Prevention and healing of diabetes-related foot ulcers - Motivational interviewing, objective adherence and offloading
With this thesis the knowledge and understanding of the prevention and healing of foot ulcers in people with diabetes in clinical practice are expanded. First, it was shown that adherence to wearing orthopedic shoes is suboptimal in most people at moderate-to-high risk of foot ulceration. People with a consistent wearing pattern showed higher daily wearing times than those with an inconsistent pattern. Besides, orthopedic shoes were worn less during weekend days compared to weekdays. Secondly, following the triangulation of the qualitative and quantitative results of the application of MI it can be concluded that after a basic MI-training, podiatrists can effectively apply MI in daily clinical practice at a solid beginner level. Furthermore, the findings support implementation of MI in practice and encourage MI training in the primary podiatrist training and maintenance training for daily clinical practice. Thirdly, one podiatrist-led MI-consultation did not contribute to improving adherence to wearing orthopedic shoes in people with diabetes at low-to-high risk of foot ulceration. Finally, if a wound occurs due to low adherence or due to another reason, a knee-high and non-removable device ensures the best plantar pressure reduction. Overall, it can be concluded that there seems to be no simple standalone solution to prevent and heal diabetes-related foot ulcers and that improved communication of the whole multidisciplinary team with the patient is necessary to help patients at risk as good as possible. We hope that the findings of this thesis support researchers and clinicians in further investigating strategies to prevent and heal foot ulcers in people with diabetes.
