Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers

• Published in: BMJ open diabetes research & care 2022-02, Vol.10 (1), p.e002640
• Main Authors: Ababneh, Anas, Finlayson, Kathleen, Edwards, Helen, Lazzarini, Peter A
• Format: Article
• Language: English
• Subjects: Activities of daily living; adherence; Alzheimer's disease; Amputation; Clinical medicine; compliance; Contraindications; Cross-Sectional Studies; Diabetes; Diabetes Mellitus; diabetic foot; Diabetic Foot - therapy; Foot diseases; Humans; Infections; Ischemia; Leg ulcers; Likert scale; Male; Medical records; Patient Compliance; Patients; Peripheral neuropathy; Physiology; Psychological aspects; Psychosocial Research; Qualitative research; Regression analysis; Sociodemographics; Vein & artery diseases; Weight-Bearing; Wound Healing - physiology
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2021-002640

IntroductionAdherence to using knee-high offloading treatment is critical for healing diabetes-related foot ulcers (DFUs). However, few studies have investigated patients’ adherence to using knee-high offloading treatment. We aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment among patients with DFUs.Research design and methodsIn this multicenter cross-sectional study, we investigated adherence to using knee-high RCWs in 57 participants with DFUs. All participants were clinically examined for multiple sociodemographic, physiological, and psychosocial factors. Each participant’s adherence level to using RCWs was then objectively measured using dual activity monitors (attached to the wrist and RCW) over a 1-week period. Multiple linear regression was undertaken to determine those factors independently associated with adherence levels.ResultsThe mean adherence level to using RCWs was 33.6% (SD 16.5) of weight-bearing activity. Factors independently associated with lower adherence levels were being male, longer diabetes duration, not having peripheral artery disease (PAD), and having higher perceived RCW heaviness (p≤0.05). No associations were found with psychosocial factors.ConclusionsPatients with DFUs adhered to using their RCWs on average for only a third of their prescribed weight-bearing treatment duration. Factors linked to lower RCW adherence levels were being male, longer diabetes duration, not having PAD, and perceived heavier RCWs. These findings highlight the importance of using gold standard non-removable knee-high offloading device treatment. Furthermore, these findings suggest, when gold standard devices are containdicated, that these factors be considered when prescribing the second choice RCW offloading treatment to optimise adherence. Regardless, further longitudinal studies are needed to confirm these factors.