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Jarl, G., Hulshof, C. M., Busch-Westbroek, T. E., Bus, S. A. & van Netten, J. J. (2023). Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use?. Sensors, 23(3), Article ID 1648.
Open this publication in new window or tab >>Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use?
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2023 (English)In: Sensors, E-ISSN 1424-8220, Vol. 23, no 3, article id 1648Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
diabetic foot, foot ulcer, footwear, patient compliance, shoes, treatment adherence and compliance, validation study
National Category
Endocrinology and Diabetes Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-104141 (URN)10.3390/s23031648 (DOI)000930383800001 ()36772691 (PubMedID)2-s2.0-85147892737 (Scopus ID)
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2023-03-08Bibliographically approved
Hellstrand Tang, U., Jarl, G., Eriksson, M., Johannesson, G. A. & Rusaw, D. F. (2023). Clinical guidelines recommending prosthetics and orthotics in Sweden: Agreement between national and regional guidelines. Prosthetics and Orthotics International
Open this publication in new window or tab >>Clinical guidelines recommending prosthetics and orthotics in Sweden: Agreement between national and regional guidelines
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2023 (English)In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Despite the presence of both national and regional clinical practical guidelines (CPGs) in Sweden, no previous studies have investigated the quality of CPGs or the level of agreement between national and regional CPGs.

OBJECTIVES: This study aimed to assess the quality of national CPGs recommending prosthetics and orthotics (P&O) and quantify the agreement between national and regional CPGs in Sweden.

STUDY DESIGN: Literature Review.

METHODS: National and regional CPGs were identified in public databases and by surveyed local nurse practitioners. Quality of the national guidelines was assessed by using AGREE II. Agreement between recommendations in the national and regional CPGs was quantified on a 4-grade rating scale ("similar," "partially similar," "not similar/not present," and "different").

RESULTS: Of 18 national CPGs, 3 CPGs (CPGs of Diabetes, Musculoskeletal disorders, and Stroke) had 9 recommendations related to P&O. The Musculoskeletal disorders and Stroke CPGs had quality scores .60% in all domains, and the Diabetes CPG had scores .60% in 5 of 6 domains according to AGREE II. Seven regional CPGs for P&O treatment were identified. Three national recommendations (in Diabetes CPGs) showed "similar" content for all regions, and 2 national recommendations (in Diabetes CPGs) showed "not similar" content for all regions. The remaining recommendations (Diabetes, Musculoskeletal disorders, and Stroke CPGs) had varying agreement with regional CPGs.

CONCLUSIONS: There is a limited number of national recommendations for treatment within P&O. There was variation in the agreement of P&O-related recommendations in national and regional CPGs, which might lead to unequal care throughout the national healthcare system.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
orthotic device, prosthetic limb, practice guidelines, guidelines, healthcare management
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-106637 (URN)10.1097/PXR.0000000000000244 (DOI)37369017 (PubMedID)
Available from: 2023-06-28 Created: 2023-06-28 Last updated: 2023-07-11Bibliographically approved
Appelros, P., Matérne, M., Jarl, G. & Arvidsson Lindvall, M. (2023). Comorbidity in Stroke Survivors in a Medium-Sized Swedish Municipality. In: : . Paper presented at 14th World Congress on Brain Injury, Dublin, Ireland, March 29 April, 2023..
Open this publication in new window or tab >>Comorbidity in Stroke Survivors in a Medium-Sized Swedish Municipality
2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-105849 (URN)
Conference
14th World Congress on Brain Injury, Dublin, Ireland, March 29 April, 2023.
Available from: 2023-05-05 Created: 2023-05-05 Last updated: 2023-11-02Bibliographically approved
Appelros, P., Matérne, M., Jarl, G. & Arvidsson Lindvall, M. (2023). Comorbidity in stroke survivors in a medium-sized Swedish municipality. Paper presented at 14th World Congress on Brain Injury, Dublin, Ireland, March 29 April, 2023. Brain Injury, 37(Suppl. 1), 135-136
Open this publication in new window or tab >>Comorbidity in stroke survivors in a medium-sized Swedish municipality
2023 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 37, no Suppl. 1, p. 135-136Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objectives: The purpose of this study was to evaluate the prevalence and impact of stroke-related comorbidity in a community-based sample of stroke survivors. With respect to the patients’ functional outcomes and general health, we wanted to find out which types of comorbidity were most important.

