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Liew H, Tang W, Plassmann P, Machin G, Simpson R, Edmonds ME, Petrova NL. Infrared Thermography Shows That a Temperature Difference of 2.2°C (4°F) or Greater Between Corresponding Sites of Neuropathic Feet Does Not Always Lead to a Diabetic Foot Ulcer. J Diabetes Sci Technol 2024:19322968241249970. [PMID: 38708580 DOI: 10.1177/19322968241249970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND There is emerging interest in the application of foot temperature monitoring as means of diabetic foot ulcer (DFU) prevention. However, the variability in temperature readings of neuropathic feet remains unknown. The aim of this study was to analyze the long-term consistency of foot thermograms of diabetic feet at the risk of DFU. METHODS A post-hoc analysis of thermal images of 15 participants who remained ulcer-free during a 12-month follow-up were unblinded at the end of the trial. Skin foot temperatures of 12 plantar, 15 dorsal, 3 lateral, and 3 medial regions of interests (ROIs) were derived on monthly thermograms. The temperature differences (∆Ts) of corresponding ROIs of both feet were calculated. RESULTS Over the 12-month study period, out of the total 2026 plantar data points, 20.3% ROIs were rated as abnormal (absolute ∆T ≥ 2.2°C). There was a significant between-visit variability in the proportion of plantar ROIs with ∆T ≥ 2.2°C (range 7.6%-30.8%, chi-square test, P = .001). The proportion of patients presenting with hotspots (ROIs with ∆T ≥ 2.2°C), abnormal plantar foot temperature (mean ∆T of 12 plantar ROIs ≥ 2.2°C), and abnormal whole foot temperature (mean ∆T of 33 ROIs ≥ 2.2°C) varied between visits and showed no pattern (P > .05 for all comparisons). This variability was not related to the season of assessment. CONCLUSIONS Despite the high rate of hotspots on monthly thermograms, all feet remained intact. This study underscores a significant between-visit inconsistency in thermal images of neuropathic feet which should be considered when planning DFU-prevention programs for self-testing and behavior modification.
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Affiliation(s)
- Huiling Liew
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Wegin Tang
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Graham Machin
- Temperature and Humidity Group, National Physical Laboratory, London, UK
| | - Robert Simpson
- Temperature and Humidity Group, National Physical Laboratory, London, UK
| | - Michael E Edmonds
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nina L Petrova
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Faus Camarena M, Izquierdo-Renau M, Julian-Rochina I, Arrébola M, Miralles M. Update on the Use of Infrared Thermography in the Early Detection of Diabetic Foot Complications: A Bibliographic Review. SENSORS (BASEL, SWITZERLAND) 2023; 24:252. [PMID: 38203114 PMCID: PMC10781348 DOI: 10.3390/s24010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
Foot lesions are among the most frequent causes of morbidity and disability in the diabetic population. Thus, the exploration of preventive control measures is vital for detecting early signs and symptoms of this disease. Infrared thermography is one of the complementary diagnostic tools available that has proven to be effective in the control of diabetic foot. The last review on this topic was published in 2015 and so, we conducted a bibliographic review of the main databases (PubMed, the Web of Science, Cochrane library, and Scopus) during the third quarter of 2023. We aimed to identify the effectiveness of infrared thermography as a diagnostic element in pre-ulcerous states in diabetic patients and to detect diabetic foot ulcer complications. We obtained a total of 1199 articles, 26 of which were finally included in the present review and published after 2013. After analyzing the use of infrared thermography in diabetic patients both with and without ulcers, as well as in healthy individuals, we concluded that is an effective tool for detecting early-stage ulcers in diabetic foot patients.
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Affiliation(s)
- Marina Faus Camarena
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
| | - Marta Izquierdo-Renau
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
| | - Iván Julian-Rochina
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Manel Arrébola
- Department Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.A.); (M.M.)
| | - Manuel Miralles
- Department Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.A.); (M.M.)
- Department of Surgery, University of Valencia, 46010 Valencia, Spain
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute, Hospital La Fe, 46026 Valencia, Spain
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Haryanto H, Amrullah S, Jais S, Supriadi S, Imran I, Sari Y. INDIFURUTO: A novel tool for assessing diabetic foot recurrence risk in type 2 diabetes. J Med Life 2023; 16:1514-1518. [PMID: 38313180 PMCID: PMC10835566 DOI: 10.25122/jml-2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024] Open
Abstract
This study aimed to evaluate diabetic foot ulcer recurrence using the Indonesia Diabetic Foot Ulcer Recurrence Assessment Tool (INDIFURUTO), a new diabetic foot risk recurrence assessment tool. This study used a prospective cohort design. A total of thirty-three participants met the inclusion criteria. We used sensitivity, specificity values, AUC, and, respectively, a 95% confidence interval (CI) to calculate prognostic accuracy measures. The results showed that this study had an AUC of 0,97 [95% confidence interval (CI) 0.91-1.00]. The cut-off point (Youden Index) was <45, with sensitivity and specificity values of 100% and 90%, respectively. The utilization of this model can facilitate the monitoring and enhancement of foot ulcer recurrence prevention in individuals diagnosed with diabetes. This study showed that the new model had a high prediction. Therefore, this model better stratifies people at high risk of foot ulceration.
