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Updated: Jul 30, 2025

Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers
Published on: March 3, 2023
The Validity and Reliability of Self-Reported Adherence to Using Offloading Treatment in People with Diabetes-Related
Anas Ababneh1,2, Kathleen Finlayson2,3, Helen Edwards2,3
1Faculty of Nursing, Applied Science Private University, Amman 11931, Jordan.
Self-reported adherence to removable cast walker (RCW) offloading treatment for diabetes-related foot ulcers (DFUs) is unreliable. Patients significantly overestimate adherence, highlighting the need for objective adherence measures in DFU care.
Area of Science:
- Podiatry
- Diabetology
- Biomedical Engineering
Background:
- Adherence to offloading treatment is critical for healing diabetes-related foot ulcers (DFUs).
- Objective monitoring of offloading adherence is recommended, but self-report is commonly used.
- The validity and reliability of self-reported adherence to removable cast walkers (RCWs) in DFUs are not well-established.
Purpose of the Study:
- To assess the validity and reliability of self-reported adherence to RCW offloading treatment in individuals with DFUs.
- To compare self-reported adherence with objectively measured adherence using activity monitors.
- To evaluate the test-retest reliability of self-reported adherence.
Main Methods:
- Fifty-three participants with DFUs using RCWs self-reported adherence.
- Objective adherence was measured using dual activity monitors.
- Test-retest reliability was assessed in 19 participants after one week.
- Validity was analyzed using Pearson's r and Bland-Altman tests; reliability using Cohen's kappa.
Main Results:
- Self-reported adherence (90%) was significantly higher than objectively measured adherence (35%) (p < 0.01).
- Validity showed fair agreement (r = 0.46) with significant proportional bias.
- Test-retest reliability demonstrated minimal agreement (K = 0.36).
Conclusions:
- Self-reported adherence to RCW offloading in DFUs has only fair validity and reliability.
- Individuals with DFUs tend to overestimate their adherence to offloading treatment.
- Objective adherence measures are recommended for both clinical practice and research in DFU management.
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