title: Adherence to wearing therapeutic shoes among people with diabetes: a systematic review and reflections.
abstract: BACKGROUND
  Therapeutic shoes are prescribed to prevent diabetic foot ulcers, but adherence to wearing the shoes is often poor.
  
  
  OBJECTIVE
  The aim of this study was to review the literature on factors that are associated with adherence to wearing therapeutic shoes and construct a model of adherence to aid future research and development in the field.
  
  
  METHODS
  We conducted a systematic search in PubMed, CINAHL, and PsycINFO for quantitative studies on factors associated with adherence to wearing therapeutic shoes among people with diabetes.
  
  
  RESULTS
  Six studies were included in the review. The studies focused mainly on patient-, therapy-, and condition-related adherence factors. There is some evidence (three to five studies) that sex, diabetes duration, and ulcer history are not associated with adherence. The evidence for or against the other factors was weak (only one or two studies) or conflicting.
  
  
  CONCLUSIONS
  There is no conclusive evidence for using any factor to predict adherence to wearing therapeutic shoes, but there is some evidence against using certain factors for predicting adherence. Future studies should include a broader range of factors, including health system and social/economic factors, and they should investigate perceived costs and benefits of wearing therapeutic shoes in comparison with other shoes or no shoes. A seesaw model is presented illustrating the complex phenomenon of adherence. Further research is needed to identify factors associated with adherence to wearing therapeutic shoes, to enable the development of interventions to improve adherence and thereby reduce ulceration rates among people with diabetic foot complications.
authors.affiliation: Department of Prosthetics and Orthotics, Faculty of Medicine and Health; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Gustav
authors.initials: G
authors.lastname: Jarl
authors.affiliation: University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Lars-Olov
authors.initials: LO
authors.lastname: Lundqvist
keywords: Patient compliance; diabetes complications; diabetic foot; diabetic neuropathies; foot ulcer; shoes