Abstract

Background

Diabetic foot ulcers have a high impact on mobility and daily functioning and lead to high treatment costs, for example, by hospitalization and amputation. To prevent (re)ulcerations, custom-made orthopedic shoes are considered essential. However, adherence to wearing the orthopedic shoes is low, and improving adherence was not successful in the past. We propose a novel care approach that combines motivational interviewing (MI) with a digital shoe-fitting procedure to improve adherence to orthopedic shoes. The aim of this trial is to assess the (cost-)effectiveness of this novel care approach compared to usual care (no MI and casting-based shoe-fitting) in promoting footwear adherence and ulcer prevention.

Methods

The trial will include people with diabetes, with IWGDF Risk categories 1–3, who have been prescribed orthopedic shoes. Participants will be randomized at the level of the podiatrist to the novel care approach or usual care. The primary outcome is the proportion of participants who adhere to the use of their orthopedic shoes, that is, who take at least 80% of their total daily steps with orthopedic shoes. A temperature microsensor will be built into the participants’ orthopedic shoes to measure wearing time continuously over 12 months. In addition, daily activity will be measured periodically using log data with an activity monitor. Data from the temperature microsensor and activity monitor will be combined to calculate adherence. (Re-)experienced complications after receiving orthopedic shoes will be registered. Questionnaires and interviews will measure the experiences of participants regarding orthopedic shoes, experiences of podiatrists regarding motivational interviewing, care consumption, and quality of life. Differences in costs and quality of life will be determined in a cost-effectiveness analysis.

Discussion

This trial will generate novel insights into the socio-economic and well-being impact and the clinical effectiveness of the novel care approach on adherence to wearing orthopedic shoes.

Trial registration

Netherlands Trial Register NL7710. Registered on 6 May 2019

Details

Title
Using motivational interviewing combined with digital shoe-fitting to improve adherence to wearing orthopedic shoes in people with diabetes at risk of foot ulceration: study protocol for a cluster-randomized controlled trial
Author
Jongebloed-Westra, M. 1   VIAFID ORCID Logo  ; Bode, C. 1 ; van Netten, J. J. 2 ; ten Klooster, P. M. 1 ; Exterkate, S. H. 3 ; Koffijberg, H. 4 ; van Gemert-Pijnen, J. E. W. C. 1 

1  University of Twente, Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, Enschede, The Netherlands (GRID:grid.6214.1) (ISNI:0000 0004 0399 8953) 
2  Amsterdam Movement Sciences, Department of Rehabilitation, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); Hospital Group Twente, Diabetic Foot Unit, Department of Surgery, Almelo, The Netherlands (GRID:grid.417370.6) (ISNI:0000 0004 0502 0983) 
3  Voetencentrum Wender, Hengelo, The Netherlands (GRID:grid.6214.1); Voetmax Orthopedie, Hengelo, The Netherlands (GRID:grid.6214.1) 
4  University of Twente, Department of Health Technology and Services Research, TechMed Centre, Enschede, The Netherlands (GRID:grid.6214.1) (ISNI:0000 0004 0399 8953) 
Pages
750
Publication year
2021
Publication date
Dec 2021
Publisher
Springer Nature B.V.
e-ISSN
17456215
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13063-021-05680-0
ProQuest document ID
2730341927
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.