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A Method for Assessing Off-loading Compliance

Ryan T. Crews, MS ^*, David G. Armstrong, DPM, PhD ^* and Andrew J.M. Boulton, MD  

^* 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.
University Department of Medicine and Diabetes, Manchester Royal Infirmary, Manchester, England.
Division of Endocrinology, Metabolism, and Diabetes, University of Miami School of Medicine, Miami, FL.

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)

Abstract

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)