Materials and Methods: All stroke survivors (n = 330) living in a medium-sized Swedish municipality were included. To determine the presence of comorbidities patient records were reviewed. A selection of patient reported outcomes were used to assess subjective symptoms, functional outcomes, and general health. All patients were asked to answer a questionnaire, the Swedish Stroke Register (Riksstroke). Three questions from the questionnaire were used as additional measures of comorbidity. “Do you feel tired?,” “Do you have pain?” and “Do you feel depressed?” As outcome measures the patient reported measures from the Riksstroke questionnaire were used: * Do you still have problems after your stroke? * Have you been able to return to the life and activities you had before the stroke? * How is your mobility now? * Do you get help from someone when visiting the toilet? * Do you get help with dressing and undressing? * How do you assess your general health? Logistic regression models were used to investigate the association between comorbidities, residual symptoms, and subjective symptoms on the one hand, and functional outcomes and general health on the other hand.

Results: Hypertension (80%) was the most common cardiovascular risk factor. Ischemic heart disease was found in 18% and congestive heart failure in 10%. Of non-cardiovascular disorders, orthopedic diseases were commonest (30%). Psychiatric disorders and cognitive impairment were present in 11% and 12% respectively. Logistic regression analyses found that hemiparesis was associated with both poorer functional outcomes and lower general health. Additionally, orthopedic disorders, vertigo, cognitive impairment, nicotine use, chronic pulmonary disorders, and older age, were also associated with poorer functional outcomes. Psychiatric, orthopedic and neurological disorders were associated with poorer general health. The patient-reported outcome measure “feeling of tiredness” was a predictor of both outcomes, while “feeling depressed” and “having pain” were associated with poorer general health.

Conclusions: Many medical conditions, several of which have received little attention so far, are associated with poorer functional outcome and lower general health among stroke survivors. Future research into comorbidities relevant to function and general health in stroke patients could further focus on these disorders that hitherto have received little attention.

Place, publisher, year, edition, pages
Informa Healthcare, 2023
Keywords
Cerebrovascular disorders, Epidemiology, Sweden
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-110854 (URN)001092280000257 ()
Conference
14th World Congress on Brain Injury, Dublin, Ireland, March 29 April, 2023
Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-02-02Bibliographically approved
Lazzarini, P. A., Armstrong, D. G., Crews, R. T., Gooday, C., Jarl, G., Kirketerp-Moller, K., . . . Bus, S. A. (2023). Effectiveness of offloading interventions for people with diabetes-related foot ulcers: A systematic review and meta-analysis. Diabetes/Metabolism Research Reviews, e3650
Open this publication in new window or tab >>Effectiveness of offloading interventions for people with diabetes-related foot ulcers: A systematic review and meta-analysis
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2023 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, p. e3650-Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Offloading treatment is crucial to heal diabetes-related foot ulcers (DFU). This systematic review aimed to assess the effectiveness of offloading interventions for people with DFU.

METHODS: We searched PubMed, EMBASE, Cochrane databases, and trials registries for all studies relating to offloading interventions in people with DFU to address 14 clinical question comparisons. Outcomes included ulcers healed, plantar pressure, weight-bearing activity, adherence, new lesions, falls, infections, amputations, quality of life, costs, cost-effectiveness, balance, and sustained healing. Included controlled studies were independently assessed for risk of bias and had key data extracted. Meta-analyses were performed when outcome data from studies could be pooled. Evidence statements were developed using the GRADE approach when outcome data existed.

RESULTS: From 19,923 studies screened, 194 eligible studies were identified (47 controlled, 147 non-controlled), 35 meta-analyses performed, and 128 evidence statements developed. We found non-removable offloading devices likely increase ulcers healed compared to removable offloading devices (risk ratio [RR] 1.24, 95% CI 1.09-1.41; N = 14, n = 1083), and may increase adherence, cost-effectiveness and decrease infections, but may increase new lesions. Removable knee-high offloading devices may make little difference to ulcers healed compared to removable ankle-high offloading devices (RR 1.00, 0.86-1.16; N = 6, n = 439), but may decrease plantar pressure and adherence. Any offloading device may increase ulcers healed (RR 1.39, 0.89-2.18; N = 5, n = 235) and cost-effectiveness compared to therapeutic footwear and may decrease plantar pressure and infections. Digital flexor tenotomies with offloading devices likely increase ulcers healed (RR 2.43, 1.05-5.59; N = 1, n = 16) and sustained healing compared to devices alone, and may decrease plantar pressure and infections, but may increase new transfer lesions. Achilles tendon lengthening with offloading devices likely increase ulcers healed (RR 1.10, 0.97-1.27; N = 1, n = 64) and sustained healing compared to devices alone, but likely increase new heel ulcers.

