Patient and Provider Perspective of Smart Wearable Technology in Diabetic Foot Ulcer Prevention: A Systematic Review

Abstract

Background and Objectives: Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. However, factors determining their acceptance are poorly understood. This systematic review aims to examine the literature on patient and provider perspectives of smart wearable devices in DFU prevention. Materials and Methods: PubMed, Scopus, and Web of Science were systematically searched up to October 2021. The selected articles were assessed for methodological quality using the quality assessment tool for studies with diverse designs. Results: A total of five articles were identified and described. The methodological quality of the studies ranged from low to moderate. Two studies employed a quantitative study design and focused on the patient perspective, whereas three studies included a mixed, quantitative/qualitative design and explored patient or provider (podiatrist) perspectives. Four studies focused on an insole system and one included a smart sock device. The quantitative studies demonstrated that devices were comfortable, well designed and useful in preventing DFU. One mixed design study reported that patients did not intend to adopt an insole device in its current design because of malfunctions, a lack of comfort. and alert intrusiveness, despite the general perception that the device was a useful tool for foot risk monitoring. Two mixed design studies found that performance expectancy was a predictor of a podiatrist’s behavioural intention to recommend an insole device in clinical practice. Disappointing participant experiences negatively impacted the podiatrists’ intention to adopt a smart device. The need for additional refinements of the device was indicated by patients and providers before its use in this population. Conclusions: The current evidence about patient and provider perspectives on smart wearable technology is limited by scarce methodological quality and conflicting results. It is, thus, not possible to draw definitive conclusions regarding acceptability of these devices for the prevention of DFU in people with diabetes.

Distal Metatarsal Osteotomies for Chronic Plantar Diabetic Foot Ulcers

“…64 There are smart socks, an optical fiber-based smart textile that allows the measurement of plantar foot temperature, and insole devices that monitor plantar pressure through specific sensors. 65 Recently, a proof-of-concept study conducted in the UK demonstrated that CPDFU recurrence can be significantly reduced by 71% compared with the standard of care by providing timely feedback on foot pressures to individuals through smart insoles. 66 Moreover, a recent study shows that the incidence of first DFU, but not recurrent ulceration, is reduced in association with improvements in diabetes foot care.…”

The quest for wellness: How to optimise self‐care strategies for diabetic foot management?

“…While promising, digital technologies introduce additional layers of complexity to footcare, with technology design, cost, alignment with patient goals and integration with health-care as previously identified important factors. 35,36 It is imperative that end users be consulted in the design process and established theories of technology adoption are used to inform design and implementation. 35,36 An Australian research group was the first to specifically explore patient and provider perspectives on the use of a smart insole technology using a mixed-methods approach.…”

“…35,36 It is imperative that end users be consulted in the design process and established theories of technology adoption are used to inform design and implementation. 35,36 An Australian research group was the first to specifically explore patient and provider perspectives on the use of a smart insole technology using a mixed-methods approach. [37][38][39] These studies used the Unified Theory of Acceptance and Use of Technology (UTAUT) as a theoretical underpinning, which articulates the way in which key psychosocial domains interact to influence behavioural intention to adopt a technology in a healthcare context for both patients and health professionals.…”

A novel diabetic foot ulcer diagnostic model: identification and analysis of genes related to glutamine metabolism and immune infiltration

“…In the clinical management of DFU, various approaches are used, including intravenous administration of antibiotics and local treatments such as silver ion dressings, insulin topical application, and anti-inflammatory gels. However, long-term use of these treatments can lead to drug resistance and even delay wound healing [ 3 , 4 ]. Therefore, researching the molecular mechanisms of DFU and developing new therapies that can suppress chronic wound inflammation are crucial for improving treatment outcomes and prognosis for patients with DFU.…”