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Affiliation(s)
- Haryanto Haryanto
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Syahid Amrullah
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Suriadi Jais
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Supriadi Supriadi
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Imran Imran
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Yunita Sari
- Department of Nursing, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
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Villar Rodríguez J, Pérez Pico AM, García Blázquez FM, Morán Cortés JF, Mayordomo Acevedo R. Evaluation of Thermography as a Diagnostic Technique in Asymptomatic or Incipient Onychomycosis. J Fungi (Basel) 2023; 9:jof9040444. [PMID: 37108899 PMCID: PMC10144260 DOI: 10.3390/jof9040444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Onychomycosis is usually diagnosed symptomatically due to the very clear signs caused by the fungus on the nail surface and structure, although the growth of the infecting agent must also be verified by culture in an enriched medium. This procedure is normally lengthy (four weeks), and samples can be contaminated, delaying the prescription of appropriate and effective treatment. Only one previous study has addressed the possibility of using thermography as a diagnostic method for onychomycosis in older people (31–70 years). The present study confirms this use but in individuals aged 18–31 years with incipient mycosis and no pathological signs. Using an FLIR E60 BX camera in a study with 214 samples, we found that men had more onychomycosis than women. We observed a relation between the presence of infection and nail temperature, with a higher temperature in yeast infections (+1 °C) and a lower temperature in dermatophyte infections (−2 °C). A higher temperature by almost 1 °C was also observed in older participants. Thermography can be viewed as a new diagnostic method in asymptomatic or incipient onychomycosis, providing the thermographic camera is sufficiently sensitive and the appropriate procedure is followed, although fungal culture is always necessary to confirm recovery after treatment.
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Affiliation(s)
- Julia Villar Rodríguez
- Department of Anatomy, Cellular Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | - Ana María Pérez Pico
- Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | | | - Juan Francisco Morán Cortés
- Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | - Raquel Mayordomo Acevedo
- Department of Anatomy, Cellular Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
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Calvo-Lobo C, San-Antolín M, García-García D, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Cosín-Matamoros J, Casado-Hernández I, Martínez-Jiménez EM, Mazoteras-Pardo V, Rodríguez-Sanz D. Intra- and inter-session reliability and repeatability of an infrared thermography device designed for materials to measure skin temperature of the triceps surae muscle tissue of athletes. PeerJ 2023; 11:e15011. [PMID: 36919164 PMCID: PMC10008311 DOI: 10.7717/peerj.15011] [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: 10/21/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Background Infrared thermography devices have been commonly applied to measure superficial temperature in structural composites and walls. These tools were cheaper than other thermographic devices used to measure superficial human muscle tissue temperature. In addition, infrared thermography has been previously used to assess skin temperature related to muscle tissue conditions in the triceps surae of athletes. Nevertheless, the reliability and repeatability of an infrared thermography device designed for materials, such as the Manual Infrared Camera PCE-TC 30, have yet to be determined to measure skin temperature of the triceps surae muscle tissue of athletes. Objective The purpose was to determine the procedure's intra- and inter-session reliability and repeatability to determine skin temperature within the Manual Infrared Camera PCE-TC 30 thermography device in the triceps surae muscle tissue of athletes, which was initially designed to measure the superficial temperature of materials. Methods A total of 34 triceps surae muscles were bilaterally assessed from 17 healthy athletes using the Manual Infrared Camera PCE-TC 30 thermography device to determine intra- (at the same day separated by 1 h) and inter-session (at alternate days separated by 48 h) reliability and repeatability of the skin temperature of the soleus, medial and lateral gastrocnemius muscles. The triceps surae complex weas measured by a region of interest of 1 cm2 through five infrared thermography images for each muscle. Statistical analyses comprised intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MCD), systematic error of measurement, correlation (r), and Bland-Altman plots completed with linear regression models (R 2). Results Intra- and inter-session measurements of the proposed infrared thermography procedure showed excellent reliability (ICC(1,2) = 0.968-0.977), measurement errors (SEM = 0.186-0.232 °C; MDC = 0.515-0.643 °C), correlations (r = 0.885-0.953), and did not present significant systematic error of measurements (P > 0.05). Adequate agreement between each pair of measurement moments was presented by the Bland-Altman plots according to the limits of agreement and non-significant linear regression models (R 2 = 0.000-0.019; P > 0.05). Conclusions The proposed procedure to determine skin temperature within the Manual Infrared Camera PCE-TC 30 thermography device presented excellent intra- and inter-session reliability and repeatability in athletes' triceps surae muscle tissue. Future studies should consider the SEM and MDC of this procedure to measure the skin temperature of soleus, medial, and lateral gastrocnemius muscles to promote triceps surae muscle prevention and recovery in athletes.
