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 Aug 19;12:44. doi: 10.1186/s13047-019-0355-9. eCollection 2019.
Non-removable offloading devices are recommended for the treatment of uncomplicated plantar diabetic foot ulcers because adherence to using removable devices is low. However, patients may not always understand how crucial the non-removability is to ulcer healing, leaving them with the impression that it is the device per se that heals the ulcer. Thus, after ulcer healing when patients return to using removable offloading devices, typically therapeutic footwear, they often return to a low level of adherence resulting in high reulceration rates. To change this pattern of behavior based on a misconception, we need to start with how we as clinicians are conceptualizing treatment with offloading devices.
NON-REMOVABLE OFFLOADING DEVICES AS COMMITMENT DEVICES: Commitment devices are voluntary restrictions people put on their future selves to resist short-term temptations and achieve long-term goals. In this paper, it is suggested that a change from viewing non-removable offloading devices as means to force compliance, to viewing them as commitment devices could facilitate a change to a clinical thinking that emphasizes the importance of high adherence without compromising respect for patient autonomy.
Viewing non-removable offloading devices as commitment devices seems to be a promising approach to emphasize the importance of adherence while respecting patient autonomy. Hopefully, patients' higher appreciation of the role of adherence can lead to higher adherence to using therapeutic footwear after healing and consequently to reduced reulceration rates.
对于非复杂性足底糖尿病溃疡的治疗，建议使用不可移除的减压装置，因为患者对可移除设备的依从性较低。然而，患者可能并不总是理解不可移除性对溃疡愈合的重要性，这使他们误以为是设备本身治愈了溃疡。因此，当溃疡愈合后，患者开始使用可移除的减压装置（通常是治疗性鞋具）时，他们往往会回到低依从性的状态，从而导致溃疡复发率较高。为了改变这种基于误解的行为模式，我们需要从我们临床医生对减压装置治疗的概念入手。
承诺装置是人们对自己未来的一种自愿限制，以抵制短期诱惑，实现长期目标。在本文中，建议将不可移除的减压装置从作为强制依从性的手段转变为承诺装置，这可能有助于改变一种临床思维，即强调高依从性的重要性，而不损害对患者自主权的尊重。
将不可移除的减压装置视为承诺装置似乎是一种很有前途的方法，可以在尊重患者自主权的同时强调依从性的重要性。希望患者对依从性作用的更高认识能够导致愈合后使用治疗性鞋具的更高依从性，从而降低溃疡复发率。
