Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use?

Abstract

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.

Evaluation of usability, adherence, and clinical efficacy of therapeutic footwear in persons with diabetes at moderate to high risk of diabetic foot ulcers: A multicenter prospective study

“…Finally, in the current research wearing time of therapeutic footwear was measured with self-report questions (included in Mos-Post questionnaire); Jarl G et al questioned this kind of subjective method to assess wearing time and adherence, thus our results could be overestimated. 27 Further research should confirm our results with a larger sample population. Finally, we only included patients with moderate to high risk (IWGDF risk 2-3) of diabetic foot ulcer.…”

“…Finally, in the current research wearing time of therapeutic footwear was measured with self-report questions (included in Mos-Post questionnaire); Jarl G et al questioned this kind of subjective method to assess wearing time and adherence, thus our results could be overestimated. 27…”

The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies

“…However, that study used only two measurements (daily steps and in-device plantar pressures), which were measured only once (at baseline). Additionally, adherence was measured via self-report, which has since been found to be unreliable [ 36 ], and barefoot pressures and shear stress were not measured. To improve reliability in this study, we used four sensor devices to measure and determine CPTS in our current studies, and we attempted to collect the data three times during follow-up to investigate changes over time.…”

“…Next, the number of strides taken when using and not using the offloading device were determined. Adherence was then determined as the proportion of strides when wearing the offloading device of the total number of strides taken by the participant [ 36 ].…”

Offloading and adherence through technological advancements: Modern approaches for better foot care in diabetes

“…For these reasons, self‐reported adherence, being quick, cost‐effective, and easy to implement, is more extensively utilised in clinical practice and research 29 . Despite its convenience, self‐reported adherence measures have proven to be unreliable when compared to objective measures, as seen in the use of footwear or offloading devices in people with diabetic foot disease and analogous treatments such as brace treatments for scoliosis 29–31 . Recent research has shown a significant discrepancy between patient self‐reported and objectively measured adherence, indicating an overestimation of the former by approximately 2.6 times 29 .…”