4. Discussion
amputations, ulcer, diabetic foot, diabetes
OF FOOT ULCER, ULCERS, DIABETIC FOOT, ULCER, DIABETES
This study sought to examine user perspectives of irremovable, removable, and sensorized offloading boots (smart boot) to provide insight on ways to help promote adherence and gain insight about factors associated with the acceptance of a smart offloading device with a remote patient monitoring component. Correlation results suggest smart offloading may ultimately help promote adherence, since sensorized boot users were more inclined to report that learning how to use the boot was easy. Additionally, participants with lower cadence or deeper ulcers tended to report that the boot helped them follow physician instructions, regardless of group. Chi-squared results suggest that participants who identified as Hispanic or Latino, as well as those who had fewer or no retrospective falls, tended to rate their offloading boot more favorably regardless of group. These findings provide supporting evidence that older adults could find a sensorized offloading boot easy to use for DFU management. Further, people who do not identify as Hispanic or Latino, report falling in the past 12 months, or report less severe symptoms (e.g., higher cadence, shallower ulcer) may need additional targeted patient education to promote adherence. Age, dropout from the study, group assignment, fear of falling, or cognition did not show significant associations with TAM ratings. Based on previous work that has indicated people prefer lower-profile walkers that are removable [In previous research, people with diabetes who identify as Hispanic or Latino have been shown to experience higher rates of foot ulcers and subsequent amputations, be more likely to develop chronic foot wounds despite receiving regular care, and be less likely to receive diabetic foot care and attempted limb salvage [Participants who reported having fewer falls in the past 12 months (correlation results) or were non-fallers (Chi-squared results) tended to report more favorable perceptions, particularly regarding the design and ease of taking the device on and off. This appears to be aligned with prior work that found postural instability was a factor associated with low adherence to boot use [This study had a limited sample size of 21 participants, and acceptability was determined by a single questionnaire. Our findings could help inform directions for a thematic analysis, which would provide more detailed user perceptions on specific factors to help promote adherence. While this study focused on patient factors, the WHO recommends four other dimensions of factors (social/economic, therapy-related, condition-related, and health-system related) that should also be considered [