Effects of diabetes mellitus on step length and minimum toe clearance adaptation.

BACKGROUND: Adaptive gait involves the ability to adjust the leading foot in response to the requirement of dynamic environments during walking. Accurate adjustments of the minimum toe clearance (MTC) height and step length can prevent older people from falling when walking and responding to hazards. Although older people with diabetes fall more frequently than healthy older adults, no previous studies have quantified their adaptive gait abilities. This study aimed to investigate the effects of diabetes mellitus on step length and MTC height adjustments using a non-immersive virtual-reality system. METHODS: Sixteen young adults (26 ± 5 years, 7 females), 16 healthy older adults (68 ± 5 years, 6 females), and 16 older adults with diabetes (70 ± 5 years, 6 females) completed adaptability tests while walking on a treadmill. A computer system visualised a continuous real-time signal of absolute step length and MTC on a monitor. Each person responded to four discrete participant-specific step length and MTC visual targets that were presented on the same signal. Tasks were to match the peaks of interest on each signal to presented targets. Targets were 10% longer or shorter than the mean baseline step length, and 2.5 cm, and 3.5 cm higher than the mean baseline MTC. When a target was displayed, it remained unchanged for 10 consecutive foot displacement adaptation attempts. Then, the target was removed and a new target or the same target was present after 10 consecutive steps and remained for 10 steps. Each target was randomly presented three times (3 × 10). Step length and MTC height adjustments in response to targets were measured and compared among groups. RESULTS: Mean preferred walking speeds were not different among groups significantly when no targets were presented on the monitor in baseline walking. However, when participants walked on a treadmill while attempting to match step lengths or MTC heights to displayed targets on the monitor, the group with diabetes had reduced step length and MTC adjustments compared with other groups significantly. They showed greater errors (differences between their step lengths/MTC heights and presented targets) on the monitor. CONCLUSIONS: This study quantified reduced abilities for older individuals with diabetes to adjust both step length and MTC in response to stimuli compared to healthy older counterparts. Reduced step length and MTC height adjustments can increase falls in at risk populations. The presented virtual-reality system has merits for assessing and training step and MTC adaptation.

Older People With Type 2 Diabetes-Individualising Management With a Specialised Community Team (OPTIMISE): Perspectives of Participants on Care.

Despite the high prevalence of diabetes in older people, there is limited information on optimal methods to support their diabetes management, including how to incorporate technology. This article reports on the results of semi-structured interviews with 41 adult participants with type 2 diabetes (mean age 74 ± 7 years) on their perspectives of a new model of care (the Older People With Type 2 Diabetes-Individualising Management With a Specialised Community Team [OPTIMISE] program) for older people with type 2 diabetes. The OPTIMISE program involved telemedicine consultations, home visits by a credentialed diabetes educator, and intermittent flash glucose monitoring. Human connection and relationships were key to the positive perspectives expressed by participants in this program that used technology to enhance the care of older people in their homes.

The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study.

BACKGROUND: The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians. METHODS: Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants' experiences and understanding of diversity concepts and their care needs. RESULTS: Fifteen older people (seven female, eight male), mean age 76 years (range 71-85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed. CONCLUSION: Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care.

Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations.

BACKGROUND: Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems. OBJECTIVE: To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action. DESIGN: Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study. SETTING AND PARTICIPANTS: Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations. INTERVENTIONS: Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care. MAIN OUTCOME MEASURES: Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA. RESULTS: The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples. DISCUSSION AND CONCLUSIONS: The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.

Predicting delayed healing: The diagnostic accuracy of a venous leg ulcer risk assessment tool.

The aim of this study was to validate a newly developed tool that can predict the risk of failure to heal of a venous leg ulcer in 24 weeks. The risk assessment tool was validated, and performance of the tool was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Retrospective and prospective validation was conducted through multi-site, longitudinal studies. In the retrospective study (n = 318), 30% of ulcers did not heal within 24 weeks, with the tool demonstrating an AUC of 0.80 (95% CI, 0.68-0.93, P < .001) for the total score. In the prospective study across 10 clinical sites (n = 225), 31% (n = 68) of ulcers did not heal within 24 weeks. Participants were classified with the RAT at enrolment as being at low risk (27%), moderate risk (53%) or high risk (20%) of delayed healing; the proportion of wounds unhealed at 24 weeks was 6%, 29% and 59%, respectively. Validation results of the total score indicated good discrimination and goodness of fit with an AUC of 0.78 (95% CI, 0.71-0.85, P < .001). Validation of this risk assessment tool offers assurance that realistic outcomes can be predicted for patients, and scores can guide early decisions on interventions to address specific risk factors for failing to heal, thus promoting timely healing.

Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool.

