and minimal agreement for test-retest reliability (K = 0.36; p < 0.01). The validity and reliability of self-reported offloading adherence in people with DFU are fair at best. People with DFU significantly overestimate their offloading adherence. Clinicians and researchers should instead use objective adherence measures.
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Affiliation(s)
- Anas Ababneh
- Faculty of Nursing, Applied Science Private University, Amman 11931, Jordan
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Kathleen Finlayson
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, 1105 AZ Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation and Development, 1105 AZ Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Peter A. Lazzarini
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
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7
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Jones K, Backhouse MR, Bruce J. Rehabilitation for people wearing offloading devices for diabetes-related foot ulcers: a systematic review and meta-analyses. J Foot Ankle Res 2023; 16:16. [PMID: 36966316 PMCID: PMC10039553 DOI: 10.1186/s13047-023-00614-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Offloading devices improve healing of diabetes-related foot ulcers (DFUs) but they can limit mobilisation. Rehabilitation during or after removal of these devices may promote physical activity in a population at risk of poor health outcomes for which inactivity is a reversible risk factor. METHODS This systematic review examined the effectiveness of rehabilitation interventions to promote physical activity during and/or after wearing an offloading device to treat diabetes-related foot ulcers. Searches using MESH terms and free-text combinations: 'foot ulcer', 'diabetic foot', 'casts, surgical', 'orthotic devices' were applied to MEDLINE, Embase, The Cochrane Library and clinical trial registers for randomised and observational studies published to September 2022. Methodological quality assessment of included studies was undertaken using the Cochrane Risk of Bias (RoB 2.0) and Risk of Bias In Non-randomised studies of Interventions (ROBINS-I) tools. RESULTS Of 3332 records identified, eight studies (441 participants), four clinical trials and four cohort studies, were included. None delivered or tested a structured rehabilitation programme, but all reported physical activity outcomes during or after device use. People wearing non-removable total contact casts were less active than those wearing devices (SMD -0.45; 95% CI - 0.87 to - 0.04; p = 0.03; I2 56%; 4 trials). Diabetes-related foot ulcers in people wearing total contact casts were more likely to heal compared to removable devices at 12 weeks (OR 2.69; 95% CI 0.97 to 7.45; p = 0.06; I2 = 64%; 4 trials) and 20 weeks (OR 2.35; 95% CI 0.95 to 5.82; p = 0.07; I2 = 65%; 4 trials). CONCLUSIONS Despite physical activity being low throughout off-loading treatment, no studies have specifically tested rehabilitation. There is a need to investigate the clinical and cost-effectiveness of rehabilitation programmes in this population. High quality trials are needed to provide robust evidence to support to rehabilitation after DFU treatment.
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Affiliation(s)
- K Jones
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK.
| | - M R Backhouse
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
- University Hospitals Coventry Warwickshire NHS Trust, Coventry, UK
| | - J Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
- University Hospitals Coventry Warwickshire NHS Trust, Coventry, UK
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Finco MG, Cay G, Lee M, Garcia J, Salazar E, Tan TW, Armstrong DG, Najafi B. Taking a Load Off: User Perceptions of Smart Offloading Walkers for Diabetic Foot Ulcers Using the Technology Acceptance Model. SENSORS (BASEL, SWITZERLAND) 2023; 23:2768. [PMID: 36904971 PMCID: PMC10006940 DOI: 10.3390/s23052768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
People with diabetic foot ulcers (DFUs) are commonly prescribed offloading walkers, but inadequate adherence to prescribed use can be a barrier to ulcer healing. This study examined user perspectives of offloading walkers to provide insight on ways to help promote adherence. Participants were randomized to wear: (1) irremovable, (2) removable, or (3) smart removable walkers (smart boot) that provided feedback on adherence and daily walking. Participants completed a 15-item questionnaire based on the Technology Acceptance Model (TAM). Spearman correlations assessed associations between TAM ratings with participant characteristics. Chi-squared tests compared TAM ratings between ethnicities, as well as 12-month retrospective fall status. A total of 21 adults with DFU (age 61.5 ± 11.8 years) participated. Smart boot users reported that learning how to use the boot was easy (ρ =-0.82, p≤ 0.001). Regardless of group, people who identified as Hispanic or Latino, compared to those who did not, reported they liked using the smart boot (p = 0.05) and would use it in the future (p = 0.04). Non-fallers, compared to fallers, reported the design of the smart boot made them want to wear it longer (p = 0.04) and it was easy to take on and off (p = 0.04). Our findings can help inform considerations for patient education and design of offloading walkers for DFUs.
