Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free‐living environments

Sheahan, Helen; Canning, Kimberley; Refausse, Nishka; Kinnear, Ewan M; Jorgensen, Greg; Walsh, James; Lazzarini, Peter A

doi:10.1111/iwj.12782

Cited by 23 publications

(44 citation statements)

References 47 publications

(152 reference statements)

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“…A validation set of 30 publications was created, including key studies known to the authors published since our previous search (July 29, 2014) . Using this set, the search strings used were validated; ie, each publication had to be identified before the search strings were used in this systematic review.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

246

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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.

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Section: Methodsmentioning

confidence: 99%

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

246

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“…With advances in signal processing and multi‐sensor devices, it is now possible to comprehensively monitor activity beyond counting steps. This includes measurements of total weight‐bearing activity, bouts of weight‐bearing activity, and activity intensity . Najafi et al found that neuropathic patients spent approximately three folds as much time weight‐bearing per day as walking, and that daily standing time may be predictive of worse DFU healing outcomes .…”

Section: Technologies For Effective and Personalized Prescription Of mentioning

confidence: 99%

“…This includes measurements of total weight-bearing activity, bouts of weight-bearing activity, and activity intensity. [28][29][30] Najafi et al 31 found that neuropathic patients spent approximately three folds as much time weight-bearing per day as walking, and that daily standing time may be predictive of worse DFU healing outcomes. 32 In a recent exploratory study, 33 Figure 3).…”

Section: Technologies For Effective and Personalized Prescription Omentioning

confidence: 99%

Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission

Najafi

Reeves

Armstrong

2020

Diabetes Metabolism Res

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The prevalent and long neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. Management of the DFU is multifaceted and requires constant monitoring from patients, caregivers, and healthcare providers. The alarmingly high rates of recurrence of ulcerations in the diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. Our efforts should be directed not only on healing of open wounds, but also on maximizing ulcer‐free days for the patient in diabetic foot remission. The increasing development and use of technology within every aspect of our lives represents an opportunity for creative solutions to prevent or better manage this devastating condition. In particular, recent advances in wearable and mobile health technologies appear to show promise in measuring and modulating dangerous foot pressure and inflammation to extend remission and improve the quality of life for these most complex patients. This review article discusses how harnessing wearables and digital technologies may improve the management and optimize prevention of DFUs by identifying high‐risk patients for triage and timely intervention, personalizing prescription of offloading, and improving adherence to protective footwear. While still in their infancy, we envisage a future network of skin‐worn, jewellery‐worn, and implantable sensors that, if allowed to effectively communicate with one another and the patient, could dramatically impact measuring, personalizing, and managing how we and the patients we serve move through our collective world.

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“…23 These calculations suggested 25 participants were required in each group to determine a statistical difference for daily steps which is considered a surrogate marker of daily activity. 23,24…”

Section: Sample Sizementioning

confidence: 99%

“…23 No further advice was provided as the study aim was to observe typical daily activity of participants in their normal free-living everyday environment. 23 At least five days of data from wearing the device for at least 22 hours on each of those days, with at least one of those days being a weekend day, was required to be eligible for the participant's data to be included, as this period has been previously validated to be representative of typical daily activity. [31][32][33][34] Days in which a participant wore the device for less than 22 hours were excluded.…”

Section: Participant Characteristicsmentioning

confidence: 99%

Moderate-to-Vigorous-Intensity Physical Activity Observed in People With Diabetes-Related Foot Ulcers Over a One-Week Period

Lee

Netten

Sheahan

et al. 2019

J Diabetes Sci Technol

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Background: Regular moderate-to-vigorous-intensity physical activity results in health benefits in people with diabetes. No study has observed the moderate-to-vigorous-intensity physical activity typically performed by people with diabetes-related foot ulcers (DFU) in their everyday free-living environments. We observed the bouts, and accumulated time, spent doing moderate-to-vigorous-intensity physical activity in cases with DFU compared with diabetes-related peripheral neuropathy (DPN) and diabetes (DM) controls over a one-week period. Methods: This was a secondary analysis of a cross-sectional case-control study. Participants wore a multisensor device for >5 days (>22 hours per day). Primary outcomes included the number, duration (minutes) and intensity (metabolic equivalent tasks [METs]) of bouts of moderate-to-vigorous-intensity physical activity (defined as at least >3 METs for >10 consecutive minutes). Secondary outcomes included the total accumulated times spent doing moderate-to-vigorous-intensity physical activity (>3 METs) and doing sedentary-intensity activity (<1.5 METs). DFU subgroups with minor amputations and nonremovable offloading devices were also analyzed. Results: Overall, 15 DM, 23 DPN, and 27 DFU participants were included. All groups recorded similar low median daily numbers (0.33, 0.29, 0.25 numbers, respectively), duration (15, 17, 14 minutes), and intensity of daily bouts of moderate-to-vigorous-intensity physical activity (4.1, 4.3, 3.9 METs) (all, P > .1). Median accumulated daily time spent doing moderate-to-vigorous-intensity physical activity was also similar (40, 37, 36 minutes; P > .8). Those with DFU had more mean accumulated daily time spent doing sedentary-intensity activity (796 minutes) compared to DPN (720 minutes; P < .05), but not compared to DM (728 minutes; P < .08). DFU subgroups with minor amputations had more median accumulated daily time spent doing moderate-to-vigorous-intensity physical activity (66, 28 minutes; P < .05) and less mean time doing sedentary-intensity activity (745, 837; P < .05) than those without amputations. Conclusions: People with DFU performed similar low numbers of daily bouts of moderate-to-vigorous-intensity physical activity to controls, but spend more time doing sedentary-intensity activities. Interventions that gradually increase the moderate-to-vigorous-intensity physical activity in people with DFU should be investigated.

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Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free‐living environments

Cited by 23 publications

References 47 publications

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission

Moderate-to-Vigorous-Intensity Physical Activity Observed in People With Diabetes-Related Foot Ulcers Over a One-Week Period

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