Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading @ALPSLimb #ActAgainstAmputation

This from our colleagues at Charing Cross Hospital.

Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading


A review of adherence to offloading treatment for people with diabetes and foot disease.•

Adherence to offloading treatment is influenced by biological and psychosocial factors.•

Abnormal gait and postural instability reduce the levels of adherence to foot offloading treatment.•

Stigma associated with offloading and lack of motivation negatively influence adherence to offloading.

Diabetic foot
Foot ulcer prevention Foot ulcer management Foot offloading Adherence

1. Introduction

Foot ulceration is a severe and common microvascular compli- cation of diabetes mellitus (DM), leading to high rates of impair- ment, mortality, and costs to individuals and health organizations [1,2]. Annually, around 2% of the diabetes population develops foot ulceration, equating to nine million worldwide [3] and over 70,000 in the UK [4]. Furthermore, those with diabetes have a 19%e34% probability of developing diabetic foot ulceration (DFU) in their lifetime [5,6].

Recent data show that DFU is highly recurrent, with relapse rates of around 40% in the first year [7]. Over 50% of DFUs become infected, resulting in chronic wounds and often amputations [5]. Yearly, there are over one million amputations worldwide [1] and over 9,000 in the UK [4]. These figures are shocking because around 80% (four in five) of foot ulcers can be prevented with optimum care [4,7]. Diabetic foot disease is a worrying outcome because of its

* Corresponding author. Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK. Tel.: þ44 (0) 20 331 17335.

E-mail address: (S. Racaru).


Background and aims: To identify measurement methods, proportions of adherent participants, factors affecting adherence, and concordance promoting interventions.
Methods: A systematic scoping review was conducted by searching Medline, CINAHL, PubMed, EMBASE, and EMCARE databases.

Results: Twenty-four trials were identified from 1001 citations. Only 25% of the included studies used objective methods to quantify adherence. The proportion of adherent participants (!80% of daily steps/ time) ranged from 28% to 60%. Psychosocial factors are the most common influencers of adherence. However, interventions for improving compliance are lacking.

Conclusion: There is a need to accurately quantify and optimize adherence to foot offloading in people with diabetes.

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