PURPOSE: To enhance the learner's competence with knowledge of the effectiveness of shear-reducing insoles for prevention of foot ulceration in patients with high-risk diabetes. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of foot ulceration risk, risk factors, incidence, and prevention.2. Apply knowledge gained from reviewing this study and a literature review about the use of shear-reducing insoles to patient scenarios. OBJECTIVE: The objective of this study was to evaluate the effectiveness of a shear-reducing insole compared with a standard insole design to prevent foot ulceration in high-risk patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulceration were randomized into a standard therapy group (n = 150) or a shear-reducing insole group (n = 149). Patients were evaluated for 18 months. Standard therapy group consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. The shear-reducing insole group included a novel insole designed to reduce both pressure and shear on the sole of the foot. Insoles were replaced every 4 months in both groups. The primary clinical outcome was foot ulceration. The authors used Cox proportional hazards regression to evaluate time to ulceration. RESULTS: There were 2 significant factors from the Cox regression model: insole treatment and history of a foot complication. The standard therapy group was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group (hazard ratio, 3.47; 95% confidence interval, 0.96-12.67). CONCLUSIONS: These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.
RCT Entities:
PURPOSE: To enhance the learner's competence with knowledge of the effectiveness of shear-reducing insoles for prevention of foot ulceration in patients with high-risk diabetes. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of foot ulceration risk, risk factors, incidence, and prevention.2. Apply knowledge gained from reviewing this study and a literature review about the use of shear-reducing insoles to patient scenarios. OBJECTIVE: The objective of this study was to evaluate the effectiveness of a shear-reducing insole compared with a standard insole design to prevent foot ulceration in high-risk patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulceration were randomized into a standard therapy group (n = 150) or a shear-reducing insole group (n = 149). Patients were evaluated for 18 months. Standard therapy group consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. The shear-reducing insole group included a novel insole designed to reduce both pressure and shear on the sole of the foot. Insoles were replaced every 4 months in both groups. The primary clinical outcome was foot ulceration. The authors used Cox proportional hazards regression to evaluate time to ulceration. RESULTS: There were 2 significant factors from the Cox regression model: insole treatment and history of a foot complication. The standard therapy group was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group (hazard ratio, 3.47; 95% confidence interval, 0.96-12.67). CONCLUSIONS: These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.
Authors: Lawrence A Lavery; Kevin R Higgins; Javier La Fontaine; Ruben G Zamorano; George P Constantinides; Paul J Kim Journal: Int Wound J Date: 2014-02-21 Impact factor: 3.315
Authors: Fay Crawford; Francesca M Chappell; James Lewsey; Richard Riley; Neil Hawkins; Donald Nicolson; Robert Heggie; Marie Smith; Margaret Horne; Aparna Amanna; Angela Martin; Saket Gupta; Karen Gray; David Weller; Julie Brittenden; Graham Leese Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014
Authors: Anna L Hatton; Elise M Gane; Jayishni N Maharaj; Joshua Burns; Joanne Paton; Graham Kerr; Keith Rome Journal: BMJ Open Date: 2019-07-17 Impact factor: 2.692
Authors: Fay Crawford; Donald J Nicolson; Aparna E Amanna; Angela Martin; Saket Gupta; Graham P Leese; Robert Heggie; Francesca M Chappell; Heather H McIntosh Journal: Diabetologia Date: 2019-11-27 Impact factor: 10.122