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Affiliation(s)
- Cesar Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta San-Antolín
- Departamento de Psicología, Universidad de Valladolid, Valladolid, Valladolid, Spain
| | - Daniel García-García
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.,Escuela de Doctorado, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | | | - Julia Cosín-Matamoros
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Israel Casado-Hernández
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Victoria Mazoteras-Pardo
- Department of Nursing, Physiotherapy and Occupational Therapy, School of Physiotherapy and Nursing, Universidad de Castilla La Mancha, Toledo, Spain, Spain
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
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Kaselimi M, Protopapadakis E, Doulamis A, Doulamis N. A review of non-invasive sensors and artificial intelligence models for diabetic foot monitoring. Front Physiol 2022; 13:924546. [PMID: 36338484 PMCID: PMC9635839 DOI: 10.3389/fphys.2022.924546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/05/2022] [Indexed: 06/04/2024] Open
Abstract
Diabetic foot complications have multiple adverse effects in a person's quality of life. Yet, efficient monitoring schemes can mitigate or postpone any disorders, mainly by early detecting regions of interest. Nowadays, optical sensors and artificial intelligence (AI) tools can contribute efficiently to such monitoring processes. In this work, we provide information on the adopted imaging schemes and related optical sensors on this topic. The analysis considers both the physiology of the patients and the characteristics of the sensors. Currently, there are multiple approaches considering both visible and infrared bands (multiple ranges), most of them coupled with various AI tools. The source of the data (sensor type) can support different monitoring strategies and imposes restrictions on the AI tools that should be used with. This review provides a comprehensive literature review of AI-assisted DFU monitoring methods. The paper presents the outcomes of a large number of recently published scholarly articles. Furthermore, the paper discusses the highlights of these methods and the challenges for transferring these methods into a practical and trustworthy framework for sufficient remote management of the patients.
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Affiliation(s)
- Maria Kaselimi
- National Technical University of Athens, School of Rural, Surveying and Geoinformatics Engineering, Athens, Greece
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Stefanopoulos S, Ayoub S, Qiu Q, Ren G, Osman M, Nazzal M, Ahmed A. Machine learning prediction of diabetic foot ulcers in the inpatient population. Vascular 2021; 30:1115-1123. [PMID: 34461765 DOI: 10.1177/17085381211040984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of this study was to create an algorithm that could predict diabetic foot ulcer (DFU) incidence in the in-patient population. MATERIALS AND METHODS The Nationwide Inpatient Sample datasets were examined from 2008 to 2014. The International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) and the Agency for Healthcare Research and Quality comorbidity codes were used to assist in the data collection. Chi-square testing was conducted, using variables that positively correlated with DFUs. For descriptive statistics, the Student T-test, Wilcoxon rank sum test, and chi-square test were used. There were six predictive variables that were identified. A decision tree model CTREE was utilized to help develop an algorithm. RESULTS 326,853 patients were noted to have DFU. The major variables that contributed to this diagnosis (both with p < 0.001) were cellulitis (OR 63.87, 95% CI [63.87-64.49]) and Charcot joint (OR 25.64, 95% CI [25.09-26.20]). The model performance of the six-variable testing data was 79.5% (80.6% sensitivity and 78.3% specificity). The area under the curve (AUC) for the 6-variable model was 0.88. CONCLUSION We developed an algorithm with a 79.8% accuracy that could predict the likelihood of developing a DFU.
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Affiliation(s)
- Stavros Stefanopoulos
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
| | - Samar Ayoub
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
| | - Qiong Qiu
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
| | - Gang Ren
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
| | - Mohamed Osman
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
| | - Munier Nazzal
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
| | - Ayman Ahmed
- Department of Surgery, College of Medicine and Life Sciences, 7923University of Toledo, Toledo, OH, USA
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Oe M, Tsuruoka K, Ohashi Y, Takehara K, Noguchi H, Mori T, Yamauchi T, Sanada H. Prevention of diabetic foot ulcers using a smartphone and mobile thermography: a case study. J Wound Care 2021; 30:116-119. [PMID: 33573481 DOI: 10.12968/jowc.2021.30.2.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Early identification of pre-ulcerative pathology is important to preventing diabetic foot ulcers (DFU), but signs of inflammation are difficult to detect on the feet of patients with diabetic neuropathy due to decreased sensation. However, infrared thermography can objectively identify inflammation. Therefore, a device that allows patients to visualise thermograms of their feet might be an effective way to prevent DFU. We aimed to determine the effects of a novel self-monitoring device to prevent DFU using a thermograph attached to a smartphone. METHOD A self-monitoring device comprising a mobile thermograph attached to a smartphone on a selfie stick was created, and its effects in two patients with diabetic neuropathy and foot calluses assessed. RESULTS For one patient, he understood that walking too much increased the temperature in the skin of his feet (a sign of inflammation). The other patient could not detect high-risk findings, because the temperature of his skin did not increase during the study period. CONCLUSION This device might provide self-care incentives to prevent DFU, although some issues, such as the automatic detection of high-risk thermographic changes, need to be improved.
