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Commitment devices in the treatment of diabetic foot ulcers
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics.ORCID iD: 0000-0002-6410-2474
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. Vol. 12, no 1, article id 44
Keywords [en]
Diabetes complications, Diabetic foot, Shoes, Patient compliance, Treatment adherence and compliance, Casts, surgical, Orthotic devices
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-76445DOI: 10.1186/s13047-019-0355-9ISI: 000483085000001PubMedID: 31452689Scopus ID: 2-s2.0-85070982474OAI: oai:DiVA.org:oru-76445DiVA, id: diva2:1351582
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2020-12-01Bibliographically approved

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Jarl, Gustav

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