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A Method for Assessing Off-loading Compliance

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  • 1 Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, Chicago, IL. Dr. Armstrong is now with University of Arizona College of Medicine, Tucson, AZ.
  • | 2 University Department of Medicine and Diabetes, Manchester Royal Infirmary, Manchester, England.
  • | 3 Division of Endocrinology, Metabolism, and Diabetes, University of Miami School of Medicine, Miami, FL.
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Background: Off-loading excessive pressure is essential to healing diabetic foot ulcers. However, many patients are not compliant in using prescribed footwear or off-loading devices. We sought to validate a method of objectively measuring off-loading compliance via activity monitors.

Methods: For 4 days, a single subject maintained a written compliance diary concerning use of a removable cast walker. He also wore a hip-mounted activity monitor during all waking hours. An additional activity monitor remained mounted on the cast walker at all times. At the conclusion of the 4 days, the time-stamped hip activity data were independently coded for walker compliance by the compliance diary and by using the time-stamped walker activity data.

Results: An intraclass reliability of 0.93 was found between diary-coded and walker monitor–coded activity.

Conclusions: These results support the use of this dual activity monitor approach for assessing off-loading compliance. An advantage of this approach versus a patient-maintained diary is that the monitors are not susceptible to incorrect patient recall or a patient’s desire to please a caregiver by reporting inflated compliance. Furthermore, these results seem to lend support to existing reports in the literature using similar methods. (J Am Podiatr Med Assoc 99(2): 100–103, 2009)

Corresponding author: Ryan T. Crews, MS, Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064. (E-mail: ryan.crews @rosalindfranklin.edu)