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Affiliation(s)
- Makoto Oe
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kahori Tsuruoka
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Kimie Takehara
- School of Health Sciences, Graduate School of Medicine Department of Nursing, Nagoya University, Aichi, Japan
| | - Hiroshi Noguchi
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mori
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hiromi Sanada
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
BACKGROUND The purpose of this study was with a simple clinical setting to compare skin temperature changes in the feet before and after revascularization and to identify possible correlation between ankle brachial index (ABI) and toe pressure (TP) values and foot skin temperature patient with and without diabetes. METHODS Forty outpatient clinic patients were measured ABI, TP, and the skin temperature using infrared thermography (IRT) at the foot before and after revascularization. Patients in the revascularization group were divided into subgroups depending on whether they had diabetes or not and a wound or not. RESULTS There were clear correlation between increase of ABI and TP and increase of the mean skin temperature on the feet after revascularization. The temperature was higher and the temperature change was greater among patients with diabetes. Side-to-side temperature difference between the revascularized feet and contralateral feet decreased after treatment. The mean temperature was higher in the feet with wound whether patient had diabetes mellitus or not. CONCLUSION The simple, prompt, and noninvasive IRT procedure showed its potential as a follow-up tool among patients with diabetes or peripheral arterial disease and previous lower limb revascularization.
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Affiliation(s)
- Arjaleena Ilo
- Department of Vascular Surgery, Oulu University Hospital and Oulu University, Finland
- Arjaleena Ilo, MD, Department of Vascular Surgery, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland.
| | - Pekka Romsi
- Department of Vascular Surgery, Oulu University Hospital and Oulu University, Finland
| | - Matti Pokela
- Department of Vascular Surgery, Oulu University Hospital and Oulu University, Finland
| | - Jussi Mäkelä
- Department of Cardiothoracic Surgery, Oulu University Hospital and Oulu University, Finland
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The Concurrent Validity, Test-Retest Reliability and Usability of a New Foot Temperature Monitoring System for Persons with Diabetes at High Risk of Foot Ulceration. SENSORS 2021; 21:s21113645. [PMID: 34073853 PMCID: PMC8197257 DOI: 10.3390/s21113645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
At-home foot temperature monitoring may be useful in the early recognition of imminent foot ulcers that occur through biomechanical loading in people with diabetes. We assessed the concurrent validity, test–retest reliability, and usability of a new plantar foot temperature monitoring device in 50 people with diabetes and peripheral neuropathy. We compared plantar foot temperature measurements with a platform system that consists of embedded temperature sensors with those from a handheld infrared thermometer that was used as a reference. Repeated platform assessments were compared for test–retest reliability. Usability was assessed in 15 participants who used both devices daily for two weeks at home, after which they completed a questionnaire. Agreement between devices was excellent for the metatarsal heads and heel (ICCs ≥ 0.98, LOA: −0.89 °C; 1.16 °C) and hallux and lateral midfoot (0.93 ≤ ICC ≤ 0.96, LOA: −2.87 °C; 2.2 °C), good for digits 2–5 (0.75 ≤ ICC ≤ 0.88, LOA: −5.04 °C; 2.76 °C), and poor for the medial midfoot (ICC = 0.19, LOA: −8.21 °C; −0.05 °C). Test–retest reliability was high (ICC = 0.99, LOA: −0.59 °C; 1.35 °C). Participants scored between 3.8 and 4.3 on a 5-point Likert scale for willingness to measure, ease of use, measurement comfort, and duration. In conclusion, the platform shows good concurrent validity in foot regions where most ulcers occur, good test–retest reliability, and good usability for measuring plantar foot temperature. Further research should assess the clinical validity of the platform to help prevent plantar diabetic foot ulcers.
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Torreblanca González J, Gómez-Martín B, Hernández Encinas A, Martín-Vaquero J, Queiruga-Dios A, Martínez-Nova A. The Use of Infrared Thermography to Develop and Assess a Wearable Sock and Monitor Foot Temperature in Diabetic Subjects. SENSORS (BASEL, SWITZERLAND) 2021; 21:1821. [PMID: 33807804 PMCID: PMC7961733 DOI: 10.3390/s21051821] [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] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
One important health problem that could affect diabetics is diabetic foot syndrome, as risk of ulceration, neuropathy, ischemia and infection. Unnoticed minor injuries, subsequent infection and ulceration may end in a foot amputation. Preliminary studies have shown a relationship between increased skin temperature and asymmetries between the same regions of both feet. In the preulceration phase, to develop a smart device able to control the temperature of these types of patients to avoid this risk might be very useful. A statistical analysis has been carried out with a sample of foot temperature data obtained from 93 individuals, of whom 44 are diabetics and 49 nondiabetics and among them 43% are men and 57% are women. Data obtained with a thermographic camera has been successful in providing a set of regions of interest, where the temperature could influence the individual, and the behavior of several variables that could affect these subjects provides a mathematical model. Finally, an in-depth analysis of existing sensors situated in those positions, namely, heel, medial midfoot, first metatarsal head, fifth metatarsal head, and first toe has allowed for the development of a smart sock to store temperatures obtained every few minutes in a mobile device.
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Affiliation(s)
- José Torreblanca González
- School of Industrial Engineering, University of Salamanca, E37700 Salamanca, Spain; (J.T.G.); (A.Q.-D.)
| | - Beatriz Gómez-Martín
- Department of Nursing, Centro Universitario de Plasencia, University of Extremadura, E10600 Plasencia, Spain; (B.G.-M.); (A.M.-N.)
| | | | - Jesús Martín-Vaquero
- School of Industrial Engineering, University of Salamanca, E37700 Salamanca, Spain; (J.T.G.); (A.Q.-D.)
| | - Araceli Queiruga-Dios
- School of Industrial Engineering, University of Salamanca, E37700 Salamanca, Spain; (J.T.G.); (A.Q.-D.)
| | - Alfonso Martínez-Nova
- Department of Nursing, Centro Universitario de Plasencia, University of Extremadura, E10600 Plasencia, Spain; (B.G.-M.); (A.M.-N.)
