title: A method for assessing off-loading compliance.
abstract: BACKGROUND
  Off-loading excessive pressure is essential to healing diabetic foot ulcers. However, many patients are not compliant in using prescribed footwear or off-loading devices. We sought to validate a method of objectively measuring off-loading compliance via activity monitors.
  
  
  METHODS
  For 4 days, a single subject maintained a written compliance diary concerning use of a removable cast walker. He also wore a hip-mounted activity monitor during all waking hours. An additional activity monitor remained mounted on the cast walker at all times. At the conclusion of the 4 days, the time-stamped hip activity data were independently coded for walker compliance by the compliance diary and by using the time-stamped walker activity data.
  
  
  RESULTS
  An intraclass reliability of 0.93 was found between diary-coded and walker monitor-coded activity.
  
  
  CONCLUSIONS
  These results support the use of this dual activity monitor approach for assessing off-loading compliance. An advantage of this approach versus a patient-maintained diary is that the monitors are not susceptible to incorrect patient recall or a patient's desire to please a caregiver by reporting inflated compliance. Furthermore, these results seem to lend support to existing reports in the literature using similar methods.
authors.affiliation: Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, Chicago, IL 60064, USA. ryan.crews@rosalindfranklin.edu
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Crews
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000328:Adult; D005528:Foot / Q000502:physiology*; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D009989:Orthotic Devices; D010349:Patient Compliance; D015203:Reproducibility of Results; D012775:Shoes; D016474:Weight-Bearing / Q000502:physiology