The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0.83 (95% CI, 0.76-0.90, P < .001). The prospective study (n = 143) observed that 50.4% (n = 63) of venous leg ulcers recurred within 12 months of healing. Participants were classified using the risk assessment tool as being at low risk (28%), moderate risk (59%), and high risk (13%); the proportion of wounds recurring at 12 months was 15%, 61%, and 67% for each group, respectively. Validation results indicated good discrimination and goodness of fit, with an AUC of 0.73 (95% CI, 0.64-0.82, P < .001). Validation of this risk assessment tool for the recurrence of venous leg ulcers provides clinicians with a resource to identify high-risk patients and to guide decisions on adjunctive, tailored interventions to address the specific risk factors to decrease the risk of recurrence.

A pilot study evaluating protein abundance in pressure ulcer fluid from people with and without spinal cord injury.

OBJECTIVE: To determine whether the biochemistry of chronic pressure ulcers differs between patients with and without chronic spinal cord injury (SCI) through measurement and comparison of the concentration of wound fluid inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases. DESIGN: Survey. SETTING: Tertiary spinal cord rehabilitation center and skilled nursing facilities. PARTICIPANTS: Twenty-nine subjects with SCI and nine subjects without SCI (>18 years) with at least one chronic pressure ulcer Stage II, III, or IV were enrolled. OUTCOME MEASURES: Total protein and 22 target analyte concentrations including inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases were quantified in the wound fluid and blood serum samples. Blood samples were tested for complete blood count, albumin, hemoglobin A1c, total iron binding capacity, iron, percent (%) saturation, C-reactive protein, and erythrocyte sedimentation rate. RESULTS: Wound fluid concentrations were significantly different between subjects with SCI and subjects without SCI for total protein concentration and nine analytes, MMP-9, S100A12, S100A8, S100A9, FGF2, IL-1b, TIMP-1, TIMP-2, and TGF-b1. Subjects without SCI had higher values for all significantly different analytes measured in wound fluid except FGF2, TGF-b1, and wound fluid total protein. Subject-matched circulating levels of analytes and the standardized local concentration of the same proteins in the wound fluid were weakly or not correlated. CONCLUSIONS: The biochemical profile of chronic pressure ulcers is different between SCI and non-SCI populations. These differences should be considered when selecting treatment options. Systemic blood serum properties may not represent the local wound environment.

Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team.

A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.

The metamorphosis of a collaborative team: from creation to operation.

This paper reports on the process of developing a community-based interprofessional team to provide diabetes related foot ulcer care. A new interprofessional team was formed in a local community, and the process of building a successful team was examined by the adoption of an exploratory qualitative case study approach that gathered a series of one-on-one interviews with participants at three points in time - prior to the team's formation, two months into the team's operation, and finally seven months later - shortly before the team and its clinic closed. Interviews were also conducted with a small sample of the team's patients. The factors linked to the successes and challenges of building a care team in a community setting are explored. Informants highlighted the value of regular team meetings, role clarity, and a commitment to patient-centered care. However effective collaboration was not sufficient to maintain the team in the face of poor institutional and government support.

Describing the development and implementation of a novel collaborative multidisciplinary approach to deliver foot health supports for individuals experiencing homelessness and its outcomes.

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.

Development of a Translation Standard to support the improvement of health literacy and provide consistent high-quality information.

Australia has a high number of people from culturally and linguistically diverse (CALD) backgrounds whose primary language is not English. CALD population groups have comparatively lower levels of education and health literacy, and poorer health outcomes compared with the Australian-born population. The delivery of consumer health information to people from CALD backgrounds usually includes the use of translated resources. Unfortunately, the quality of translated resources available on health issues is highly variable and may impact efforts to address the disparities in health outcomes. Currently applied guides to translation focus on accuracy and literalness of the translation; however, for health translations, conveying meaning and incorporating culturally relevant information is essential. Minimum standards for developing translated resources are needed to provide an indication of quality for end users, including healthcare providers, the client and carer. This paper describes the development of a Translation Standard, led by a community nursing organisation in collaboration and consultation with CALD community members and peak community organisations in Melbourne, Australia. The Translation Standard includes 10 components that have been identified as necessary to ensure a minimum standard of translation that is of high quality and caters to the health literacy levels of the target audience.

Overground gait adaptability in older adults with type 2 diabetes in response to virtual targets and physical obstacles.

