Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy

Clinical Snapshot

Key Findings

• P Value: P = 0.009 (differential temperature vs individual), P = 0.001 (accelerometer vs individual), P = 0.024 (foot proximity vs temperature), P = 0.005 (foot proximity vs acceleration)

• Effect Size: Correlation coefficient of 0.96 for multi-sensor analysis

• Primary Outcome: Correlation between multi-sensor algorithm and wear-time diaries

• Nnt Or Sensitivity: Multi-sensor approach significantly more accurate than individual sensors

• Confidence Interval: Not reported in abstract

Clinical Application

Technology appears feasible but requires validation in clinical population with cost-effectiveness assessment Could potentially support PBS-funded diabetic foot care programs if validated clinically, aligning with RACGP diabetes management guidelines emphasising adherence monitoring Limited applicability - study conducted in healthy volunteers rather than diabetic patients with foot ulcers

Abstract

BACKGROUND: Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types. METHODS: An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers' wear diaries using confusion matrix predictive analytics. RESULTS: Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms (P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature (P = .024), and acceleration algorithms (P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries. CONCLUSIONS: Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.

References

1. 1.Havey, R. M., Patwardhan, A. G., Stuck, R. M., Keen, S. A., & Muriuki, M. G. (2024). Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy. Journal of Diabetes Science and Technology. https://doi.org/10.1177/19322968241304751