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Effect of 660/850 nm LED on the microcirculation of the foot: neurovascular biphasic reflex. Lasers Med Sci 2021; 36:1883-1889. [PMID: 33398615 DOI: 10.1007/s10103-020-03235-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
Phototherapy (LED) can be used to stimulate the healing of chronic ulcers of the lower limb, as it affects healing cells and neurons. In this way, this study has sought to know if the heat stimulus of the 660-/850-nm contact LED is sufficient to trigger the response in the peripheral sympathetic nervous system of normal volunteers. The LED was applied on the right foot of forty-two normal volunteers followed by serial infrared images. After the stimulus, a biphasic hyperthermia curve was observed synchronously in both feet, in the right and left halluxes, while hyperthermia was attributed to the redistribution of postural blood flow in the plantar region, which may indicate independent neurovascular mechanisms. Thus, periodic thermographic analysis can be used in the evolution of the LED treatment.
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Valga F, Monzón T, Henriquez F, Anton-Pérez G. Valoración del orificio de inserción del catéter tunelizado para hemodiálisis mediante el uso de cámara térmica acoplada a smartphone: estudio piloto. Nefrologia 2020; 40:673-674. [DOI: 10.1016/j.nefro.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/10/2019] [Accepted: 11/17/2019] [Indexed: 11/25/2022] Open
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14
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Plantar temperature and vibration perception in patients with diabetes: A cross-sectional study. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Whatley JA, Kay S. Using thermal imaging to measure changes in breast cancer-related lymphoedema during reflexology. Br J Community Nurs 2020; 25:S6-S11. [PMID: 33030372 DOI: 10.12968/bjcn.2020.25.sup10.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Reflexology lymph drainage (RLD) for breast cancer-related lymphoedema (BCRL) may have a positive impact on arm swelling and pain. Thermal imaging is a means of tracking temperature change by visual images. This study aimed to explore the use of thermal imaging in treatment for BCRL. The swollen arms of two participants with BCRL were photographed using a thermal imaging camera during a single RLD treatment. Limb Volume Circumferential Measurement (LVCM) of both arms was taken before, after and the next day. The images were examined for visual changes, and temperature data were extracted. Images showed differences in temperature within the affected hand and arm over 45 minutes. LVCM data indicated a loss of limb volume in the affected arm in both cases, which continued to decrease over 24 hours. Thus, thermal imaging may be useful in tracking temperature change during treatment for BCRL.
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Affiliation(s)
- Judith Anne Whatley
- Senior Lecturer, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University
| | - Sally Kay
- Reflexologist, Trainer in Reflexology Lymphatic Drainage, Newport, South Wales
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16
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Evaluation of an Explanted Porcine Skin Model to Investigate Infection with the Dermatophyte Trichophyton rubrum. Mycopathologia 2020; 185:233-243. [PMID: 32108288 DOI: 10.1007/s11046-020-00438-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/17/2020] [Indexed: 01/06/2023]
Abstract
Dermatophytosis is a fungal infection of skin, hair and nails, and the most frequently found causative agent is Trichophyton rubrum. The disease is very common and often recurring, and it is therefore difficult to eradicate. To develop and test novel treatments, infection models that are representative of the infection process are desirable. Several infection models have been developed, including the use of cultured cells, isolated corneocytes, explanted human skin or reconstituted human epidermis. However, these have various disadvantages, ranging from not being an accurate reflection of the site of infection, as is the case with, for example, cultured cells, to being difficult to scale up or having ethical issues (e.g., explanted human skin). We therefore sought to develop an infection model using explanted porcine skin, which is low cost and ethically neutral. We show that in our model, fungal growth is dependent on the presence of skin, and adherence of conidia is time-dependent with maximum adherence observed after ~ 2 h. Scanning electron microscopy suggested the production of fibril-like material that links conidia to each other and to skin. Prolonged incubation of infected skin leads to luxurious growth and invasion of the dermis, which is not surprising as the skin is not maintained in conditions to keep the tissue alive, and therefore is likely to lack an active immune system that would limit fungal growth. Therefore, the model developed seems useful to study the early stages of infection. Furthermore, we demonstrate that the model can be used to test novel treatment regimens for tinea infections.
