Predictors of adherence to wearing therapeutic footwear among people with diabetes

Abstract

Aims: People at increased risk of developing diabetic foot ulcers often wear therapeutic footwear less frequently than is desirable. The aims were to identify patient groups prone to nonadherence to wearing therapeutic footwear and modifiable factors associated with adherence. Materials and methods: A questionnaire was mailed to 1230 people with diabetes who had been fitted with therapeutic footwear. Independent variables were categorized into five domains. For each domain, variables that were associated with adherence in a univariate regression analysis were entered into a multiple regression analysis. Results: A total of 429 (34.9%) questionnaires were analyzed. Multiple regression analyses showed significant associations (p < 0.05) between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear, and a belief that therapeutic footwear promotes ulcer healing. The five multivariate models explained 2-28% of the variance in adherence, with the strategies for footwear use domain explaining the most. Conclusions: Patients without paid employment or without foot ulcer experience are more prone to nonadherence. To improve adherence, clinicians should advise patients to store therapeutic footwear in a visible place at home and put conventional footwear away and encourage patients' self-efficacy and habitual use of therapeutic footwear. Future studies should investigate this topic further and explore ways to promote changes in habits. A study limitation was that all variables were self-reported.

Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation: A focus group study

“…Group-TF&HoU ranked this factor third. The positive association between severity of the foot condition (Group-TF&HoU persons had poor foot health) and the importance of using TF is in line with previous literature [ 24 – 26 ]. The reason why this factor was not ranked in first place could be related to subjects’ underestimation of their actual foot health.…”

“…A possible solution might be to introduce regular motivational interviewing sessions instead of only once (with 2 45-minute sessions in 1 week). Other suggestions to increase the use of TF were given by Jarl et al [ 26 ]. Their suggestion was to eliminate the temptation to use non-TF and provide a reminder to use TF [ 26 ].…”

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

“…Yet, studies have found these different offloading treatments offer different levels of desirable and undesirable effects and in turn produce different healing outcomes [ 9 , 10 , 11 ]. Additionally, studies have indicated that best practice offloading treatments have low rates of use; i.e., low prescription by clinicians [ 8 , 15 , 16 , 17 ] and low adherence by patients [ 18 , 19 , 20 , 21 , 22 , 23 ]. Further studies suggest there are many potential barriers and solutions to the use of these best practice offloading treatments [ 15 , 20 , 21 , 24 ].…”

“…Additionally, studies have indicated that best practice offloading treatments have low rates of use; i.e., low prescription by clinicians [ 8 , 15 , 16 , 17 ] and low adherence by patients [ 18 , 19 , 20 , 21 , 22 , 23 ]. Further studies suggest there are many potential barriers and solutions to the use of these best practice offloading treatments [ 15 , 20 , 21 , 24 ]. Thus, the aims of this paper were to review the best available evidence firstly on the effects of offloading treatments to heal people with DFU, secondly on the use of offloading treatments in clinical practice, thirdly on the common barriers and solutions to using these offloading treatments, and lastly discuss promising emerging solutions that may improve offloading treatments in future.…”

Diabetic Foot Assessment of People With Diabetic Peripheral Neuropathy And Associated Factors To Plantar Pressure Changes.

“…According to Collings et al (2019) [40] and Jarls et al (2020) [41], therapeutic / suitable footwear is often used to reduce high tissue pressures associated with the risk of foot ulceration, therefore, guidelines for the care of the feet of people with diabetes recommend the use of therapeutic shoes or personalized insoles in the preventive management of people at risk of foot ulceration, as de ned by the National Institute for Health and Care Excellence [38].…”