背景:糖尿病足溃疡(DFU)是糖尿病的破坏性并发症。在预防糖尿病足并发症方面存在许多挑战,并且在实现已建立的足部护理指南中建议的护理过程方面存在障碍。多方面的数字健康解决方案,结合了多模态传感,面向患者的生物反馈,和远程患者监护(RPM),在提高我们的理解能力方面表现出希望,防止,并管理DFU。
方法:将有糖尿病足底溃疡病史的患者纳入一项前瞻性队列研究,并配备定制的感觉鞋垫以追踪足底压力,足底温度,步数,和依从性数据。感觉鞋垫数据使面向患者的生物反馈能够提示积极的足底卸载,以响应持续的高足底压力,和RPM评估,以响应足底压力关注的数据趋势,足底温度,或感官鞋垫粘附。在本病例系列中,选择了三名非连续病例参与者,这些参与者最终在研究过程中出现了溃疡前病变(足足底表面的愈伤组织和/或红斑区域)。
结果:在三个说明性患者中,连续足底压力监测显示,有望为患者和医疗服务提供者提供数据驱动的压力卸载治疗管理信息.
结论:多方面的数字健康解决方案可以自然地实现和加强综合足部护理指南。跨多个生理领域的多模式感测支持在沿着DFU发病途径的各个阶段监测足部健康。此外,配备远程患者监测的数字医疗解决方案为个性化治疗提供了新的机会,提供定期的自我护理强化,并鼓励患者参与,这是提高患者对糖尿病足护理计划依从性的关键工具。
BACKGROUND: Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs.
METHODS: Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive
case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this
case series.
RESULTS: Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments.
CONCLUSIONS: Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.