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. 2024 Sep;17(3):e70002.
doi: 10.1002/jfa2.70002.

Adherence to wearing prescribed footwear in people at risk of diabetes-related foot ulcers

Gustav Jarl  1   2 , Chantal M Hulshof  3   4 , Kim A Tijhuis  3 , Tessa E Busch-Westbroek  3   4 , Sicco A Bus  3   4 , Jaap J van Netten  3   4
Affiliations

Adherence to wearing prescribed footwear in people at risk of diabetes-related foot ulcers

Gustav Jarl et al. J Foot Ankle Res. 2024 Sep.

Abstract

Introduction: Adherence to wearing prescribed footwear is paramount in reducing the risk of developing diabetes-related foot ulcers, but adherence is often lower than optimal. This study aimed to investigate predictors of footwear adherence and variations in adherence and activity in people at risk of diabetes-related foot ulceration.

Methods: Sixty people at high foot ulcer risk were included. We measured the proportion of weight-bearing acitivity time the prescribed footwear was worn for seven days. Multiple linear regression and analysis of variance were used.

Results: Mean overall adherence was 63%. Adherence was lower at home than away from home (59% vs. 74%), while activity was higher at home (2.2 vs. 1.2 h/day). Adherence was similar across activities (61%-63%). No variable predicted the overall adherence. Higher Hba1c predicted lower adherence at home (β = -0.34, p = 0.045, R2 = 11.6%). More daily steps predicted lower adherence away from home (β = -0.30, p = 0.033, R2 = 9.3%). Adherence and activity were highest in mornings (71%, 1.1 h) and afternoons (71%, 1.5 h), and lower in evenings (40%, 0.8 h) and at nights (9%, 0.1 h). Adherence was similar on weekdays and weekend days (63% vs. 60%), but activity was higher on weekdays (3.4 vs. 3.0 h).

Conclusion: Adherence levels and predictors thereof differed between adherence at home and away from home, so we suggest to treat them as different concepts. Due to the low explained variance, future studies should focus on other predictors such as psychological variables.

Keywords: diabetic foot; foot ulcer; patient compliance; prevention; shoes.

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Conflict of interest statement

Gustav Jarl is a consultant for Novo Nordisk. Chantal M. Hulshof, Kim A. Tijhuis, Tessa E. Busch‐Westbroek, Sicco A. Bus, and Jaap J. van Netten have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Variations of weight‐bearing activity and adherence to prescribed footwear.
See this image and copyright information in PMC

References

    1. Bus, S. A. , Sacco I. C. N., Monteiro‐Soares M., Raspovic A., Paton J., Rasmussen A., Lavery L. A., and van Netten J. J.. 2023. “Guidelines on the Prevention of Foot Ulcers in Persons With Diabetes (IWGDF 2023 Update).” Diabetes/Metabolism Research and Reviews 40(3): e3651. 10.1002/dmrr.3651. - DOI - PubMed
    1. van Netten, J. J. , Raspovic A., Lavery L. A., Monteiro‐Soares M., Paton J., Rasmussen A., Sacco I. C. N., and Bus S. A.. 2023. “Prevention of Foot Ulcers in Persons With Diabetes at Risk of Ulceration: A Systematic Review and Meta‐analysis.” Diabetes/Metabolism Research and Reviews 40(3): e3652. 10.1002/dmrr.3652. - DOI - PubMed
    1. Armstrong, D. G. , Boulton A. J. M., and Bus S. A.. 2017. “Diabetic Foot Ulcers and Their Recurrence.” New England Journal of Medicine 376(24): 2367–2375. 10.1056/nejmra1615439. - DOI - PubMed
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    1. Waaijman, R. , Keukenkamp R., de Haart M., Polomski W. P., Nollet F., and Bus S. A.. 2013. “Adherence to Wearing Prescription Custom‐Made Footwear in Patients With Diabetes at High Risk for Plantar Foot Ulceration.” Diabetes Care 36(6): 1613–1618. 10.2337/dc12-1330. - DOI - PMC - PubMed

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