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Affiliation(s)
- M. G. Finco
- Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Gozde Cay
- Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Myeounggon Lee
- Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jason Garcia
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Elia Salazar
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Tze-Woei Tan
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Bijan Najafi
- Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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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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Al Ayed MY, Ababneh A, Alwin Robert A, Ahmed R, Al Ghofaili I, Al Saeed A, Al Dawish MA. Factors Associated With Self-Efficacy of Foot Self-Care Among Patients With Diabetes Attending a Tertiary Care Center in Saudi Arabia. INT J LOW EXTR WOUND 2023:15347346221148820. [PMID: 36597574 DOI: 10.1177/15347346221148820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several reports have shown self-efficacy to be a reliable way of predicting foot self-care behavior in patients with diabetes. However, at a global level in general, and in Saudi Arabia in particular, investigation of the factors related to self-efficacy in executing foot self-care continues to remain inadequate. This study endeavors to identify the factors associated with the self-efficacy of foot self-care among patients with diabetes in Saudi Arabia. From a tertiary diabetes care center in Saudi Arabia, 175 patients with diabetes were selected to participate in this cross-sectional study. Employing the Arabic version of the Foot Care Confidence Scale (FCCS), the principal end results and the sociodemographic, clinical, and psychosocial independent variables were collected and assessed. From the total reported FCCS score, the mean was found to be 28.1 ± 8.2. Multiple linear regression analysis indicated 2 independent factors were positively associated with a higher reported FCCS score; being middle-aged (< 60 years old) (β=0.31, P< .01) and having a higher score on the Foot Care Outcome Expectations Scale (FCOES) (β=0.36, P< .01). In conclusion, patients with diabetes in Saudi Arabia have a mild level of self-efficacy to perform the needed foot self-care. Therefore, this has turned the spotlight on the young or middle-aged < 60-year-old Saudi population with diabetes as the target group, making them the priority for future self-efficacy promotion programs to upgrade the level of foot self-care.
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Affiliation(s)
- Musab Yousef Al Ayed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Anas Ababneh
- Faculty of Nursing, 59177Applied Science Private University, Amman, Jordan
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rania Ahmed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Al Ghofaili
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulghani Al Saeed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Jarl G, Rusaw DF, Terrill AJ, Barnett CT, Woodruff MA, Lazzarini PA. Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers. J Diabetes Sci Technol 2023; 17:99-106. [PMID: 35658555 PMCID: PMC9846383 DOI: 10.1177/19322968221101632] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach. PURPOSE The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development. METHODS Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each individual's needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from the device to accommodate different patients' needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence. CONCLUSIONS By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.
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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
- Gustav Jarl, PhD, University Health
Care Research Center, Örebro University Hospital, S-huset, vån 1,
Örebro, SE-701 85, Sweden.
| | - David F. Rusaw
- School of Health and Welfare,
Jönköping University, Jönköping, Sweden
| | - Alexander J. Terrill
- School of Mechanical, Medical and
Process Engineering, Queensland University of Technology, Brisbane, QLD,
Australia
- Centre for Biomedical
Technologies, Queensland University of Technology, Brisbane, QLD,
Australia
- Faculty of Health, Southern Cross
University, Gold Coast, QLD, Australia
| | | | - Maria A. Woodruff
- School of Mechanical, Medical and
Process Engineering, Queensland University of Technology, Brisbane, QLD,
Australia
- Centre for Biomedical
Technologies, Queensland University of Technology, Brisbane, QLD,
Australia
| | - Peter A. Lazzarini
- School of Public Health and
Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research
Collaborative, The Prince Charles Hospital, Brisbane, Australia
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12
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Palmer KNB, Crocker RM, Marrero DG, Tan TW. A vicious cycle: employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1027578. [PMID: 37124466 PMCID: PMC10140327 DOI: 10.3389/fcdhc.2023.1027578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023]
Abstract
Aim To describe patients' reported employment challenges associated with diabetic foot ulcers (DFUs). Methods Fifteen patients from under-resourced communities in Southern Arizona, with a history of DFUs and/or amputations, were recruited from a tertiary referral center from June 2020 to February 2021. Participants consented to an audio-recorded semi-structured phone interview. Interviews were transcribed and thematically analyzed using the Dedoose data analysis platform. Results Participants shared a common theme around the cyclic challenges of DFU prevention/management and employment. Those employed in manual labor-intensive jobs or jobs requiring them to be on their feet for long durations of time believed working conditions contributed to the development of their DFUs. Patients reported work incapacity due to declines in mobility and the need to offload for DFU management. Many expressed frustration and emotional distress related to these challenges noting that DFUs resulted in lower remuneration as medical expenses increased. Consequently, loss of income and/or medical insurance often hindered participants' ability to manage DFUs and subsequent complications. Conclusion These data illuminate the vicious cycle of DFU and employment challenges that must be addressed through patient-centered prevention strategies. Healthcare providers should consider a person's contextual factors such as employment type to tailor treatment approaches. Employers should establish inclusive policies that support patients with DFUs returning to work through flexible working hours and adapted work tasks as needed. Policymakers can also mitigate employment challenges by implementing social programs that provide resources for employees who are unable to return to work in their former capacity.