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17
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van Doremalen RFM, van Netten JJ, van Baal JG, Vollenbroek-Hutten MMR, van der Heijden F. Infrared 3D Thermography for Inflammation Detection in Diabetic Foot Disease: A Proof of Concept. J Diabetes Sci Technol 2020; 14:46-54. [PMID: 31200612 PMCID: PMC7189170 DOI: 10.1177/1932296819854062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Thermal assessment of the plantar surface of the foot using spot thermometers and thermal imaging has been proven effective in diabetic foot ulcer prevention. However, with traditional cameras this is limited to single spots or a two-dimensional (2D) view of the plantar side of foot, where only 50% of the ulcers occur. To improve ulcer detection, the view has to be extended beyond 2D. Our aim is to explore for proof of concept the combination of three-dimensional (3D) models with thermal imaging for inflammation detection in diabetic foot disease. METHOD From eight participants with a current diabetic foot ulcer we simultaneously acquired a 3D foot model and three thermal infrared images using a high-resolution medical 3D imaging system aligned with three smartphone-based thermal infrared cameras. Using spatial transformations, we aimed to map thermal images onto the 3D model, to create the 3D visualizations. Expert clinicians assessed these for quality and face validity as +, +/-, -. RESULTS We could replace the texture maps (color definitions) of the 3D model with the thermal infrared images and created the first-ever 3D thermographs of the diabetic foot. We then converted these models to 3D PDF-files compatible with the hospital IT environment. Face validity was assessed as + in six and +/- in two cases. CONCLUSIONS We have provided a proof of concept for the creation of clinically useful 3D thermal foot images to assess the diabetic foot skin temperature in 3D in a hospital IT environment. Future developments are expected to improve the image-processing techniques to result in easier, handheld applications and driving further research.
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Affiliation(s)
- Rob F. M. van Doremalen
- University of Twente, Enschede, the
Netherlands
- Ziekenhuisgroep Twente, Almelo and
Hengelo, the Netherlands
- Rob F. M. van Doremalen, University of
Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Jaap J. van Netten
- Ziekenhuisgroep Twente, Almelo and
Hengelo, the Netherlands
- Amsterdam UMC, University of Amsterdam,
Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Queensland University of Technology,
School of Clinical Sciences, Brisbane, Australia
| | - Jeff G. van Baal
- Ziekenhuisgroep Twente, Almelo and
Hengelo, the Netherlands
- Cardiff University, Cardiff, Wales,
UK
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18
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Petrova NL, Donaldson NK, Tang W, MacDonald A, Allen J, Lomas C, Leech N, Ainarkar S, Bevans J, Plassmann P, Kluwe B, Ring F, Whittam A, Rogers L, McMillan J, Simpson R, Donaldson ANA, Machin G, Edmonds ME. Infrared thermography and ulcer prevention in the high-risk diabetic foot: data from a single-blind multicentre controlled clinical trial. Diabet Med 2020; 37:95-104. [PMID: 31629373 DOI: 10.1111/dme.14152] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. METHODS People with diabetes (n = 110), neuropathy and history of ≥ 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature ≥ 2.2°C higher than the corresponding contralateral site) and acted upon as per local standards. RESULTS After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. CONCLUSIONS Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.
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Affiliation(s)
- N L Petrova
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - N K Donaldson
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | - W Tang
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | - A MacDonald
- Microvascular Diagnostics, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - J Allen
- Microvascular Diagnostics, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - C Lomas
- Podiatry Department, Diabetes Centre, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - N Leech
- Podiatry Department, Diabetes Centre, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - S Ainarkar
- Community Podiatry Department, Pennine Acute Hospitals Trust, Manchester, UK
| | - J Bevans
- Community Podiatry Department, Pennine Acute Hospitals Trust, Manchester, UK
| | | | - B Kluwe
- Department of Computing, University of South Wales, Pontypridd, UK
| | - F Ring
- Department of Computing, University of South Wales, Pontypridd, UK
| | - A Whittam
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - L Rogers
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - J McMillan
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - R Simpson
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - A N A Donaldson
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | - G Machin
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - M E Edmonds
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
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19
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Jones P, Bibb R, Davies M, Khunti K, McCarthy M, Webb D, Zaccardi F. Prediction of Diabetic Foot Ulceration: The Value of Using Microclimate Sensor Arrays. J Diabetes Sci Technol 2020; 14:55-64. [PMID: 31596145 PMCID: PMC7189165 DOI: 10.1177/1932296819877194] [Citation(s) in RCA: 8] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND Accurately predicting the risk of diabetic foot ulceration (DFU) could dramatically reduce the enormous burden of chronic wound management and amputation. Yet, the current prognostic models are unable to precisely predict DFU events. Typically, efforts have focused on individual factors like temperature, pressure, or shear rather than the overall foot microclimate. METHODS A systematic review was conducted by searching PubMed reports with no restrictions on start date covering the literature published until February 20, 2019 using relevant keywords, including temperature, pressure, shear, and relative humidity. We review the use of these variables as predictors of DFU, highlighting gaps in our current understanding and suggesting which specific features should be combined to develop a real-time microclimate prognostic model. RESULTS The current prognostic models rely either solely on contralateral temperature, pressure, or shear measurement; these parameters, however, rarely reach 50% specificity in relation to DFU. There is also considerable variation in methodological investigation, anatomical sensor configuration, and resting time prior to temperature measurements (5-20 minutes). Few studies have considered relative humidity and mean skin resistance. CONCLUSION Very limited evidence supports the use of single clinical parameters in predicting the risk of DFU. We suggest that the microclimate as a whole should be considered to predict DFU more effectively and suggest nine specific features which appear to be implicated for further investigation. Technology supports real-time in-shoe data collection and wireless transmission, providing a potentially rich source of data to better predict the risk of DFU.
