Abstract
Background and Objectives: Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. However, factors determining their acceptance are poorly understood. This systematic review aims to examine the literature on patient and provider perspectives of smart wearable devices in DFU prevention. Materials and Methods: PubMed, Scopus, and Web of Science were systematically searched up to October 2021. The selected articles were assessed for methodological quality using the quality assessment tool for studies with diverse designs. Results: A total of five articles were identified and described. The methodological quality of the studies ranged from low to moderate. Two studies employed a quantitative study design and focused on the patient perspective, whereas three studies included a mixed, quantitative/qualitative design and explored patient or provider (podiatrist) perspectives. Four studies focused on an insole system and one included a smart sock device. The quantitative studies demonstrated that devices were comfortable, well designed and useful in preventing DFU. One mixed design study reported that patients did not intend to adopt an insole device in its current design because of malfunctions, a lack of comfort. and alert intrusiveness, despite the general perception that the device was a useful tool for foot risk monitoring. Two mixed design studies found that performance expectancy was a predictor of a podiatrist’s behavioural intention to recommend an insole device in clinical practice. Disappointing participant experiences negatively impacted the podiatrists’ intention to adopt a smart device. The need for additional refinements of the device was indicated by patients and providers before its use in this population. Conclusions: The current evidence about patient and provider perspectives on smart wearable technology is limited by scarce methodological quality and conflicting results. It is, thus, not possible to draw definitive conclusions regarding acceptability of these devices for the prevention of DFU in people with diabetes.
Highlights
Foot ulceration is the most devastating complication of diabetes, affecting up to onethird of people with diabetes during their lifetime [1]
It has been reported that the National Health Service in England spends over £1 billion annually managing diabetic foot ulcers (DFUs) and their consequences, which accounts for ~10% of the National Health Service diabetes budget [2]
The quantitative studies obtained a lower total score compared with their qualitative counterparts (QNT: 42.9% vs. QLT: 69.8%)
Summary
Foot ulceration is the most devastating complication of diabetes, affecting up to onethird of people with diabetes during their lifetime [1]. 20% of people with a DFU may require lower extremity amputation because of moderate to severe infection This complication results in frequent and long-term hospitalisations and an increase in mortality at five years, which may exceed 70% in some patients [4]. Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. Conclusions: The current evidence about patient and provider perspectives on smart wearable technology is limited by scarce methodological quality and conflicting results. It is, not possible to draw definitive conclusions regarding acceptability of these devices for the prevention of DFU in people with diabetes
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