TY - JOUR
T1 - Differences in adherence to using removable cast walker treatment during daytime and nighttime weight-bearing activities in people with diabetes-related foot ulcers
AU - Ababneh, Anas
AU - Finlayson, Kathleen
AU - Edwards, Helen
AU - van Netten, Jaap J.
AU - Lazzarini, Peter A.
N1 - Funding Information: The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: AA acknowledges the financial support of a student allocation from QUT Health Research Services. Funding Information: AA acknowledges the Australian government research training programme stipend (International) and QUT tuition fee sponsorship as this study has been undertaken in partial fulfilment of a Doctor of Philosophy. PAL also acknowledges support by an Australian National Health and Medical Research Council Early Career Fellowship (#1143435). The authors would like to especially acknowledge Ms Lee Jones (Statistician, QUT) for statistical advice. Publisher Copyright: © The Author(s), 2023.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Aims: Patients’ adherence to using knee-high offloading treatment is critical to effective healing of diabetes-related foot ulcers (DFUs). Previous studies have found that patients generally have low adherence to using removable knee-high offloading treatments, yet no study has investigated whether their adherence differs during daytime and nighttime. This study aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment during daytime and nighttime weight-bearing activities in people with DFUs. Methods: This was a secondary analysis of data collected from a multi-centre cross-sectional study investigating adherence to using knee-high RCWs among 57 participants with DFUs. All participants had multiple socio-demographic, physiological and psychosocial factors collected, before having their adherence to using RCWs during weight-bearing activity monitored over a 1-week period using the dual activity monitor method. Adherence data were categorised into daytime (06:00–18:00) and nighttime (18:00–06:00) periods and calculated separately. Multiple linear regression was used to identify factors associated with daytime and nighttime adherence. Results: Mean adherence to using RCW during weight-bearing activities in people with DFUs was higher during daytime compared with nighttime [39.9% (SD = 18.9) versus 20.4% (SD = 16.7), p < 0.001]. Factors independently associated with lower adherence during daytime were being male, longer diabetes duration, not having peripheral artery disease (PAD), and higher perceived RCW heaviness. Factors associated with lower adherence during nighttime were higher mean daytime steps, not having retinopathy and having dyslipidaemia. Conclusions: Adherence to using RCWs during weight-bearing activities reduced significantly at nighttime compared with daytime among people with DFUs, and this was associated with different factors. Interventions to improve adherence, in research and clinical practice, should incorporate methods to target daytime or nighttime adherence specifically.
AB - Aims: Patients’ adherence to using knee-high offloading treatment is critical to effective healing of diabetes-related foot ulcers (DFUs). Previous studies have found that patients generally have low adherence to using removable knee-high offloading treatments, yet no study has investigated whether their adherence differs during daytime and nighttime. This study aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment during daytime and nighttime weight-bearing activities in people with DFUs. Methods: This was a secondary analysis of data collected from a multi-centre cross-sectional study investigating adherence to using knee-high RCWs among 57 participants with DFUs. All participants had multiple socio-demographic, physiological and psychosocial factors collected, before having their adherence to using RCWs during weight-bearing activity monitored over a 1-week period using the dual activity monitor method. Adherence data were categorised into daytime (06:00–18:00) and nighttime (18:00–06:00) periods and calculated separately. Multiple linear regression was used to identify factors associated with daytime and nighttime adherence. Results: Mean adherence to using RCW during weight-bearing activities in people with DFUs was higher during daytime compared with nighttime [39.9% (SD = 18.9) versus 20.4% (SD = 16.7), p < 0.001]. Factors independently associated with lower adherence during daytime were being male, longer diabetes duration, not having peripheral artery disease (PAD), and higher perceived RCW heaviness. Factors associated with lower adherence during nighttime were higher mean daytime steps, not having retinopathy and having dyslipidaemia. Conclusions: Adherence to using RCWs during weight-bearing activities reduced significantly at nighttime compared with daytime among people with DFUs, and this was associated with different factors. Interventions to improve adherence, in research and clinical practice, should incorporate methods to target daytime or nighttime adherence specifically.
KW - adherence
KW - compliance
KW - diabetes-related foot ulcer
KW - offloading
KW - removable cast walker
UR - http://www.scopus.com/inward/record.url?scp=85146174408&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/20420188221142457
DO - https://doi.org/10.1177/20420188221142457
M3 - Article
C2 - 36643893
SN - 2042-0188
VL - 14
JO - Therapeutic Advances in Endocrinology and Metabolism
JF - Therapeutic Advances in Endocrinology and Metabolism
ER -