Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
J Foot Ankle Res. 2020 Jul 13;13(1):45. doi: 10.1186/s13047-020-00413-z.
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.
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.
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.
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.
有发生糖尿病足溃疡风险的人群经常不能按照要求频繁地穿着治疗性鞋具。本研究旨在确定易发生不依从穿用治疗性鞋具行为的患者群体，并确定与依从性相关的可修正因素。
向 1230 名已配备治疗性鞋具的糖尿病患者邮寄问卷。将自变量分为五个领域。对于每个领域，在单变量回归分析中与依从性相关的变量被纳入多变量回归分析。
共分析了 429 份（34.9%）问卷。多变量回归分析显示，较高的依从性与有报酬的就业、当前的足部溃疡、既往足部溃疡、对随访的满意度、自我效能、理解感觉丧失作为足部溃疡的危险因素、在家中可见的治疗性鞋具储存、将常规鞋具存放在看不见的地方、对穿着哪种鞋具类型的一致选择、以及认为治疗性鞋具可促进溃疡愈合相关（p<0.05）。五个多变量模型解释了依从性差异的 2-28%，其中鞋具使用策略领域解释了最大的差异。
没有报酬性工作或没有足部溃疡经历的患者更容易不依从。为了提高依从性，临床医生应建议患者在家中可见的地方储存治疗性鞋具，并将常规鞋具收起来，同时鼓励患者的自我效能和习惯性使用治疗性鞋具。未来的研究应进一步探讨这一主题，并探索促进习惯改变的方法。本研究的一个局限性是所有变量均为自我报告。
