Smart Offloading Boot System for Remote Patient Monitoring: Toward Adherence Reinforcement and Proper Physical Activity Prescription for Diabetic Foot Ulcer Patients

Abstract

Background: A critical factor in healing diabetic foot ulcers is patient adherence to offloading devices. We tested a smart offloading boot (SmartBoot) combined with a smartwatch app and cloud dashboard to remotely monitor patient adherence and activity. In addition, the impact of SmartBoot on balance, gait, and user experience was investigated. Methods: Fourteen volunteers (31.6±8.7 years; 64% female) performed natural activities (eg, sitting, standing, walking) with and without the SmartBoot for approximately 30 minutes. All participants completed balance tests, 10-meter walking tests at slow, normal, and fast pace while wearing the SmartBoot, and a user experience questionnaire. The accuracy of real-time adherence reporting was assessed by comparing the SmartBoot and staff observation. Center of mass (COM) sway and step counts were measured using a validated wearable system. Results: Average sensitivity, specificity, and accuracy for adherence and non-adherence were 90.6%, 88.0%, and 89.3%, respectively. The COM sway area was significantly smaller with the SmartBoot than without the SmartBoot regardless of test condition. Step count error was 4.4% for slow waking, 36.2% for normal walking, 16.0% for fast walking. Most participants agreed that the SmartBoot is easy to use, relatively comfortable, nonintrusive, and innovative. Conclusions: To our knowledge, this is the first smart offloading system that enables remote patient monitoring and real-time adherence and activity reporting. The SmartBoot enhanced balance performance, likely due to somatosensory feedback. Questionnaire results highlight SmartBoot’s technical and clinical potential. Future studies warrant clinical validation of real-time non-adherence alerting to improve wound healing outcomes in people with diabetic foot ulcers.

Association between Fall History and Gait, Balance, Physical Activity, Depression, Fear of Falling, and Motor Capacity: A 6-Month Follow-Up Study

“…Then, all participants completed a static balance test with their eyes open and closed. During all static balance tests, participants were instructed to have their feet hip-width apart and parallel, stand upright, cross their arms at their chest, keep their knees extended, and breathe normally for 30 s [ 23 ]. After the static balance test, all participants performed single-task and dual-task walking tests for 10 m with their comfortable walking speed [ 24 ].…”

Objective Assessment of Upper-Extremity Motor Functions in Spinocerebellar Ataxia Using Wearable Sensors

“…A reduced number of motor tasks may improve the feasibility of using the platform in a non-clinical setting and for remote patient monitoring. Digital health technologies are poised to become an integral part of modern health care, expedited by the surge in remote care necessitated by the COVID-19 pandemic [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The proposed solution paves the way to integrating digital health technology (i.e., wearables) to enhance the utility of objective measures of ataxia.…”

Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers

“…Real-time feedback using "smart insoles" or similar devices with incorporated sensors that measure PP, activity, and adherence are already becoming available and showing promise in changing patients offloading treatment behavior. [66][67][68][69][70] For example, the SurroSense Rx intelligent insoles system (Orpyx Medical Technologies, Calgary, Canada) provides feedback on PP to patients via a smartwatch to help facilitate the patient to change their behavior regarding their weight-bearing activity and in turn potentially reduce reulcerations. 66,67 Similarly, the SmartBoot (Sensoria Health Inc., Redmond, WA, USA) provides feedback on adherence to the patient via a smartwatch.…”