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© 2003 by the American Diabetes Association, Inc.
Emerging Treatments and Technologies |
Activity Patterns of Patients With Diabetic Foot Ulceration
Patients with active ulceration may not adhere to a standard pressure off-loading regimen
1 Department of Surgery, Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona
2 Department of Medicine, Manchester Royal Infirmary, Manchester, U.K
3 Scott and White Hospital, Temple, Texas
4 Department of Medicine, University of Miami, Miami, Florida
Address correspondence and reprint requests to D.G. Armstrong, Department of Surgery, Southern Arizona Veterans Affairs Medical Center, 3601 South Sixth Ave., Tucson, AZ 85723. E-mail: armstrong{at}usa.net
OBJECTIVE—To evaluate the activity of patients with diabetic foot ulcerations and their adherence to their pressure off-loading device.
RESEARCH DESIGN AND METHODS—We enrolled 20 subjects treated for neuropathic diabetic foot wounds corresponding to University of Texas grade 1 stage A. All were off-loaded using a removable cast walker (RCW). We recorded the total activity (measured in activity steps per day) taken on a waist-worn computerized accelerometer. We subsequently correlated this to activity recorded on an RCW-mounted accelerometer, which was not readily accessible to the patient.
RESULTS—There were a mean 1,219.1 ± 821.2 activity units (steps) taken per patient per day. Patients logged significantly more daily activity units with the protective RCW off than with it on (873.7 ± 828.0 vs. 345.3 ± 219.1, P = 0.01). This amounts to only 28% of total daily activity recorded while patients were wearing their RCW. Although a total of 30% of the patients in the study recorded more daily activity units while wearing the device, this subset most adherent to their off-loading regimen still only wore the device for a total of 60% of their total daily activity.
CONCLUSIONS—Subjects with diabetic foot ulcerations appear to wear their off-loading devices for only a minority of steps taken each day. This may partially explain the poor results reported from many trials of agents designed to help speed the healing of these wounds. Control of this important aspect of care with less easily removable devices may increase the prevalence of healing.
Abbreviations: RCW, removable cast walker • TCC, total-contact cast
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