CONCLUSIONS: Non-removable offloading devices are likely superior to all other offloading interventions to heal most plantar DFU. Digital flexor tenotomies and Achilles tendon lengthening in combination with offloading devices are likely superior for some specific plantar DFU locations. Otherwise, any offloading device is probably superior to therapeutic footwear and other non-surgical offloading interventions to heal most plantar DFU. However, all these interventions have low-to-moderate certainty of evidence supporting their outcomes and more high-quality trials are needed to improve our certainty for the effectiveness of most offloading interventions.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
diabetes mellitus, diabetic foot, foot ulcer, footwear, off-loading, offloading
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-106385 (URN)10.1002/dmrr.3650 (DOI)001007197400001 ()37292021 (PubMedID)2-s2.0-85159640606 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-06-28Bibliographically approved
Jansson, S. P., Ramstrand, S., Carlberg, M., Johannesson, G. A., Hiyoshi, A. & Jarl, G. (2023). Exploring potential risk factors for lower limb amputation in people with diabetes: an observational cohort study of 66,565 individuals with diabetes in Sweden. Paper presented at 59th EASD Annual Meeting of the European Association for the Study of Diabetes, Hamburg, Germany, October 2-6, 2023. Diabetologia, 66(Suppl. 1), S114-S115, Article ID 216.
Open this publication in new window or tab >>Exploring potential risk factors for lower limb amputation in people with diabetes: an observational cohort study of 66,565 individuals with diabetes in Sweden
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2023 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 66, no Suppl. 1, p. S114-S115, article id 216Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and aims: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how demographic and socioeconomic, medical and life-style risk factors may be associated with LLA in people with newly diagnosed diabetes.

Materials and methods: We conducted a cohort study using Swedish national register-linked data. We identified, through the Swedish national diabetes register, all individuals 18 years or older with an incident diabetes diagnosis and no previous amputation from 2007 to 2016. These individuals were followed from the date of the diagnosis to amputation, emigration, death, or the end of the study in 2017, whichever occurred first. Several national Swedish registers were used to obtain data on incident LLA and potential risk factors, including demographic and socioeconomic, medical and lifestyle variables. Variables with more than 40% missing data were excluded from the analysis. The cohort consisted of 66,569 individuals, where of 133 hadan amputation. Cox proportional hazards models were used to obtain hazard ratio (HR) with 95% confidence interval (CI) for associations between demographic and socioeconomic, medical and lifestyle vari-ables and amputation risk. Both unadjusted and mutually adjusted models were fitted.

Results: During the median follow-up time of 4 years there were in total 133 LLA. Based on the model mutually adjusting for all variables, higher age, HR 1.08 (95% CI, 1.05 - 1.10) per year, and being divorced compared with being married, HR 1.67 (1.07 - 2.60) showed positive association. Male sex indicated higher risk, HR 1.57 (1.06 - 2.34). Individuals with an increased foot risk at baseline had increased risk for LLA compared to individuals with healthy feet (neuropathy/angiopathy, HR 4.12 (2.84 - 5.98), previous wounds, HR 8.26 (3.29 - 20.74), ongoing severe foot disease, HR 11.24 (4.82 - 26.23). Insulin treatment compared with diet-only treatment showed HR 2.03 (1.10 - 3.74). Hypertension and HbA1c were not statistically significantly associated with LLA risk. People with obesity had a statistically significant lower risk, HR 0.46 (0.29 - 0.75), compared with individuals with normal weight. Smoking was associated with an increased risk compared with no smoking, HR 1.99 (1.28 - 3.09). Finally, low physical activity (<1 time/week) was associated with an increased risk with a HR of 2.05 (1.30 - 3.23) compared with daily physical activity.

