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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: 2020-03-17Bibliographically approved
Jarl, G., Rusaw, D. F. & Johannesson, A. (2020). Comment on van Netten, et al: Definitions and criteria for diabetic foot disease. Endocrinology, Diabetes and Metabolism
Open this publication in new window or tab >>Comment on van Netten, et al: Definitions and criteria for diabetic foot disease
2020 (English)In: Endocrinology, Diabetes and Metabolism, ISSN 2398-9238Article in journal (Refereed) Published
Abstract [en]

Objective: The International Working Group on the Diabetic Foot (IWGDF) recently published updated definitions for the diabetic foot field. However, the suggested definitions of lower limb amputations differ from the definitions of the International Organization of Standardization (ISO), which may create problems when implementing the definitions. This paper compares and discusses the amputation definitions of IWGDF and ISO.

Results: Despite many similarities, the IWGDF and ISO systems have some important differences. First, the IWGDF uses the term “minor amputation” which is value-laden, arbitrary and has been defined in several different ways in the literature. Second, the IWGDF system lacks descriptions of amputations distal or through the ankle, which may increase the risk for misclassification. Third, hip disarticulations and transpelvic amputations are not included in the IWGDF system.

Conclusion: It is suggested that future updates of the IWGDF definitions should be aligned with those of ISO, to meet the goal of global consensus on terminology related to lower limb amputation. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Amputation, classification, diabetic foot
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-81875 (URN)10.1002/edm2.142 (DOI)
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-19Bibliographically approved
Lazzarini, P. A., Jarl, G., Gooday, C., Viswanathan, V., Caravaggi, C. F., Armstrong, D. G. & Bus, S. A. (2020). Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review. Diabetes/Metabolism Research Reviews, 36(Suppl. 1), Article ID e3275.
Open this publication in new window or tab >>Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review
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2020 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 36, no Suppl. 1, article id e3275Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Offloading interventions are commonly used in clinical practice to heal foot ulcers. The aim of this updated systematic review is to investigate the effectiveness of offloading interventions to heal diabetic foot ulcers.

METHODS: We updated our previous systematic review search of PubMed, EMBASE, and Cochrane databases to also include original studies published between July 29, 2014 and August 13, 2018 relating to four offloading intervention categories in populations with diabetic foot ulcers: (a) offloading devices, (b) footwear, (c) other offloading techniques, and (d) surgical offloading techniques. Outcomes included ulcer healing, plantar pressure, ambulatory activity, adherence, adverse events, patient-reported measures, and cost-effectiveness. Included controlled studies were assessed for methodological quality and had key data extracted into evidence and risk of bias tables. Included non-controlled studies were summarised on a narrative basis.

RESULTS: We identified 41 studies from our updated search for a total of 165 included studies. Six included studies were meta-analyses, 26 randomised controlled trials (RCTs), 13 other controlled studies, and 120 non-controlled studies. Five meta-analyses and 12 RCTs provided high-quality evidence for non-removable knee-high offloading devices being more effective than removable offloading devices and therapeutic footwear for healing plantar forefoot and midfoot ulcers. Total contact casts (TCCs) and non-removable knee-high walkers were shown to be equally effective. Moderate-quality evidence exists for removable knee-high and ankle-high offloading devices being equally effective in healing, but knee-high devices have a larger effect on reducing plantar pressure and ambulatory activity. Low-quality evidence exists for the use of felted foam and surgical offloading to promote healing of plantar forefoot and midfoot ulcers. Very limited evidence exists for the efficacy of any offloading intervention for healing plantar heel ulcers, non-plantar ulcers, and neuropathic ulcers with infection or ischemia.

CONCLUSION: Strong evidence supports the use of non-removable knee-high offloading devices (either TCC or non-removable walker) as the first-choice offloading intervention for healing plantar neuropathic forefoot and midfoot ulcers. Removable offloading devices, either knee-high or ankle-high, are preferred as second choice over other offloading interventions. The evidence bases to support any other offloading intervention is still weak and more high-quality controlled studies are needed in these areas.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Diabetes mellitus, diabetic foot, foot ulcer, footwear, off-loading, offloading, offloading device, pressure, surgery, systematic review
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-80912 (URN)10.1002/dmrr.3275 (DOI)32176438 (PubMedID)2-s2.0-85081724588 (Scopus ID)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2020-03-30Bibliographically approved
Bus, S. A., Armstrong, D. G., Gooday, C., Jarl, G., Caravaggi, C., Viswanathan, V., . . . International Working Group on the Diabetic Foot, (. (2020). Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes/Metabolism Research Reviews, 36(Suppl 1), Article ID e3274.
Open this publication in new window or tab >>Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)
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2020 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 36, no Suppl 1, article id e3274Article in journal (Refereed) Published
Abstract [en]

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee-high offloading device is the first choice of offloading treatment. A removable knee-high and removable ankle-high offloading device are to be considered as the second- and third-choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth-choice offloading treatment. If non-surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Cast, diabetic foot, foot ulcer, footwear, guidelines, offloading, surgery
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-80913 (URN)10.1002/dmrr.3274 (DOI)32176441 (PubMedID)2-s2.0-85081900932 (Scopus ID)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2020-03-30Bibliographically 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
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6410-2474

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