BACKGROUND: To step over an unexpected obstacle, individuals adapt gait; they adjust step length in the anterior-posterior direction prior to the obstacle and minimum toe clearance height in the vertical direction during obstacle avoidance. Inability to adapt gait may lead to falls in older adults with diabetes as the results of the effects of diabetes on the sensory-motor control system. Therefore, this study aimed to investigate gait adaptability in older adults with diabetes. RESEARCH QUESTION: Would diabetes impair gait adaptability and increase sagittal foot adjustment errors? METHODS: Three cohorts of 16 people were recruited: young adults (Group I), healthy older adults (Group II), and older adults with diabetes (Group III). Participants walked in baseline at their comfortable speeds. They then walked and responded to what was presented in gait adaptability tests, which included 40 trials with four random conditions: step shortening, step lengthening, obstacle avoiding, and walking through. Virtual step length targets were 40% of the baseline step length longer or shorter than the mean baseline step length; the actual obstacle was a 5-cm height across the walkway. A Vicon three-dimensional motion capture system and four A.M.T.I force plates were used to quantify spatiotemporal parameters of a gait cycle and sagittal foot adjustment errors (differences between desired and actual responses). Analyses of variance (ANOVA) repeated measured tests were used to investigate group and condition effects on dependent gait parameters at a significance level of 0.05. RESULTS: Statistical analyses of Group I (n = 16), Group II (n = 14) and Group III (n = 13) revealed that gait parameters did not differ between groups in baseline. However, they were significantly different in adaptability tests. Group III significantly increased their stance and double support times in adaptability tests, but these adaptations did not reduce their sagittal foot adjustment errors. They had the greatest step length errors and lowest toe-obstacle clearance, which could cause them to touch the obstacle more. SIGNIFICANCE: The presented gait adaptability tests may serve as entry tests for falls prevention programs.

Can Thermal Imaging Technique be Used to Predict the Healing Status of a Venous Leg Ulcer?

Venous leg ulcers (VLUs) are the most common chronic wound types in older populations, with many wounds not healing in the normal trajectory. Many older people with wounds are treated in their homes, currently assessed by monitoring the wound area over weeks to ascertain the potential for healing. A noncontact method using thermal imaging has been shown to predict the healing trajectory of diabetes-related foot ulcers, although has not been tested in VLU or the home setting. This project investigated the effectiveness of using thermal imaging to predict VLU healing in the homes of participants. Images of 78 ulcers were collected weekly using a thermal camera from 67 participants in their homes, at 5 consecutive time points. Final follow-up calls were undertaken at 12 weeks to ascertain healing status (healed/unhealed). Images were preprocessed and segmented and the area of the region of the wound was extracted. Kruskal-Wallis tests were performed to test the association of the change of areas over the 5 consecutive weeks with the healing status of the ulcers at 12 weeks. The 95% confidence interval plots were obtained to study the distribution of the area in the healed and unhealed cases. This study found that the difference in the imaged areas between unhealed ulcers at 12 weeks did not reach statistical significance using thermal imaging. Therefore, thermal images could not predict healing progression in VLUs when the images were taken in the homes of participants. Future research to improve the prediction of venous leg ulcer healing should include developing a protocol to standardize conditions, improve imaging process methods, and use machine learning.

Application of StyleGAN Architecture for Generating Venous Leg Ulcer Images.

Leg ulcers caused by impaired venous blood return are the most typical chronic wound form and have a significant negative impact on the lives of people living with these wounds. Thus, it is important to provide early assessment and appropriate treatment of the wounds to promote their healing in the normal trajectory. Gathering quality wound data is an important component of good clinical care, enabling monitoring of healing progress. This data can also be useful to train machine learning algorithms with a view to predicting healing. Unfortunately, a high volume of good-quality data is needed to create datasets of suitable volume from people with wounds. In order to improve the process of gathering venous leg ulcer (VLU) data we propose the generative adversarial network based on StyleGAN architecture to synthesize new images from original samples. We utilized a dataset that was manually collected as part of a longitudinal observational study of VLUs and successfully synthesized new samples. These synthesized samples were validated by two clinicians. In future work, we plan to further process these new samples to train a fully automated neural network for ulcer segmentation.

Computerised prediction of healing for venous leg ulcers.

Early prediction of delayed healing for venous leg ulcers could improve management outcomes by enabling earlier initiation of adjuvant therapies. In this paper, we propose a framework for computerised prediction of healing for venous leg ulcers assessed in home settings using thermal images of the 0 week. Wound data of 56 older participants over 12 weeks were used for the study. Thermal images of the wounds were collected in their homes and labelled as healed or unhealed at the 12th week follow up. Textural information of the thermal images at week 0 was extracted. Thermal images of unhealed wounds had a higher variation of grey tones distribution. We demonstrated that the first three principal components of the textural features from one timepoint can be used as an input to a Bayesian neural network to discriminate between healed and unhealed wounds. Using the optimal Bayesian neural network, the classification results showed 78.57% sensitivity and 60.00% specificity. This non-contact method, incorporating machine learning, can provide a computerised prediction of this delay in the first assessment (week 0) in participants' homes compared to the current method that is able to do this in 3rd week and requires contact digital planimetry.