Conclusion: This study found a higher risk for LLA among people with higher age, male sex, who were divorced, who had a higher foot risk group, who were on insulin treatment, lower physical activity levels, and who were smoking. Obesity was associated with lower risk for LLA. Thus, these variables may have important roles in LLA risk among individuals with diabetes.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-109778 (URN)001065473000216 ()
Conference
59th EASD Annual Meeting of the European Association for the Study of Diabetes, Hamburg, Germany, October 2-6, 2023
Funder
NyckelfondenRegion Örebro County
Note

The study was funded by Nyckelfonden and Forskningskommitten at Region Örebro County and by Fonden for rehabilitering och medicinsk forskning.

Available from: 2023-11-21 Created: 2023-11-21 Last updated: 2023-11-21Bibliographically approved
Jarl, G., van Netten, J. J. & Lazzarini, P. A. (2023). Fragile Feet and Trivial Trauma: Communicating the Etiology of Diabetic Foot Ulcers to Patients. Journal of the American Podiatric Medical Association (Print), 113(1), Article ID 21-027.
Open this publication in new window or tab >>Fragile Feet and Trivial Trauma: Communicating the Etiology of Diabetic Foot Ulcers to Patients
2023 (English)In: Journal of the American Podiatric Medical Association (Print), ISSN 8750-7315, E-ISSN 1930-8264, Vol. 113, no 1, article id 21-027Article in journal (Refereed) Published
Abstract [en]

People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a simplified model of DFU etiology and prevention to aid communication with patients. The Fragile Feet & Trivial Trauma model focuses on two broad sets of risk factors: predisposing and precipitating. Predisposing risk factors (eg, neuropathy, angiopathy, and foot deformity) are usually lifelong and result in "fragile feet." Precipitating risk factors are usually different forms of everyday trauma (eg, mechanical, thermal, and chemical) and can be summarized as "trivial trauma." We suggest that the clinician consider discussing this model with their patient in three steps: 1) explain how a patient's specific predisposing risk factors result in fragile feet for the rest of life, 2) explain how specific risk factors in a patient's environment can be the trivial trauma that triggers development of a DFU, and 3) discuss and agree on with the patient measures to reduce the fragility of the feet (eg, vascular surgery) and prevent trivial trauma (eg, wear therapeutic footwear). By this, the model supports the communication of two essential messages: that patients may have a lifelong risk of ulceration but that there are health-care interventions and self-care practices that can reduce these risks. The Fragile Feet & Trivial Trauma model is a promising tool for aiding communication of foot ulcer etiology to patients. Future studies should investigate whether using the model results in improved patient understanding and self-care and, in turn, contributes to lower ulceration rates.

Place, publisher, year, edition, pages
American Podiatric Medical Association, 2023
National Category
Endocrinology and Diabetes Nursing
Identifiers
urn:nbn:se:oru:diva-104891 (URN)10.7547/21-027 (DOI)001112027400002 ()36905618 (PubMedID)2-s2.0-85150225601 (Scopus ID)
Available from: 2023-03-13 Created: 2023-03-13 Last updated: 2024-01-22Bibliographically approved
Bus, S. A., Armstrong, D. G., Crews, R. T., Gooday, C., Jarl, G., Kirketerp-Moller, K., . . . Lazzarini, P. A. (2023). Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research Reviews, Article ID e3647.
Open this publication in new window or tab >>Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update)
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2023 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, article id e3647Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes-related foot ulcers. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on offloading interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline.

MATERIALS AND METHODS: We followed the GRADE approach by devising clinical questions and important outcomes in the PICO (Patient-Intervention-Control-Outcome) format, undertaking a systematic review and meta-analyses, developing summary of judgement tables and writing recommendations and rationales for each question. Each recommendation is based on the evidence found in the systematic review, expert opinion where evidence was not available, and a careful weighing of GRADE summary of judgement items including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability.

RESULTS: For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, use a non-removable knee-high offloading device as the first-choice offloading intervention. If contraindications or patient intolerance to non-removable offloading exist, consider using a removable knee-high or ankle-high offloading device as the second-choice offloading intervention. If no offloading devices are available, consider using appropriately fitting footwear combined with felted foam as the third-choice offloading intervention. If such a non-surgical offloading treatment fails to heal a plantar forefoot ulcer, consider an Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or metatarsal osteotomy. For healing a neuropathic plantar or apex lesser digit ulcer secondary to flexibile toe deformity, use digital flexor tendon tenotomy. For healing rearfoot, non-plantar or ulcers complicated with infection or ischaemia, further recommendations have been outlined. All recommendations have been summarised in an offloading clinical pathway to help facilitate the implementation of this guideline into clinical practice.

