Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration.

OBJECTIVE: To assess the perceived usability and use of custom- made footwear in diabetic patients who are at high-risk for foot ulceration, and to elucidate the determinants of usability and use. DESIGN: Survey. SUBJECTS: A total of 153 patients with diabetes, peripheral neuropathy, prior plantar foot ulceration and newly prescribed custom-made footwear, recruited from 10 Dutch multidisciplinary foot clinics. METHODS: The Questionnaire of Usability Evaluation was used to assess the patients' perception of weight, appearance, comfort, durability, donning/doffing, stability, benefit and overall appreciation of their prescription footwear (all expressed as visual analogue scores). Data on priorities for usability and footwear use (in h/day) were obtained from patient reports. Multivariate logistic regression analysis was used to assess determinants of usability and use. RESULTS: Median (interquartile range) score for overall appreciation was 8.3 (7.1-9.1). Scores ranged from 6.5 (4.5-8.6) for weight to 9.6 (6.3-9.9) for donning/doffing. Footwear comfort was listed most often (33.3%) as the highest priority. Footwear use was <60% of daytime (where daytime was defined as 16 h out of bed) in 58% of patients. The only significant determinant of footwear use was the perceived benefit of the footwear (p = 0.045). CONCLUSION: Perceived usability of footwear was mostly positive, although individual scores and priorities varied considerably. Footwear use was low to moderate and dependent only on the perceived benefit of the footwear. Therefore, practitioners should focus on enhancing the patient's ap-preciation of the therapeutic benefit of custom-made footwear.

Predictive factors of cessation of ambulation in patients with Duchenne muscular dystrophy.

OBJECTIVES: To identify baseline patient and treatment characteristics that can predict wheelchair dependency within 2 yr. DESIGN: This prospective cohort study included 44 subjects who met study inclusion criteria. The same investigator examined them at 6-mo intervals. Ambulatory status, anthropometric data, muscle strength, range of motion of weight bearing joints, scoliosis, WeeFIM instrument, Functional Status II revised, and use of standing and walking aids. Cox proportional hazards regression analysis and the stepwise technique were used to search for prognostic factors of wheelchair dependency within 2 yr. RESULTS: Children with impaired hip extension and ankle dorsiflexion strength are 11.5 (95% confidence interval, 3.2-40.5) and 3.7 (95% confidence interval, 1.4-9.7) times, respectively, more likely to stop ambulating within 2 yr. CONCLUSIONS: This study confirms that strength loss, specifically in hip extension and ankle dorsiflexion, are the primary predictors of loss of ambulation in Duchenne muscular dystrophy. Further research is needed for medical interventions that can improve hip extension or ankle dorsiflexion and actually can improve ambulation.