New monitoring technology to objectively assess adherence to prescribed footwear and assistive devices during ambulatory activity

Arch Phys Med Rehabil. 2012 Nov;93(11):2075-9. doi: 10.1016/j.apmr.2012.06.019. Epub 2012 Jul 4.


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.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Diabetic Foot / rehabilitation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Ambulatory / instrumentation*
  • Patient Compliance*
  • Reproducibility of Results
  • Shoes*
  • Time Factors