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Affiliation(s)
- Kelly N. B. Palmer
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
- *Correspondence: Kelly N.B. Palmer,
| | - Rebecca M. Crocker
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
| | - David G. Marrero
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Tze-Woei Tan
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, United States
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13
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Ababneh A, Finlayson K, Edwards H, van Netten JJ, Lazzarini PA. Differences in adherence to using removable cast walker treatment during daytime and nighttime weight-bearing activities in people with diabetes-related foot ulcers. Ther Adv Endocrinol Metab 2023; 14:20420188221142457. [PMID: 36643893 PMCID: PMC9837274 DOI: 10.1177/20420188221142457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/13/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Patients' adherence to using knee-high offloading treatment is critical to effective healing of diabetes-related foot ulcers (DFUs). Previous studies have found that patients generally have low adherence to using removable knee-high offloading treatments, yet no study has investigated whether their adherence differs during daytime and nighttime. This study aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment during daytime and nighttime weight-bearing activities in people with DFUs. METHODS This was a secondary analysis of data collected from a multi-centre cross-sectional study investigating adherence to using knee-high RCWs among 57 participants with DFUs. All participants had multiple socio-demographic, physiological and psychosocial factors collected, before having their adherence to using RCWs during weight-bearing activity monitored over a 1-week period using the dual activity monitor method. Adherence data were categorised into daytime (06:00-18:00) and nighttime (18:00-06:00) periods and calculated separately. Multiple linear regression was used to identify factors associated with daytime and nighttime adherence. RESULTS Mean adherence to using RCW during weight-bearing activities in people with DFUs was higher during daytime compared with nighttime [39.9% (SD = 18.9) versus 20.4% (SD = 16.7), p < 0.001]. Factors independently associated with lower adherence during daytime were being male, longer diabetes duration, not having peripheral artery disease (PAD), and higher perceived RCW heaviness. Factors associated with lower adherence during nighttime were higher mean daytime steps, not having retinopathy and having dyslipidaemia. CONCLUSIONS Adherence to using RCWs during weight-bearing activities reduced significantly at nighttime compared with daytime among people with DFUs, and this was associated with different factors. Interventions to improve adherence, in research and clinical practice, should incorporate methods to target daytime or nighttime adherence specifically.
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Affiliation(s)
| | - Kathleen Finlayson
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Rehabilitation & Development Program, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter A. Lazzarini
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia
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14
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Ababneh A, Moosa S, Al Jarrah Q, Alsoufi Y, Abu Qamar MZ, Saleh M, Jarrah S, Younes NA. Factors Associated With Foot Self-Care in Patients With Diabetes-Related High-Risk Feet: A Cross-Sectional Design. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231220135. [PMID: 38140753 DOI: 10.1177/00469580231220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Foot self-care has been commonly studied among people with diabetes. Previous research on foot self-care among those with diabetes-related high-risk feet is almost unavailable or very limited. The current study aims to fill this gap and provide a contemporary unprecedented analysis of this area of specialization. To assess the levels of, and factors associated with foot self-care among people with diabetes-related high-risk feet. A multi-center cross-sectional study from Jordan assessed the foot self-care of 107 participants with diabetes-related high-risk feet. Multiple socio-demographic, physiological, and psychosocial factors were collected, and the Arabic version of the diabetes foot self-care behavior scale was used to estimate the foot self-care of the study population. A multiple linear regression model was employed to identify factors associated with foot self-care. The mean score of foot self-care was 25.4 ± 7.1 (35 is the highest) indicating ~73% of adherence to foot self-care. Factors associated with higher foot self-care were being treated at the King Abdullah University Hospital (β = .30, P < .01) and reporting higher scores of patients' interpretations about neuropathy physical causes of foot ulcers (β = ".22," P = .02). People with diabetes-related high-risk feet reported a relatively adequate foot self-care practice. However, clinicians are still required to enhance foot self-care among this population. Health promotion programs may benefit from engaging people in understanding the pathophysiology of diabetes-related foot ulcers to improve foot self-care practices.
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Affiliation(s)
- Anas Ababneh
- Yarmouk University, Irbid, Jordan
- Applied Science Private University, Amman, Jordan
| | - Sameh Moosa
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | | | - Yazan Alsoufi
- Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Nidal A Younes
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
- University of Jordan, Amman, Jordan
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15
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Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13:1049-1065. [PMID: 36578871 PMCID: PMC9791567 DOI: 10.4239/wjd.v13.i12.1049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chong-Xi Yuan
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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