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Affiliation(s)
- Petra Jones
- Leicester Diabetes Centre, Leicester
General Hospital, University Hospitals of Leicester, UK
- Diabetes Research Centre, University of
Leicester, Leicester General Hospital, UK
| | - Richard Bibb
- Loughborough Design School, Loughborough
University, Leicestershire, UK
| | - Melanie Davies
- Leicester Diabetes Centre, Leicester
General Hospital, University Hospitals of Leicester, UK
- Diabetes Research Centre, University of
Leicester, Leicester General Hospital, UK
- NIHR Leicester Biomedical Research
Centre, University of Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester
General Hospital, University Hospitals of Leicester, UK
- Diabetes Research Centre, University of
Leicester, Leicester General Hospital, UK
| | - Matthew McCarthy
- Leicester Diabetes Centre, Leicester
General Hospital, University Hospitals of Leicester, UK
- Diabetes Research Centre, University of
Leicester, Leicester General Hospital, UK
- NIHR Leicester Biomedical Research
Centre, University of Leicester, UK
| | - David Webb
- Leicester Diabetes Centre, Leicester
General Hospital, University Hospitals of Leicester, UK
- Diabetes Research Centre, University of
Leicester, Leicester General Hospital, UK
| | - Francesco Zaccardi
- Leicester Diabetes Centre, Leicester
General Hospital, University Hospitals of Leicester, UK
- Diabetes Research Centre, University of
Leicester, Leicester General Hospital, UK
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20
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McPoil TG. Is Excellence in the Cards? Phys Ther 2019; 99:1281-1290. [PMID: 31665788 DOI: 10.1093/ptj/pzz104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 11/14/2022]
Abstract
Thomas G. McPoil, PT, PhD, FAPTA, is Emeritus Professor of Physical Therapy at Regis University, Denver, Colorado, and Emeritus Regents' Professor of Physical Therapy at Northern Arizona University. He has served as an Adjunct Honorary Professor in the School of Physiotherapy at the University of Queensland, Brisbane, Australia, and currently serves as a consultant to the Physical Therapy Orthotics Clinic at Denver Health Medical Center, Denver, Colorado. Dr. McPoil is known nationally and internationally for his scholarly contributions that have systematically examined foot and ankle function from both scientific and clinical perspectives. Dr. McPoil is an author or coauthor of 130 publications in peer-reviewed journals, coeditor of 2 books, and coauthor of 6 book chapters. His work reaches beyond the profession of physical therapy, as he served on the editorial boards of Foot and Ankle International, the Journal of Foot and Ankle Research, and Research in Sports Medicine and is currently on the editorial boards of the Journal of the American Podiatric Medical Association and The FOOT. Dr McPoil received his PhD in kinesiology with a specialization in biomechanics from University of Illinois at Urbana-Champaign. He holds an MS in physical education with a specialization in athletic training from Louisiana State University and a BA in physical education from the California State University, Sacramento. During his career, he has held faculty appointments at the University of Illinois at Chicago, Northern Arizona University, and Regis University. Dr McPoil's clinical practice has focused on the management of chronic orthopedic foot and ankle disorders for the past 38 years. Dr McPoil is the founding president of the Foot and Ankle Special Interest Group of the Academy of Orthopaedic Physical Therapy. He has served as Vice President of the Academy of Orthopaedic Physical Therapy and as the Treasurer of the Journal of Orthopaedic and Sports Physical Therapy. He has received numerous teaching awards, including APTA's Dorothy E. Baethke & Eleanor J. Carlin Award for Excellence in Academic Teaching and the Academy of Orthopaedic Physical Therapy's James A. Gould Excellence in Teaching Orthopaedic Physical Therapy Award. He is a recipient of a Fulbright Senior Scholar Award, the William J. Stickel Award for Research in Podiatric Medicine, the Academy of Orthopaedic Physical Therapy's Stanley Paris Distinguished Service Award and was elected a Catherine Worthingham Fellow of APTA in 2007.
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21
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Macdonald A, Petrova N, Ainarker S, Allen J, Lomas C, Tang W, Plassmann P, Whittam A, Bevans J, Ring F, Kluwe B, Simpson R, Rogers L, Machin G, Edmonds M. Between visit variability of thermal imaging of feet in people attending podiatric clinics with diabetic neuropathy at high risk of developing foot ulcers. Physiol Meas 2019; 40:084004. [PMID: 31362275 DOI: 10.1088/1361-6579/ab36d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE People with diabetic neuropathy who have previously ulcerated are at high risk of re-ulceration. They should regularly attend podiatry clinics for surveillance and routine protective podiatric treatment. It has been suggested that inflammation prior to skin breakdown shows up as a hotspot on a thermal image even in the absence of clinical signs. The aim of this study is to quantify inter-patient and intra-patient thermal variations presented by diabetic feet at high risk of ulceration. APPROACH Whole foot and spot temperatures were recorded for 96 patients who attended two successive podiatry appointments without ulceration 28 [28, 31] days apart, median [interquartile range]. This was a part of a longer study into whether thermal imaging in clinic can reduce the rate of re-ulceration. MAIN RESULTS The variation in spot temperature right/left differences for single patients between visits was comparable to the variation observed between patients (0.8 [0.3, 1.5] °C compared with 0.9 [0.4, 1.7] °C). Similarly, whole foot temperature variation for a single patient between visits was comparable to the variation observed between patients (0.6 [0.2, 1.1] °C compared with 0.8 [0.2, 1.3] °C). SIGNIFICANCE Thresholds which depend on thermal differences from visit to visit are unlikely to have sufficient specificity to effectively target treatment designed to prevent the development of foot ulcers.
