TY - JOUR
T1 - The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers
T2 - Biomechanical and Feasibility Findings from Two Prospective Cohort Studies
AU - Hulshof, Chantal M.
AU - Page, Madelyn
AU - van Baal, Sjef G.
AU - Bus, Sicco A.
AU - Fernando, Malindu E.
AU - van Gemert-Pijnen, Lisette
AU - Kappert, Kilian D.R.
AU - Lucadou-Wells, Scott
AU - Najafi, Bijan
AU - van Netten, Jaap J.
AU - Lazzarini, Peter A.
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/4/10
Y1 - 2024/4/10
N2 - Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.
AB - Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.
KW - adherence
KW - daily-life activity
KW - diabetic foot
KW - foot ulcer
KW - offloading
KW - plantar pressure
KW - shear stress
UR - http://www.scopus.com/inward/record.url?scp=85191368756&partnerID=8YFLogxK
U2 - 10.3390/s24082411
DO - 10.3390/s24082411
M3 - Article
C2 - 38676030
AN - SCOPUS:85191368756
SN - 1424-8220
VL - 24
JO - Sensors
JF - Sensors
IS - 8
M1 - 2411
ER -