Does in-shoe pressure analysis to assess and modify medical grade footwear improve patient adherence and understanding? A mixed methods study

Background: Medical grade footwear (MGF) with demonstrated plantar-pressure reducing effect is recommended to reduce the risk of diabetes-related foot ulceration (DFU). Efficacy of MGF relies on high adherence (≥ 80%). In-shoe pressure analysis (IPA) is used to assess and modify MGF, however, there is limited evidence for the impact on patient adherence and understanding of MGF. The primary aim of this study was to determine if self-reported adherence to MGF usage in patients with previous DFU improved following IPA compared to adherence measured prior. The secondary aim was to determine if patient understanding of MGF improved following in-shoe pressure analysis. Methods: Patients with previous DFU fitted with MGF in the last 12 months were recruited. The first three participants were included in a pilot study to test procedures and questionnaires. MGF was assessed and modified at Week 0 based on findings from IPA using the Pedar system (Novel). Patients completed two questionnaires, one assessing patient adherence to MGF at Week 0 and Week 4, the other assessing patient understanding of MGF before and after IPA at week 0. Patient understanding was measured using a 5-point Likert scale (strongly disagree 1 to strongly agree 5). Patient experience was assessed via a telephone questionnaire administered between Weeks 0–1. Results: Fifteen participants were recruited, and all completed the study. Adherence of ≥ 80% to MGF usage inside the home was 13.3% (n = 2) pre-IPA and 20.0% (n = 3) at Week 4. Outside the home, ≥ 80% adherence to MGF was 53.3% (n = 8) pre-IPA, and 80.0% (n = 12) at Week 4. Change in scores for understanding of MGF were small, however, all participants reported that undergoing the intervention was worthwhile and beneficial. Conclusions: Self-reported adherence inside the home demonstrated minimal improvement after 4 weeks, however, adherence of ≥ 80% outside the home increased by 27%, with 80% of all participants reporting high adherence at Week 4. Participants rated their learnings from the experience of IPA as beneficial

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Australian guideline on offloading treatment for foot ulcers: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease

Background: Pressure offloading treatment is critical for healing diabetes-related foot ulcers (DFU). Yet the 2011Australian DFU guidelines regarding offloading treatment are outdated. A national expert panel aimed to develop anew Australian guideline on offloading treatment for people with DFU by adapting international guidelines thathave been assessed as suitable to adapt to the Australian context.Methods: National Health and Medical Research Council procedures were used to adapt suitable InternationalWorking Group on the Diabetic Foot (IWGDF) guidelines to the Australian context. We systematically screened,assessed and judged all IWGDF offloading recommendations using best practice ADAPTE and GRADE frameworksto decide which recommendations should be adopted, adapted or excluded in the Australian context. For eachrecommendation, we re-evaluated the wording, quality of evidence, strength of recommendation, and providedrationale, justifications and implementation considerations, including for geographically remote and Aboriginal andTorres Strait Islander peoples. This guideline, along with five accompanying Australian DFU guidelines, underwentpublic consultation, further revision and approval by ten national peak bodies (professional organisations).Results: Of the 13 original IWGDF offloading treatment recommendations, we adopted four and adapted nine. Themain reasons for adapting the IWGDF recommendations included differences in quality of evidence ratings andclarification of the intervention(s) and control treatment(s) in the recommendations for the Australian context. ForAustralians with plantar DFU, we recommend a step-down offloading treatment approach based on theircontraindications and tolerance. We strongly recommend non-removable knee-high offloading devices as first-linetreatment, removable knee-high offloading devices as second-line, removable ankle-high offloading devices thirdline,and medical grade footwear as last-line. We recommend considering using felted foam in combination withthe chosen offloading device or footwear to further reduce plantar pressure. If offloading device options fail to heala person with plantar DFU, we recommend considering various surgical offloading procedures. For people with non-plantar DFU, depending on the type and location of the DFU, we recommend using a removable offloadingdevice, felted foam, toe spacers or orthoses, or medical grade footwear. The six new guidelines and the fullprotocol can be found at: https://diabetesfeetaustralia.org/new-guidelines/.Conclusions: We have developed a new Australian evidence-based guideline on offloading treatment for peoplewith DFU that has been endorsed by ten key national peak bodies. Health professionals implementing theseoffloading recommendations in Australia should produce better DFU healing outcomes for their patients,communities, and country

Australian Diabetes Foot Network: practical guideline on the provision of footwear for people with diabetes

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system