Feasibility of a Low-Intensity, Technology-Based Intervention for Increasing Physical Activity in Adults at Risk for a Diabetic Foot Ulcer: A Mixed-Methods Study

Abstract

Background: Among adults with diabetes, 19-34% will develop a diabetic foot ulcer (DFU), which increases amputation risk and health care costs, and worsens quality of life. Regular physical activity, when increased gradually, may help prevent DFUs. In this mixed-methods study, we examined the feasibility of a low-intensity, technology-based behavioral intervention to increase activity in adults at risk for DFUs. Method: Participants at risk for a DFU (n = 12; 66% female; mean age = 59.9 years) received four in-person exercise and behavioral counseling sessions over 2-3 weeks, supplemented with use of an activity monitor (to track steps) and text messages (to reinforce behavioral strategies) for an added 8 weeks. Pre- and postintervention assessments of accelerometer measured activity, daily mobility, and glycemic control (A1C) were completed. Treatment acceptability was assessed by questionnaire and via key informant interview. Results: The program appears feasible since all but one participant attended all four sessions, all used the activity monitor and all responded to text messages. Treatment acceptability (scale: 1 = very dissatisfied, 5 = extremely satisfied) was high; average item ratings were 4.79 (SD = 0.24). Participants increased their steps by an average of 881.89 steps/day ( d = 0.66). A1C decreased on average by 0.33% ( d = 0.23). Daily mobility did not change. Interview results suggest that participants perceived benefits from the intervention. Participant recommended improvements included providing more physical activity information, addressing pain, and intervention delivery in a podiatry clinic. Conclusion: Individuals at risk for a DFU might benefit from a minimally intensive, technology-based intervention to increase their physical activity. Future research comparing the intervention to usual care is warranted.

Weight‐bearing physical activity in people with diabetes‐related foot disease: A systematic review

“…Daily steps contribute to moderate-intensity physical activity as recommended by the World Health Organization, 10 and increases in such activity are associated with higher quality of life 1,11,12 and favourable physical outcomes, such as improved blood glucose control. 1,13 This explains the growing interest in developing interventions to stimulate people to be more active without having to participate in a specific physical activity intervention program, 14 to enhance people's 'activity-rich days'. 15 Interventions aiming to improve the daily activity of people who are at risk of foot ulceration would benefit from reference data on the weight-bearing activity in this population, to help interpret individual or group outcomes.…”

Mobile Health untuk Mencegah Luka Diabetes: A Systematic Review

“…14 Scheineder, 2019. (26) A Mixed-Methods Study/ 12 pasien Intervensi berbasis teknologi menggunakan SMS digunakan dalam kontrol aktivitas fisik, kadar glukosa darah dan penghitung jejak langkah kaki.…”

“…Hasil menunjukkan bahwa peserta merasakan manfaat dari intervensi. Karena mampu memberikan lebih banyak informasi terkait aktivitas fisik dan mengatasi rasa sakit (26) .…”

“…Penelitian yang dilakukan oleh Schneider et all memberikan panduan empat latihan fisik dan monitoring aktivitas dengan mode melacak jumlah langkah dan mengirim pesan teks sebagai pengingat setiap kali jadwal dimulai. Hasil menunjukkan bahwa strategi ini dapat meningkatkan aktivitas fisik sehingga mencegah terjadinya ulkus diabetes (26) .…”

The Role of Foot-Loading Factors and Their Associations with Ulcer Development and Ulcer Healing in People with Diabetes: A Systematic Review

“…For weight-bearing activity, we included five publications investigating a direct association with ulcer development (two prospective cohorts, two randomized controlled trials, one prospective mixed method). Lemaster et al [33], Waaijman et al [12], Mueller et al [34] and Schneider et al [35] (n = 602, e = 131) found no association between level of weight-bearing activity (number of steps) and risk of ulcer development (see for details Table S5). Armstrong et al [32] (n = 100, e = 8) found that a lower average daily activity level was associated with increased risk of ulcer development.…”