Taking a Load Off: User Perceptions of Smart Offloading Walkers for Diabetic Foot Ulcers Using the Technology Acceptance Model

Abstract

People with diabetic foot ulcers (DFUs) are commonly prescribed offloading walkers, but inadequate adherence to prescribed use can be a barrier to ulcer healing. This study examined user perspectives of offloading walkers to provide insight on ways to help promote adherence. Participants were randomized to wear: (1) irremovable, (2) removable, or (3) smart removable walkers (smart boot) that provided feedback on adherence and daily walking. Participants completed a 15-item questionnaire based on the Technology Acceptance Model (TAM). Spearman correlations assessed associations between TAM ratings with participant characteristics. Chi-squared tests compared TAM ratings between ethnicities, as well as 12-month retrospective fall status. A total of 21 adults with DFU (age 61.5 ± 11.8 years) participated. Smart boot users reported that learning how to use the boot was easy (ρ =−0.82, p≤ 0.001). Regardless of group, people who identified as Hispanic or Latino, compared to those who did not, reported they liked using the smart boot (p = 0.05) and would use it in the future (p = 0.04). Non-fallers, compared to fallers, reported the design of the smart boot made them want to wear it longer (p = 0.04) and it was easy to take on and off (p = 0.04). Our findings can help inform considerations for patient education and design of offloading walkers for DFUs.

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

“…Objective measures for evaluating adherence to offloading treatment in patients with or at risk of DFUs are advocated by various guidelines 1,3,5 . These measures can encompass wearable activity monitors to gauge the extent of adherence to total weight‐bearing activity 1,16,23,24 or temperature monitors to calculate the adherence level over the total treatment time 25 . Nevertheless, hurdles such as the cost of monitors, 26 privacy concerns, 16,26,27 perceived benefit, 16 perceived ease of use, 11,12,20 and limited battery life for extended use 24,28 deter their adoption.…”

“…These measures can encompass wearable activity monitors to gauge the extent of adherence to total weight‐bearing activity 1,16,23,24 or temperature monitors to calculate the adherence level over the total treatment time 25 . Nevertheless, hurdles such as the cost of monitors, 26 privacy concerns, 16,26,27 perceived benefit, 16 perceived ease of use, 11,12,20 and limited battery life for extended use 24,28 deter their adoption. For these reasons, self‐reported adherence, being quick, cost‐effective, and easy to implement, is more extensively utilised in clinical practice and research 29 .…”

“…The application could also leverage the power of instant feedback with intuitive visual indicators, such as emoticons displaying happiness or sadness, corresponding to the patient's adherence level (Figure 1). 16,23 This approach offers immediate, understandable feedback that motivates patients to improve their adherence. Moreover, a social sharing feature can be incorporated to allow patients to share their progress with caregivers or loved ones.…”

“…Also, comfortable, well‐fitted devices encourage better adherence. Material innovations and patient feedback can contribute to design 16,37 …”

“…Risk-factor studies have shown that factors like diabetes history, body mass index, footwear appearance, being indoors, patient expectations towards efficacy, and postural issues influence adherence rates, although the explained variance is still not very high and 25% at maximum. 11,[15][16][17][18][19][20][21][22] Nevertheless, these factors should be considered and where modifiable targeted in assessing treatment adherence and determining the treatment plan to improve adherence.…”