Volunteer peer support frameworks supporting older women living alone.

Volunteer peer support is an approach that enables a supportive connection between volunteers and a sub-set of community members with shared experiences or interests. To implement co-designed strategies to support older women to maintain independence and optimise wellbeing in Australia, a volunteer peer support approach was proposed. There was limited literature describing volunteer peer support frameworks to underpin interventions of this kind; and given the increasing desire for engagement of individuals and communities, articulation of the key components of such a framework is warranted. In this paper, we define volunteers and peer support, and outline existing frameworks for volunteering and peer support. We then describe the volunteer peer support framework developed for this intervention, outlining the key requirements. This information will enable others to develop an effective and sustainable structure for peer support volunteer services.

Assessing Older Community Members Using a Social Work Tool: Developing an Organizational Response.

Social Worker's undertake psycho-social assessments and facilitate access to evidence-informed psychological and practical supports to optimize the physical, psychological, and social wellbeing of the community members in their care. Social workers employed at an aged and community care organization undertook a review of the gray and peer reviewed literature and did not identify any existing evidence-based tools. However, 10 key domains were identified from the search. Gaps in the domains were discovered, together with the need for guidance and prompts for less experienced staff and students. Five Social Workers, using co-design principles, reviewed the domains, and added further domains from their social work practice. An evidence-based assessment tool was developed which incorporated 11 domains. The tool can be used to assess the needs of people living in the community who are older and/or have compromised health and wellbeing. Further work is required to pilot test the tool.

A codesigned fit-for-purpose implementation framework for aged care.

RATIONALE, AIMS AND OBJECTIVES: The field of implementation science is critical for embedding research evidence into healthcare practice, benefiting individuals, organizations, governments, and the broader community. Implementation science is messy and complex, underpinned by many theories and frameworks. Efficacious interventions for older people with multiple comorbidities exist, yet many lack effectiveness evaluation relevant to pragmatic implementation within aged care practice. This article outlines the conceptualization and development of an Implementation Framework for Aged Care (IFAC), fit-for-purpose for an aged care organization, Bolton Clarke, intent on embedding evidence into practice. METHOD: A four-stage process was adopted to (1) explore context and relevant literature to conceptualize the IFAC; (2) identify key elements for a draft IFAC; (3) expand elements and refine the draft in consultation with experts and (4) apply the IFAC to three existing projects, identifying key learnings. A checklist to operationalize the IFAC was then developed. RESULTS: The IFAC is grounded in codesign principles and encapsulated by the implementation context, from a social, cultural and political perspective. The IFAC addresses the questions of (1) why do we need to change?; (2) what do we know?; (3) who will benefit?; (4) who will make the change?; (5) what strategies will be used?; and (6) what difference are we making? Three pilot projects: early adoption of a Wellness and Reablement approach; a care worker and virtual physiotherapist-led program to prevent falls; and a therapeutic horticulture program for residential communities, highlight learnings of applying the IFAC in practice. CONCLUSION: This fit-for-purpose IFAC was developed for a proactive and responsive aged care provider. The simplicity of the six-question IFAC is underpinned by substantial theoretical perspectives for its elements and their connections. This complexity is then consolidated into an 18-question checklist to operationalize the IFAC, necessary to advance the translation of evidence into clinical practice.

Quality of life of older Australians receiving home nursing services for complex care needs.

Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.

Oxygen tension assessment: an overlooked tool for prediction of delayed healing in a clinical setting.

Successful wound healing requires adequate transcutaneous oxygen tension (tcpO(2) ). TcpO(2) may not commonly be incorporated in clinical assessments because of variable measurement response at different sensory temperatures. This study aims to assess the relationship between changes in tcpO(2) , measured under basal (39°C) and stimulated (44°C) conditions and healing rate of chronic wounds over 4 weeks, to determine whether tcpO(2) measurement can predict delayed wound healing. TcpO(2) (Radiometer TCM400) measurements at sensor temperatures 39 and 44°C were recorded (twice, 4 weeks apart) adjacent to the ulcer site, and at a mirror image site on the contralateral leg. Ulcer outline was traced on clear acetate and perimeter and area measured (Visitrak™, Smith and Nephew). TcpO(2) measured at 44 and 39°C adjacent to all 13 wounds were lower compared to the contralateral site, significant at 44°C (P = 0·008). Significant correlation (r(2) = 0·8) occurred between wound healing rate and increased tcpO(2) at 44°C over 4 weeks. Importantly, the ratio of 39/44°C tcpO(2) , measured at the initial appointment, appeared to predict normal or delayed healing rate. TcpO(2) may provide clinicians with information regarding anticipated healing ability of wounds at the initial appointment, and hence identify wounds requiring early implementation of adjuvant therapies to accelerate healing.