Abstract
Bus SA, Waaijman R, Nollet F. New monitoring technology to objectively assess adherence
to prescribed footwear and assistive devices during ambulatory activity.
Objective
To assess the validity and feasibility of a new temperature-based adherence monitor
to measure footwear use.
Design
Observational study.
Setting
University medical center and participants' homes.
Participants
Convenience sample of healthy subjects (n=11) and neuropathic diabetic patients at
high risk for foot ulceration (n=14).
Interventions
In healthy subjects, the validity of the in-shoe attached adherence monitor was investigated
by comparing its registrations of donning and doffing of footwear during 7 days to
an accurately kept log registration. In diabetic patients, the feasibility of using
the adherence monitor for 7 days in conjunction with a time-synchronized ankle-worn
step activity monitor to register prescribed footwear use during walking was assessed.
Furthermore, a usability questionnaire was completed.
Main Outcome Measures
For validity, the mean time difference and 95% confidence interval (CI) between moments
of donning/doffing footwear recorded with the adherence monitor and in the log were
calculated. For feasibility, technical performance, usability, and the percentage
of steps that the footwear was worn (adherence) were assessed.
Results
The mean time difference between the adherence monitor and log recordings was 0.4
minutes (95% CI, 0.2–0.6min). One erroneous recording and 2 incomplete recordings
were obtained in diabetic patients. Three patients reported discomfort with the step
activity monitor, and 4 patients would not favor repeated testing. Patients used their
footwear for between 9% and 99% of their walking steps.
Conclusions
The adherence monitor shows good validity in measuring when footwear is used or not,
and is, together with instrumented monitoring of walking activity, a feasible and
objective method to assess treatment adherence. This method can have wide application
in clinical practice and research regarding prescribed footwear and other body-worn
assistive devices.
Key Words
List of Abbreviations:
CI (confidence interval)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 06, 2012
Footnotes
We certify that we have affiliations with or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants and patents received or pending, royalties) with an organization or entity with a financial interest in, or financial conflict with, the subject matter or materials discussed in the manuscript. The authors are users of the @monitor that was developed and manufactured by the Department of Medical Technological Innovation of the Academic Medical Centre in Amsterdam, The Netherlands. The authors, themselves, have not received any financial benefit from the @monitor.
In-press corrected proof published online on Sep 23, 2012, at www.archives-pmr.org.
Reprints are not available from the author
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
