Wendland Deborah M, Kline Paul W, Bohnert Kathryn L, Biven Theresa M, Sinacore David R
Deborah M. Wendland, PT, DPT, PhD, CPed is Associate Professor, Department of Physical Therapy, College of Health Professions, Mercer University, Atlanta, Georgia. Paul W. Kline, PT, DPT, PhD is Assistant Professor, Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, North Carolina. Kathryn L. Bohnert, MS is Research Patient Coordinator, Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri. Theresa M. Biven, PT, DPT, CWS is Manager, Wound Care and Hyperbaric Medicine, Piedmont Atlanta Hospital. David R. Sinacore, PT, PhD is Professor, Department of Physical Therapy, Congdon School of Health Sciences, High Point University.
Adv Skin Wound Care. 2023 Apr 1;36(4):194-200. doi: 10.1097/01.ASW.0000919476.24220.cc.
Although it is well-known that offloading devices facilitate healing in people with diabetes and neuropathic plantar ulcers, little is known about how step activity affects healing. The purposes of this study were to compare: (1) healing outcomes (time to healing, percentage of ulcers healed); (2) healing rates by ulcer location; and (3) step activity (daily step count, daily peak mean cadence) among patients using either total contact casts (TCCs) or removable cast walker boots (RCWs).
The study included 55 participants (TCC, 29; RCW, 26) with diabetes mellitus, peripheral neuropathy, and a Wagner grade 1 or 2 neuropathic plantar ulcer. Each participant wore an activity monitor for 14 consecutive days. Step activity and healing variables were assessed using independent t tests, Kruskal-Wallis, Kaplan-Meier, and Mantel-Cox log-rank tests.
Mean participant age was 55 (SD, 11) years. The percentage of ulcers healed was lower in the RCW group versus the TCC group (65% vs 93%). If healed, average healing rate was 77 (SD, 48) days in the TCC group and 138 (SD, 143) days in the RCW group. Survival distribution by ulcer location was different for RCW forefoot than other locations (132 ± 13 days vs 91 ± 15, 75 ± 11, and 102 ± 36 days for TCC forefoot, TCC-midfoot/hindfoot, and RCW-midfoot/hindfoot, respectively; χ2 = 10.69, P = .014). Average step count was 2,597 in the RCW group versus 1,813 steps in the TCC group (P = .07). The daily peak mean cadence for 20-, 30-, or 60-minute periods was greater with RCW use.
Step activity in participants with RCWs was increased compared with those with TCCs. Because of their potential to be easily removable, RCWs may impair ulcer healing by allowing greater step activity.
尽管众所周知，减负装置有助于糖尿病患者和神经性足底溃疡患者的伤口愈合，但对于步活动如何影响愈合却知之甚少。本研究的目的是比较：（1）愈合结果（愈合时间、溃疡愈合百分比）；（2）按溃疡部位划分的愈合率；以及（3）使用全接触石膏（TCC）或可拆卸石膏步行靴（RCW）的患者之间的步活动（每日步数、每日峰值平均步频）。
该研究纳入了55名患有糖尿病、周围神经病变且Wagner分级为1级或2级神经性足底溃疡的参与者（TCC组29人；RCW组26人）。每位参与者连续14天佩戴活动监测器。使用独立t检验、Kruskal-Wallis检验、Kaplan-Meier检验和Mantel-Cox对数秩检验评估步活动和愈合变量。
参与者的平均年龄为55（标准差11）岁。RCW组的溃疡愈合百分比低于TCC组（65%对93%）。如果愈合，TCC组的平均愈合时间为77（标准差48）天，RCW组为138（标准差143）天。RCW前足溃疡的生存分布与其他部位不同（RCW前足为132±13天，而TCC前足、TCC中足/后足和RCW中足/后足分别为91±15天、75±11天和102±36天；χ2=10.69，P=0.014）。RCW组的平均步数为2597步，而TCC组为1813步（P=0.07）。使用RCW时，20分钟、30分钟或60分钟时间段的每日峰值平均步频更高。
与使用TCC的参与者相比，使用RCW的参与者的步活动增加。由于RCW易于拆卸，可能会通过允许更大的步活动而损害溃疡愈合。