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Affiliation(s)
- Audrey Macdonald
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne NE7 7DN, United Kingdom
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22
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van Doremalen RFM, van Netten JJ, van Baal JG, Vollenbroek-Hutten MMR, van der Heijden F. Validation of low-cost smartphone-based thermal camera for diabetic foot assessment. Diabetes Res Clin Pract 2019; 149:132-139. [PMID: 30738090 DOI: 10.1016/j.diabres.2019.01.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 01/18/2023]
Abstract
AIMS Infrared thermal imaging (IR) is not yet routinely implemented for early detection of diabetic foot ulcers (DFU), despite proven clinical effectiveness. Low-cost, smartphone-based IR-cameras are now available and may lower the threshold for implementation, but the quality of these cameras is unknown. We aim to validate a smartphone-based IR-camera against a high-end IR-camera for diabetic foot assessment. METHODS We acquired plantar IR images of feet of 32 participants with a current or recently healed DFU with the smartphone-based FLIR-One and the high-end FLIR-SC305. Contralateral temperature differences of the entire plantar foot and nine pre-specified regions were compared for validation. Intra-class correlations coefficient (ICC(3,1)) and Bland-Altman plots were used to test agreement. Clinical validity was assessed by calculating statistical measures of diagnostic performance. RESULTS Almost perfect agreement was found for temperature measurements in both the entire plantar foot and the combined pre-specified regions, respectively, with ICC values of 0.987 and 0.981, Bland-Altman plots' mean Δ = -0.14 and Δ = -0.06. Diagnostic accuracy showed 94% and 93% sensitivity, and 86% and 91% specificity. CONCLUSIONS The smartphone-based IR-camera shows excellent validity for diabetic foot assessment.
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Affiliation(s)
- R F M van Doremalen
- University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands; Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands.
| | - J J van Netten
- Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands; School of Clinical Sciences, Queensland University of Technology, 2 George St, Brisbane City, QLD 4000, Australia
| | - J G van Baal
- Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands; Cardiff University, Cardiff, Wales, United Kingdom
| | - M M R Vollenbroek-Hutten
- University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands; Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands
| | - F van der Heijden
- University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
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23
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Scoley GE, Gordon AW, Morrison SJ. Use of thermal imaging in dairy calves: exploring the repeatability and accuracy of measures taken from different anatomical regions. Transl Anim Sci 2018; 3:564-576. [PMID: 32704827 PMCID: PMC7200435 DOI: 10.1093/tas/txy126] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022] Open
Abstract
Three experiments were undertaken to 1) quantify the repeatability and reproducibility of thermal imaging across day and operator experience and 2) assess the correlation between descriptive infrared (IR) temperature parameters from different anatomical areas and core body temperature in dairy calves under 12 wk of age. In experiment 1, a single operator captured 30 replicate images of both the left and right eyes (defined as the whole eye + 1 cm margin) and the rectal area (defined as the anus +1.5 cm margin) from each of 16 calves. In experiment 2, three operators of varying experience captured images from both the left and right eyes and the rectal area of each of 12 calves. In experiment 3, a single operator captured images of the right eye and rectal area for a period of 5 consecutive days for each of 205 calves. All images were captured between 0900 and 1300 h. Core body temperature, obtained via rectal thermometer, was recorded every day for each of the 205 calves following completion of IR image capture. Ambient temperature and relative humidity were adjusted for each thermal image prior to manual extraction of maximum, minimum, and average temperature parameters. In experiment 1, lowest error variance was found within the maximum temperature parameter and the right eye was determined as the most repeatable anatomical area, with 80.48% of the total proportion of variance attributed to the calf. Results indicated that capturing at least three replicate images would provide the precision required to identify ill-health in calves. In experiment 2, operator variance was low across anatomical areas, with values of ≤0.01°C2 for the right and left eyes and ≤0.04°C2 for the rectal area. In experiment 3, day to day variation of thermal image measurements and core body temperature were minimal across anatomical areas with values of ≤0.008°C2. Correlations ranging from 0.16 to 0.32, and from 0.31 to 0.47 were found between maximum eye and core body temperature and maximum rectal area and core body temperature, respectively. Results of the present study indicate a low level of variability and high level of repeatability within IR temperature measurements in calves under 12 wk of age, particularly within maximum temperature parameters. Providing operators of varying abilities with a basic standardized protocol is sufficient to limit between-operator variation. Further research is required to investigate whether correlation between IR and core body temperature can be improved.
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Affiliation(s)
- Gillian E Scoley
- Agri-Food and Biosciences Institute, Hillsborough, Northern Ireland, Northern Ireland.,Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland
| | - Alan W Gordon
- Agri-Food and Biosciences Institute, Newforge Lane, Belfast, Northern Ireland
| | - Steven J Morrison
- Agri-Food and Biosciences Institute, Hillsborough, Northern Ireland, Northern Ireland
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