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Jarl, G. & Lundqvist, L.-O. (2020). An alternative perspective on assistive technology: the Person-Environment-Tool (PET) model. Assistive technology, 32(1), 47-53
Open this publication in new window or tab >>An alternative perspective on assistive technology: the Person-Environment-Tool (PET) model
2020 (English)In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 32, no 1, p. 47-53Article in journal (Refereed) Published
Abstract [en]

The medical and social models of disability are based on a dichotomy that categorizes people as able-bodied or disabled. In contrast, the biopsychosocial model, which forms the basis for the International Classification of Functioning, Disability and Health (ICF), suggests a universalistic perspective on human functioning, encompassing all human beings. In this article we argue that the artificial separation of function-enhancing technology into assistive technology (AT) and mainstream technology might be one of the barriers to a universalistic view of human functioning. Thus, an alternative view of AT is needed. The aim of this article was to construct a conceptual model to demonstrate how all human activities and participation depend on factors related to the person, environment, and tools, emphasizing a universalistic perspective on human functioning. In the Person-Environment-Tool (PET) model, a person's activity and participation are described as a function of factors related to the person, environment, and tool, drawing on various ICF components. Importantly, the PET model makes no distinction between people of different ability levels, between environmental modifications intended for people of different ability levels, or between different function-enhancing technologies (AT and mainstream technology). A fictive patient case is used to illustrate how the universalistic view of the PET model lead to a different approach in rehabilitation. The PET model supports a universalistic view of technology use, environmental adaptations, and variations in human functioning.

Place, publisher, year, edition, pages
New York, USA: Taylor & Francis, 2020
Keywords
activities of daily living, environmental modifications, universal design
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-66705 (URN)10.1080/10400435.2018.1467514 (DOI)000506052500007 ()29676966 (PubMedID)2-s2.0-85065504570 (Scopus ID)
Note

Funding Agency:

Region Örebro County

Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2020-01-20Bibliographically approved
Jarl, G. & Hermansson, L. (2019). A modified walk-in clinic for shoe insoles: Follow-up of non-attendants. Prosthetics and orthotics international, 43(6), 597-600
Open this publication in new window or tab >>A modified walk-in clinic for shoe insoles: Follow-up of non-attendants
2019 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 6, p. 597-600Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: = 1286), we found that a modified walk-in system reduced waiting times for prescription of shoe insoles by 40 days compared to scheduled appointments but resulted in a non-attendance rate of 17% compared to 6% for scheduled appointments.

OBJECTIVES: To investigate the reasons for non-attendance at the modified walk-in clinic.

STUDY DESIGN: This is a cross-sectional survey.

METHODS: Unlike traditional walk-in clinics, a limited number of patients were invited each week from the waiting list to attend the modified walk-in clinic on pre-specified days during the following 5 weeks. A questionnaire was sent to 137 patients who did not attend the modified walk-in clinic, of whom 50 (36%) responded.

RESULTS: The most frequently reported reasons for not attending were the following: could not attend on the suggested days and times (30%), had already received help (18%) and illness or other medical interventions (16%). The majority of these issues could have been overcome by rescheduling to a scheduled appointment.

CONCLUSION: The main reason for not attending a modified walk-in clinic was that suggested days and times did not suit the patients. The option to reschedule the appointment needs to be clearly emphasized in the information provided to the patient.

CLINICAL RELEVANCE: With clear information about rescheduling options, a modified walk-in clinic could be used to reduce waiting times for certain groups of patients.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Rehabilitation, lower limb orthotics, orthotics
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-77462 (URN)10.1177/0309364619879285 (DOI)000491458700001 ()31621506 (PubMedID)
Note

Funding Agency:

Region Örebro County, Sweden

Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-12-12Bibliographically approved
Tranberg, R. & Jarl, G. (2019). An innovative sealed therapeutic shoe to offload and heal diabetic forefoot ulcers. In: : . Paper presented at EWMA - European Wound Management Association, 2019, Gothenburg, Sweden, 5-7 June, 2019.
Open this publication in new window or tab >>An innovative sealed therapeutic shoe to offload and heal diabetic forefoot ulcers
2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77485 (URN)
Conference
EWMA - European Wound Management Association, 2019, Gothenburg, Sweden, 5-7 June, 2019
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-22Bibliographically approved
Jarl, G. & Tranberg, R. (2019). An innovative sealed therapeutic shoe to offload and heal diabetic forefoot ulcers. In: : . Paper presented at 8th International Symposium on the Diabetic Foot, Hague, Netherlands, 22-25 May, 2019.
Open this publication in new window or tab >>An innovative sealed therapeutic shoe to offload and heal diabetic forefoot ulcers
2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77776 (URN)
Conference
8th International Symposium on the Diabetic Foot, Hague, Netherlands, 22-25 May, 2019
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-07Bibliographically approved
Alnemo, J., Tranberg, R., Lundqvist, L.-O. & Jarl, G. (2019). Are the left and right limbs unequally affected by diabetic foot complications?. In: 8th International symposium on diabetic foot: Abstract book. Paper presented at 8th Internationel Conference of the Diabetic foot, Haag, Netherlands, 22-25 May, 2019 (pp. 140-140). , Article ID P45.04.
Open this publication in new window or tab >>Are the left and right limbs unequally affected by diabetic foot complications?
2019 (English)In: 8th International symposium on diabetic foot: Abstract book, 2019, p. 140-140, article id P45.04Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Aim: There is some debate about laterality for diabetic foot complications, that is, whether the right and left limbs are unequally affected. Coxon and Gallen (1) found that more amputations were performed on the right limb and Evans et al. (2) interpreted this in the context of foot dominance: they found that most foot ulcers occured on the dominant limb (which for most people is the right one) and speculated that the dominant limb may be more exposed to mechanical stresses and injuries. However, Demetriou et al. (3) did not find any laterality in foot ulcer location. The aim was to investigate laterality for foot ulcers and amputations. Methods: A questionnaire was posted to 1245 people who had diabetes, experience of using therapeutic shoes, and who had attended one of two prosthetics and orthotics clinics during a 12 months’ period. The number of ulcers or amputations on the right and left limb were compared with a two-sided chi-square test. Results: 469 (37.7%) questionnaires were returned. 118 (25.2%) participants reported unilateral foot ulcers, 54 (11.5%) reported unilateral minor amputation, and 21 (4.5%) reported unilateral major amputation. There was no statistically significant right-left difference in foot ulcers, minor amputations or major amputations (Table 1, p-values 0.713-1.000). Conclusions: Our results do not support the hypothesis about laterality for foot ulcers and amputations.

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77196 (URN)
Conference
8th Internationel Conference of the Diabetic foot, Haag, Netherlands, 22-25 May, 2019
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-16Bibliographically approved
Alnemo, J., Tranberg, R., Lundqvist, L.-O. & Jarl, G. (2019). Are the left and right limbs unequally affected by diabetic foot complications?. In: : . Paper presented at EWMA 2019 - European Wound Management Association, Gothenburg, Sweden, 5-7 June, 2019.
Open this publication in new window or tab >>Are the left and right limbs unequally affected by diabetic foot complications?
2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77486 (URN)
Conference
EWMA 2019 - European Wound Management Association, Gothenburg, Sweden, 5-7 June, 2019
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-22Bibliographically approved
Alnemo, J., Lundqvist, L.-O., Tranberg, R. & Jarl, G. (2019). Attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications. In: 8th International symposium on diabetic foot: Absttaract book. Paper presented at 8th International conference ot the Diabetic Foot, Hague, Netherlands, May 22-25, 2019 (pp. 117-117). , Article ID P35.05.
Open this publication in new window or tab >>Attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications
2019 (English)In: 8th International symposium on diabetic foot: Absttaract book, 2019, p. 117-117, article id P35.05Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications.

Methods: A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women's and men's answers were compared using t-tests, Mann-Whitney U tests and chi-square tests with Fischer's exact tests. P-values < 0.05 were considered statistically significant.

Results: Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women (p < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes' efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support.

Conclusions: Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients' concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77212 (URN)
Conference
8th International conference ot the Diabetic Foot, Hague, Netherlands, May 22-25, 2019
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-10-16Bibliographically approved
Jarl, G. (2019). Changing concepts–changing minds: Ulysses contracts in the treatment of diabetic foot ulcers with non-removable offloading devices. In: 8th International symposium on diabetic foot: Abstract book. Paper presented at 8th International Symposium on the Diabetic Foot 2019, Hague, Netherlands, May 22-25, 2019 (pp. 89-89). , Article ID P24.02.
Open this publication in new window or tab >>Changing concepts–changing minds: Ulysses contracts in the treatment of diabetic foot ulcers with non-removable offloading devices
2019 (English)In: 8th International symposium on diabetic foot: Abstract book, 2019, p. 89-89, article id P24.02Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Aim: To change concepts is important to change how clinicians and patients conceptualize and act on diabetic foot disease. Different concepts have been introduced for different purposes, e.g., “diabetic foot attack” to emphasize urgency (1), “in remission” to emphasize the high risk of reulceration (2), and “latent diabetic foot disease” to emphasize diabetic foot disease as a single process, encompassing both active and latent phases (3). The aim was to review and discuss conceptualizations of treatment with non-removable offloading devices.

Methods: Review and analysis of literature.