CONCLUSION: These offloading guideline recommendations should help healthcare professionals provide the best care and outcomes for persons with diabetes-related foot ulcers and reduce the person's risk of infection, hospitalisation and amputation.

Place, publisher, year, edition, pages
American Physical Society, 2023
Keywords
Cast, diabetic foot, foot ulcer, footwear, offloading, surgery
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-106047 (URN)10.1002/dmrr.3647 (DOI)000994504600001 ()37226568 (PubMedID)2-s2.0-85160085141 (Scopus ID)
Note

Funding agencies:

Advanced Oxygen Therapy Inc.

Essity

Mölnlycke

Reapplix

Urgo Medical

Available from: 2023-05-26 Created: 2023-05-26 Last updated: 2023-12-08Bibliographically approved
Gigante, I., Sigurjónsdóttir, E. D., Jarl, G. & Hellstrand Tang, U. (2023). Offloading of diabetes-related neuropathic foot ulcers at Swedish prosthetic and orthotic clinics. Diabetes/Metabolism Research Reviews, 39(4), e3611
Open this publication in new window or tab >>Offloading of diabetes-related neuropathic foot ulcers at Swedish prosthetic and orthotic clinics
2023 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 39, no 4, p. e3611-Article in journal (Refereed) Published
Abstract [en]

AIM: This study aimed to assess 1) the use of different offloading interventions in Sweden for the healing of diabetes-related plantar neuropathic forefoot ulcers, 2) factors influencing the offloading intervention choice, and 3) the awareness of current gold standard offloading devices.

METHODS: An online questionnaire was distributed via SurveyMonkey to 51 prosthetic and orthotic clinics in Sweden.

RESULTS: Thirty-five (69%) practitioners responded to the questionnaire. Eighty-six percent of the practitioners provided modified off-the-shelf footwear combined with insoles to treat diabetes-related plantar neuropathic forefoot ulcers. A total contact cast (TCC) was provided by 20% of the practitioners, and a nonremovable knee-high walker was provided by 0%. Multiple practitioner-, patient-, intervention-, and wound-related factors were considered when practitioners provided offloading interventions to patients with this type of ulcer. The majority of the practitioners did not or were unsure whether they considered TCC or a nonremovable knee-high walker to be the gold standard treatment.

CONCLUSIONS: Practitioners mainly provided the offloading intervention that the International Working Group on the Diabetic Foot strongly recommends not be provided, namely, modified off-the-shelf footwear with insoles. In contrast, TCC and nonremovable knee-high walkers, as the gold standards, were vastly underutilized. Therefore, the pattern of providing offloading interventions was almost exactly opposite the recommendations of evidence-based guidelines. Different factors were considered when providing offloading interventions to patients with diabetes-related plantar neuropathic forefoot ulcers. The practitioners' lack of awareness regarding gold standard devices may have contributed to the underutilization of TCC and nonremovable knee-high walkers. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Plantar forefoot ulcer, diabetic foot, diabetic foot ulcers, evidence-based guidelines, offloading, orthotics
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-103317 (URN)10.1002/dmrr.3611 (DOI)000925738100001 ()36653883 (PubMedID)2-s2.0-85147456974 (Scopus ID)
Available from: 2023-01-23 Created: 2023-01-23 Last updated: 2023-12-08Bibliographically approved
Jarl, G., Rusaw, D. F., Terrill, A. J., Barnett, C. T., Woodruff, M. A. & Lazzarini, P. A. (2023). Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers. Journal of Diabetes Science and Technology, 17(1), 99-106
Open this publication in new window or tab >>Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers
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2023 (English)In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, Vol. 17, no 1, p. 99-106Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Diabetes Technology Society, 2023
Keywords
casts, diabetic foot, foot ulcer, orthotic devices, shoes, treatment adherence and compliance
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-99499 (URN)10.1177/19322968221101632 (DOI)000906942300012 ()35658555 (PubMedID)2-s2.0-85131536666 (Scopus ID)
Note

Funding agencies:

National Health and Medical Research Council (NHMRC) of Australia 2014165  

Urgo Foundation

Available from: 2022-06-15 Created: 2022-06-15 Last updated: 2023-01-31Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6410-2474

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