Controversies in off-loading: Should big brother be watching?

Crews, Ryan T.; Bowling, Frank L.; Boulton, Andrew J.M.

doi:10.1007/s11892-009-0068-8

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…To better understand why a patient gets a foot ulcer, heals from an ulcer, or remains free from ulceration, all above‐mentioned factors, in addition to disease‐related factors, should be considered and assessed (Figure ). Preferably, this should be done using objective and quantitative tools to improve the validity of outcomes . Although a general or individual pressure threshold for ulceration is not very likely to emerge, improved prediction based on a combined assessment of disease‐related, biomechanical and behavioural parameters should be possible.…”

Section: Offloading Studied In a Broader Perspectivementioning

confidence: 99%

Priorities in offloading the diabetic foot

Bus

2012

Diabetes Metabolism Res

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SummaryBiomechanical factors play an important role in diabetic foot disease. Reducing high foot pressures (i.e. offloading) is one of the main goals in healing and preventing foot ulceration. Evidence-based guidelines show the strong association between the efficacy to offload the foot and clinical outcome. However, several aspects related to offloading are underexposed. First, in the management of foot complications, offloading is mostly studied as a single entity, whereas it should be analysed in a broader perspective of contributing factors to better predict clinical outcome. This includes assessment of patient behavioural factors such as type and intensity of daily physical activity and adherence to prescribed treatment. Second, a large gap exists between evidence-based recommendations and clinical practice in the use of offloading for ulcer treatment, and this gap needs to be bridged. Possible ways to achieve this are discussed in this article. Third, our knowledge about the efficacy and role of offloading in treating complicated and non-plantar neuropathic foot ulcers needs to be expanded because these ulcers currently dominate presentation in multidisciplinary foot practice. Finally, foot ulcer prevention is underexposed when compared with ulcer treatment. Prevention requires a larger focus, in particular regarding the efficacy of therapeutic footwear and its relative role in comparison with other preventative strategies. These priorities need the attention of clinicians, scientists and professional societies to improve our understanding of offloading and to improve clinical outcome in the management of the diabetic foot.

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Section: Offloading Studied In a Broader Perspectivementioning

confidence: 99%

Priorities in offloading the diabetic foot

Bus

2012

Diabetes Metabolism Res

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“…However, with greater utilization of such monitoring, careful thought will need to go into the ethical considerations of whom is granted access to individuals' activity profiles and for what purposes. 23 Moderate to strong effect sizes for group comparisons 21,22 in the present study suggest at-risk patients may engage in more PA away from home compared to active DFU patients. One likely factor to contribute to the decrease in PA outside of the home by DFU patients is postural instability.…”

Section: Discussionmentioning

confidence: 57%

Monitoring Location-Specific Physical Activity via Integration of Accelerometry and Geotechnology Within Patients With or At Risk of Diabetic Foot Ulcers: A Technological Report

Crews

Yalla

Dhatt

et al. 2016

J Diabetes Sci Technol

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“…Due to the growing body of literature substantiating the link between adherence and clinical outcomes, incorporation of offloading adherence monitoring has been recommended for DFU studies whenever possible [34]. However, benefits could likely be reaped from incorporating adherence monitoring into standard clinical care [35]. Both patients and care providers may modify their practices if provided objectively gathered data regarding patients’ offloading practices.…”

Section: Offloading Adherencementioning

confidence: 99%

“…Aside from simply providing patients their adherence numbers, it may become practical to give alerts and other advice to patients in real time based upon their adherence/physical activity profiles. With the development of such capabilities will come debates as to whom should ultimately have access to the information collected [35]. There are numerous ethical and fiscal questions that will need to be considered.…”

Section: Offloading Adherencementioning

confidence: 99%

Recent Advances and Future Opportunities to Address Challenges in Offloading Diabetic Feet: A Mini-Review

et al. 2018

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Diabetic foot ulcers (DFU) are a substantial dilemma for geriatric individuals with diabetes. The breakdown in tissue associated with DFU is typically a result of repetitive cycles of physical stress placed on the feet during weight-bearing activity. Accordingly, a key tenet in healing as well as preventing DFU is the use of offloading footwear to redistribute physical stress away from high stress locations such as bony prominences. Over the last several years there has been a substantial amount of effort directed at better understanding and implementing the practice of offloading. A review of this work as well as relevant technological advances is presented in this paper. Specifically, we will discuss the following topics in association with offloading diabetic feet: achieving optimal offloading, dosing activity/physical stress, thermal monitoring to detect preulcerative tissue damage, adherence with offloading devices, and optimizing the user experience. In addition to presenting progress to date, potential directions for further advancement are discussed.

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Controversies in off-loading: Should big brother be watching?

Cited by 12 publications

References 16 publications

Priorities in offloading the diabetic foot

Priorities in offloading the diabetic foot

Monitoring Location-Specific Physical Activity via Integration of Accelerometry and Geotechnology Within Patients With or At Risk of Diabetic Foot Ulcers: A Technological Report

Recent Advances and Future Opportunities to Address Challenges in Offloading Diabetic Feet: A Mini-Review

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