• 1

    Armstrong DG, Boulton AJM, Bus SA: Diabetic foot ulcers and their recurrence. N Engl J Med 376: 2367, 2017.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 2

    Nabuurs-Franssen MH, Huijberts MS, Nieuwenhuijzen Kruseman AC, et al: Health-related quality of life of diabetic foot ulcer patients and their caregivers. Diabetologia 48: 1906, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Ragnarson Tennvall G, Apelqvist J: Health-economic consequences of diabetic foot lesions. Clin Infect Dis 39(suppl 2): S132, 2004.

  • 4

    Waaijman R, Arts ML, Haspels R, et al: Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration. Diabet Med 29: 1542, 2012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Bus SA, van Netten JJ, Lavery LA, et al: IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev 32(suppl 1): 16, 2016.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 6

    Bus SA, Waaijman R, Arts M, et al: Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial. Diabetes Care 36: 4109, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 7

    Waaijman R, Keukenkamp R, de Haart M, et al: Adherence to wearing prescription custom-made footwear in patients with diabetes at high risk for plantar foot ulceration. Diabetes Care 36: 1613, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    Knowles EA, Boulton AJ: Do people with diabetes wear their prescribed footwear? Diabet Med 13: 1064, 1996.

  • 9

    Macfarlane DJ, Jensen JL: Factors in diabetic footwear compliance. JAPMA 93: 485, 2003.

  • 10

    van Netten JJ, Price PE, Lavery LA, et al: Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 32(suppl 1): 84, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Hettema J, Steele J, Miller WR: Motivational interviewing. Annu Rev Clin Psychol 1: 91, 2005.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 12

    Gabbay RA, Kaul S, Ulbrecht J, et al: Motivational interviewing by podiatric physicians: a method for improving patient self-care of the diabetic foot. JAPMA 101: 78, 2011.

    • Search Google Scholar
    • Export Citation
  • 13

    Martins RK, McNeil DW. Review of Motivational Interviewing in promoting health behaviors. Clin Psychol Rev 29: 283, 2009.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 14

    Christie D, Channon S: The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab 16: 381, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15

    Knight KM, McGowan L, Dickens C, et al: A systematic review of motivational interviewing in physical health care settings. Br J Health Psychol 11: 319, 2006.

  • 16

    Miller WR, Rollnick S: Motivational Interviewing: Preparing People for Change, 2nd Ed, Guilford Press, New York, 2002.

  • 17

    Bus SA, Waaijman R, Nollet F: New monitoring technology to objectively assess adherence to prescribed footwear and assistive devices during ambulatory activity. Arch Phys Med Rehabil 93: 2075, 2012.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 18

    Ulbrecht JS, Hurley T, Mauger DT, et al: Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial. Diabetes Care 37: 1982, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 19

    de Jonge JM, Merkx MJ. Codeersysteem Motiverende Gespreksvoering, Hogeschool Windesheim, Zwolle, the Netherlands, 2010.

  • 20

    Coleman KL, Smith DG, Boone DA, et al: Step activity monitor: long-term, continuous recording of ambulatory function. J Rehabil Res Dev 36: 8, 1999.

  • 21

    Jansink R, Braspenning J, Keizer E, et al: No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial. Scand J Prim Health Care 31: 119, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 22

    Graves KD, Miller PM: Behavioral medicine in the prevention and treatment of cardiovascular disease. Behav Modif 27: 3, 2003.

  • 23

    Arts ML, de Haart M, Bus SA, et al: Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration. J Rehabil Med 46: 357, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 24

    Lundahl B, Moleni T, Burke BL, et al: Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Educ Counsel 93: 157, 2013.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Whitehead AL, Julious SA, Cooper CL, et al: Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res 25: 1057, 2016.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

An Explorative Study on the Efficacy and Feasibility of the Use of Motivational Interviewing to Improve Footwear Adherence in Persons with Diabetes at High Risk for Foot Ulceration

Renske Keukenkamp Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

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Maarten J. Merkx Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; HSK Group B.V., Arnhem, The Netherlands.

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Tessa E. Busch-Westbroek Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

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Sicco A. Bus Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

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Background:

In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear.

Methods:

Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie, <80% of steps taken in prescription footwear) were randomly assigned to standard education (ie, verbal and written instructions) or to standard education plus two 45-min sessions of motivational interviewing. Adherence was objectively measured over 7 days using ankle- and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability.

Results:

Median (range) baseline, 1-week, and 3-month adherence at home was 49% (6%–63%), 84% (5%–98%), and 40% (4%–80%), respectively, in the motivational interviewing group and 35% (13%–64%), 33% (15%–55%), and 31% (3%–66%), respectively, in the standard education group. Baseline, 1-week, and 3-month adherence away from home was 91% (79%–100%), 97% (62%–99%) and 92% (86%–98%), respectively, in the motivational interviewing group and 78% (32%–97%), 91% (28%–98%), and 93% (57%–100%), respectively, in the standard education group. None of the differences were statistically significant. Interviewer proficiency was good, and the protocol could be successfully executed in the given time frame.

Conclusions:

Footwear adherence at home increases 1 week after motivational interviewing to clinically relevant but not statistically significant levels (ie, 80%) but then returns over time to baseline levels. Away from home, adherence is already sufficient at baseline and remains so over time. The use of motivational interviewing seems feasible for the given purpose and patient group. These findings provide input to larger trials and provisionally suggest that additional or adjunctive therapy may be needed to better preserve adherence.

Corresponding author: Sicco A. Bus, PhD, Department of Rehabilitation, Room A01-419, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. (E-mail: s.a.bus@amc.uva.nl)