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Objective: Despite the high cumulative plantar stress associated with standing, previous physical activity reports of diabetic patients at risk of foot ulceration have not taken this activity into account. This study aimed to monitor spontaneous daily physical activity in diabetic peripheral neuropathy (DPN) patients and examine both walking and standing activities as important foot-loading conditions.
Research Design and Methods: Thirteen DPN patients were asked to wear a body worn sensor for 48 hours. Body postures (sitting, standing, lying) and locomotion (walking, number of steps, postural transition) were extracted.
Results: Patients daily spent twice as much time standing (13+/-5%) as walking (6+/-3%). They spent 37+/-6% sitting and 44%+/-8 lying down. Average steps/day was 7,754+/-4,087 and the number of walking episodes was 357+/-167 with maximum duration of 3.9+/-3.8 minutes.
Conclusion: The large portion of DPN patients' time spent standing with the feet loaded requires further consideration when treating and preventing foot ulcers.
The purpose of this study was to evaluate physical activity as a function of offloading modality in patients with diabetic foot ulcers (DFU). Forty nine eligible subjects with non-infected, non- ischemic, plantar neuropathic foot ulcers were studied. Participants were randomized to one of two off-loading modalities: removable cast walker (RCW) or instant total contact cast (iTCC). Outcomes were assessed at wound healing or at 12 weeks. Primary outcome measures included duration of wound healing and dosage of activity. There were no between groups differences observed at baseline. We identified a higher proportion of patients healed at 12 weeks in the iTCC than the RCW (p=0.03) as well as a smaller wound area amongst those remaining unhealed (p=0.01). While at baseline, the activity pattern was nearly the same between two groups, there were a number of differences in activity assessments between groups at the end of study visit. Specifically, the iTCC population had a 42.9% shorter standing period compared, a 50.0% walking period and 55.8% continuous walking period compared to the RCW group (p<0.05 for all). The period of standing (r=-0.5, p=0.04) and walking (r=-0.47, p=0.05) recorded from the weeks’ previous visit had a negative correlation with wound size reduction. A logistic regression model identified standing period as an independent predictor for success of wound healing. Results of this study revealed that, in addition to previously described problems with adherence to offloading, people using irremovable offloading had significantly different activity characteristics may explain the difference in wound healing success between groups.
The purpose of this article was to evaluate the accuracy of 2 physical activity monitors, monitors 1 and 2, for measuring weight-bearing activity in persons with prior diabetic foot ulcers.
Two recently developed monitors were used to differentiate anatomical postures such as lying, sitting, and standing upright. One monitor was designed to distinguish between duration of standing and walking and the other combines duration of standing and walking into 1 measure.
SUBJECTS AND SETTING:
Thirty-one subjects were recruited; all participants had experienced a diabetic foot ulcer and completed participation in a previous cohort study. The study setting was 2 medical centers in the Midwestern United States.
Subjects simultaneously wore the 2 monitors while performing 14 weight-bearing (ie, walking and standing) and non-weight-bearing (ie, sitting and lying) activities. The duration spent on each activity and the total number of steps taken for each walking activity were directly observed and recorded with each monitor. The accuracy of monitors 1 and 2 was assessed via direct observation as a reference standard. Paired-samples t tests were used to examine the difference in accuracy between the 2 monitors.
For measuring duration of activity, the accuracy of monitor 1 ranged from 73% to 100% for walking, 50% for standing, and from 42% to 100% for sitting/lying. In contrast, the accuracy of monitor 2 ranged from 98% to 100% for walking, 100% for standing, and from 97% to 100% for sitting/lying. The accuracy of monitor 1 for counting the number of steps ranged from 43% to 81%, while the accuracy of monitor 2 ranged from 91% to 99%. Monitor 2 was significantly more accurate than monitor 1 in measuring duration of standing still, slow walking, pedaling while sitting, lying on the left, and lying on the right, as well as measuring steps across different kinds of walking activities. Differences in monitor accuracy between subjects with and without foot pain and between subjects with and without foot amputation were not statistically significant.
These findings suggest that monitor 2 is a more accurate measure of weight-bearing activities than monitor 1 among patients with previous diabetic foot ulcers. Additionally, the 2 monitors differ in terms of function; monitor 2 distinguishes standing from walking, whereas monitor 1 combines standing and walking into 1 measure. We recommend monitor 2 to examine the impact of weight-bearing activity on foot ulceration in patients with diabetic neuropathy.