Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation

Crews, Ryan T.; Shen, Bo; Campbell, Laura; Lamont, P. J.; Boulton, Andrew J.M.; Peyrot, Mark; Kirsner, Robert S.; Vileikyte, Loretta

doi:10.2337/dc15-2373

Cited by 85 publications

(173 citation statements)

References 37 publications

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“…Outcome instruments such as NeuroQol may be more useful to study certain groups and their response to treatment, particularly with regard to distress related to neuropathy (42). Postural instability and pain, as measured from the NeuroQol, are significantly associated with noncompliance with off-loading regimens in patients with diabetes with foot ulcers (45). Identifying emotional distress in patients with diabetes with neuropathy is important because depression is associated with development of an index foot ulcer (46).…”

Section: The Impact Of Dfd On Hrqolmentioning

confidence: 99%

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Wukich

Raspovic

2018

Diabetes Care

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Patient-reported outcomes (PROs) have become an important subject in the area of diabetes-related foot complications. Self-reported health-related quality of life (HRQOL) surveys can provide a generic measure of overall health (global) and can be disease specific (i.e., diabetes) or even region specific (i.e., lower-extremity function). Analysis of PRO measures utilizing validated instruments allows health care providers to determine whether medical and surgical treatments are providing patients with the highest level of outcome possible and are actually improving HRQOL. The 36-item Short Form (SF-36), EuroQol five-dimension questionnaire (EQ-5D-5L), and Foot and Ankle Ability Measure (FAAM) are examples of commonly used HRQOL surveys. Low HRQOL has been associated with higher rates of hospital admission and mortality in patients with diabetes. Previous studies have demonstrated that patients with diabetes-related foot disease have low self-reported physical quality of life but do not typically report low mental quality of life. The impact of mental quality of life may be underestimated in these patients using the SF-36. In this article, we will discuss several widely used outcome instruments used to measure patient HRQOL and the impact of diabetic foot disease on HRQOL. As health care providers, we must continue to adjust and modify our treatments to achieve the best patient outcomes and associated high quality of life. Assessing PROs will become increasingly important as health care systems transition from a volume-based reimbursement model to a value-based model.

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Section: The Impact Of Dfd On Hrqolmentioning

confidence: 99%

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Wukich

Raspovic

2018

Diabetes Care

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“…Guidelines often categorize prevention and treatment as separate issues, and David is treated according to the guidelines. These guidelines recommend using a non-removable device such as TCC to offload and heal plantar foot ulcers [14,34] because many patients show low adherence to wearing removable offloading devices [35–40]; they also recommend that therapeutic shoes are used after healing to prevent reulceration [14,34], as the use of non-removable devices is not feasible during remission.…”

Section: New Framework: the Process Perspective On The Dfmentioning

confidence: 99%

“…For example, if the reason for his low adherence to wearing the walker is forgetfulness, a device with audio feedback when the device is not being worn could be useful [47]. If the reason for low adherence is that the walker impairs his balance [35], therapeutic shoes might be more appropriate. The important thing is to tailor the treatment regimen to maximize his chances of being successful and seeing progression of the healing.…”

Section: New Framework: the Process Perspective On The Dfmentioning

confidence: 99%

Beyond dichotomous thinking: a process perspective on diabetic foot disease

Jarl

Lundqvist

2017

Diabetic Foot & Ankle

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Background: Diabetic foot (DF) disease causes severe suffering around the world, and appropriate self-care activities are needed to prevent and treat this condition. However, all too often, self-care activities are less than optimal and clinicians find themselves unable to influence them in a positive direction. Clinicians’ and researchers’ mental models of the DF tend to be dichotomous: either the patient has or does not have an active ulcer or other DF disease. This mode of thinking hides the long-term perspective of DF disease, where patients’ previous experiences and expectations for the future influence their current behavior. Thus, there is a need for a different perspective on DF disease to better understand patients’ perspectives and thereby improve self-care, leading to more effective prevention and treatment. Objective: To present a novel framework, the process perspective on the DF, which can explain inadequate self-care behaviors not easily understood with a dichotomous perspective, and how they can be changed. Results: Three fictive clinical examples are used to illustrate how the process perspective on the DF can be used to understand how patients’ previous experiences and expectations for the future influence their current behavior. In particular, this process perspective is used to understand how patients’ beliefs and behaviors are sometimes self-reinforcing, resulting in stable behavior patterns, here referred to as ‘DF cycles’. These cycles are quite common in clinical practice but are difficult to analyze using a dichotomous perspective on DF disease. The process perspective on the DF is used to analyze specific ‘vicious’ DF cycles of inadequate patient behavior and to find ways to transform them into ‘virtuous’ DF cycles, resulting in effective prevention and treatment. Conclusions: The process perspective on the DF seems suitable for understanding inadequate patient behaviors not easily understood with a dichotomous perspective on DF disease, opening up new avenues for clinical practice and research to help patients live a life with long remission phases, few relapses, and a high quality of life.

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“…(1) appreciate the importance of our article (2) substantiating the relationship between adherence to off-loading modalities and healing of diabetic foot ulcers (DFUs). Their letter contained several comments regarding our article that we address here.…”

mentioning

confidence: 99%

Response to Comment on Crews et al. Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation. Diabetes Care 2016;39:1371–1377

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Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation

Cited by 85 publications

References 37 publications

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Beyond dichotomous thinking: a process perspective on diabetic foot disease

Response to Comment on Crews et al. Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation. Diabetes Care 2016;39:1371–1377

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