Results: The “forced compliance” concept has been used to denote the use of non-removable offloading devices as a means to secure a high level of compliance/adherence (4). However, this concept may be inappropriate for two reasons. First, the concept has a paternalistic connotation of patients obeying doctors, which is not compatible with viewing patients as partners in decision making. Second, the concept conveys the meaning of doctors as being active (“forcing” compliance) and patients as being passive (being “forced”). Although these connotations are unintended they still may counteract the active and long-term personal responsibility for self-care that we wish to stimulate in our patients. “Ulysses contracts” (originating from Homer’s Odyssey) denote freely made decisions that bind the person in the future. Conceptualizing non-removable offloading devices as Ulysses contracts rather than means to force compliance has two advantages. First, Ulysses contracts emphasize that patients make choices by free will. Second, the “forcing” (i.e., eliminating the alternative to be non-compliant/adherent in the future) does not happen between the doctor and patient, but between the patient’s current and future self. Hence, the patient remains an active and responsible agent during the treatment period which hopefully will spill over into the in remission periods, when removable devices are used and personal responsibility for adherence is crucial.

Conclusions: Ulysses contracts could be a viable way to conceptualize treatment with non-removable offloading devices.

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77284 (URN)
Conference
8th International Symposium on the Diabetic Foot 2019, Hague, Netherlands, May 22-25, 2019
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-10-16Bibliographically approved
Jarl, G. (2019). Commitment devices in the treatment of diabetic foot ulcers. Journal of Foot and Ankle Research, 12(1), Article ID 44.
Open this publication in new window or tab >>Commitment devices in the treatment of diabetic foot ulcers
2019 (English)In: Journal of Foot and Ankle Research, ISSN 1757-1146, Vol. 12, no 1, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: Non-removable offloading devices are recommended for the treatment of uncomplicated plantar diabetic foot ulcers because adherence to using removable devices is low. However, patients may not always understand how crucial the non-removability is to ulcer healing, leaving them with the impression that it is the device per se that heals the ulcer. Thus, after ulcer healing when patients return to using removable offloading devices, typically therapeutic footwear, they often return to a low level of adherence resulting in high reulceration rates. To change this pattern of behavior based on a misconception, we need to start with how we as clinicians are conceptualizing treatment with offloading devices.

Non-removable offloading devices as commitment devices: Commitment devices are voluntary restrictions people put on their future selves to resist short-term temptations and achieve long-term goals. In this paper, it is suggested that a change from viewing non-removable offloading devices as means to force compliance, to viewing them as commitment devices could facilitate a change to a clinical thinking that emphasizes the importance of high adherence without compromising respect for patient autonomy.

Conclusion: Viewing non-removable offloading devices as commitment devices seems to be a promising approach to emphasize the importance of adherence while respecting patient autonomy. Hopefully, patients' higher appreciation of the role of adherence can lead to higher adherence to using therapeutic footwear after healing and consequently to reduced reulceration rates.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Diabetes complications, Diabetic foot, Shoes, Patient compliance, Treatment adherence and compliance, Casts, surgical, Orthotic devices
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-76445 (URN)10.1186/s13047-019-0355-9 (DOI)000483085000001 ()31452689 (PubMedID)2-s2.0-85070982474 (Scopus ID)
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2019-09-16Bibliographically approved
Jarl, G. (2019). Decision trees to facilitate risk stratification of the diabetic foot. In: 8th International Symposium on diabetic foot: Abstract book. Paper presented at 8th International Symposium on the Diabetic Foot 2019, Hauge, Netherlands, May 22-25, 2019 (pp. 72-72). , Article ID P16.06.
Open this publication in new window or tab >>Decision trees to facilitate risk stratification of the diabetic foot
2019 (English)In: 8th International Symposium on diabetic foot: Abstract book, 2019, p. 72-72, article id P16.06Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Aim: Delays in referrals from primary care to specialist care clinics are a common issue in the clinical management of diabetic foot disease and are associated with worse clinical outcomes in terms of ulcer healing and major amputations (1-3). One reasons for the delays may be the complexity of risk stratification; a number of different risk factors, such as foot deformity, neuropathy and peripheral arterial disease, interact and influence the risk of developing diabetic foot complications. The aim was to illustrate how decision trees can be constructed to facilitate risk stratification.

Methods: A decision tree (4) was created based on the risk stratification described in the guideline document by the National Institute for Health and Care Excellence (NICE) (5).

Results: With the help of the decision tree in Figure 1, clinicians without specialised knowledge in diabetic foot disease can stratify all diabetic feet with only four decision points or less. This could facilitate accurate risk stratification and timely referral of patients.

Conclusions: Even complex risk stratifications as the one described by NICE can be transformed into simple decision trees for use in busy clinics. Future studies should investigate whether the use of decision trees lead to more accurate risk stratifications and referrals, improving the outcomes for people with diabetic foot disease.

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-77281 (URN)
Conference
8th International Symposium on the Diabetic Foot 2019, Hauge, Netherlands, May 22-25, 2019
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-10-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6410-2474

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