1Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden.
2University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden.
J Foot Ankle Res. 2019 Mar 29;12:21. doi: 10.1186/s13047-019-0327-0. eCollection 2019.
Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications.
A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women's and men's answers were compared using -tests, Mann-Whitney tests and chi-square tests with Fischer's exact tests. -values < 0.05 were considered statistically significant.
Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women ( < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes' efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support.
Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients' concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.
治疗鞋可预防糖尿病足溃疡，但由于鞋子具有心理和社会意义，这被认为给女性带来的负担比男性更大，因此其使用较为复杂。本研究旨在比较患有糖尿病足并发症的女性和男性使用治疗鞋的态度和属性。
向 1230 名已配备治疗鞋的糖尿病患者邮寄问卷。使用 -检验、Mann-Whitney 检验和卡方检验（Fisher 确切检验）比较女性和男性的回答。-值<0.05 被认为具有统计学意义。
分析了 443 份（36.0%）问卷（294 名男性，149 名女性，平均年龄 69.2 岁）的应答者。与女性相比，更多的男性有工作（20.4%比 9.4%），有人提醒他们穿治疗鞋（27.6%比 10.0%），且有足部溃疡史（62.9%比 46.3%）或小截肢史（17.7%比 6.7%）。更多的女性领取残疾抚恤金（18.8%比 10.2%）。女性报告的总体健康状况较差，预防溃疡的内在控制感较低，对治疗鞋的外观和价格以及在公共场合穿治疗鞋的感受更为消极。其他比较则无统计学意义：其他鞋的属性、教育程度、糖尿病类型、当前足部溃疡、大截肢、对鞋服务的满意度、对神经病作为危险因素的认识、溃疡愈合的内在控制感、对鞋预防和治愈溃疡的疗效的信念、对溃疡愈合和新溃疡的担忧、自我效能、抑郁、鞋的使用/依从性、为治疗鞋付费以及社会支持。
男性的足部并发症更严重。女性的总体健康状况较差，预防溃疡的内在控制感较低，对治疗鞋的态度更为消极。临床医生应更加关注女性患者的关注点。未来的研究和开发应侧重于改善治疗鞋的重量和外观，尤其是对女性而言。还需要研究如何促进患者从将鞋子单纯视为衣物到将其视为医疗干预的适应和重新评估过程。
