الفهرس 
Acknowledgement
Review of literatureOnly 14 pages are availabe for public view
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Abstract
Background: offloading interventions are important part of management of various diabetic foot problems, and offloading is only successful if patient adhere to wearing the device. No previous study provided satisfactory frame to measure adherence and factors affecting it. Objective: This study aims to measure adherence among diabetic foot patients who use an offloading device, and to detect determinants of that adherence. Methods: A total of sixty-eight patients who used an offloading device for a minimum of four weeks, fill in a self-reported questionnaire after their informed consent, and were then followed up for a total of 24 weeks since their first assessment in the diabetic foot clinic at Centre of Diabetes at Assiut University Hospitals. Results: Mean outdoor adherence was 82% ±22 of total time spent outdoor, while home adherence to offloading device was only 42% ±29 of total active hours spent at home. Adherence was positively associated with higher perceived efficacy of the device, pain reduction, better satisfaction, easier wearing and doffing, social support and better perceived quality of health education and communication with the treating team. On the other hand, adherence was negatively associated with postural instability and heavy weight. Outdoor adherence was particularly affected by sense of embarrassment or poor aesthetic aspects of the device. Home adherence was particularly better was cast-shoe when compared to walker, and less with leaky devices. Conclusion: This study provides tangible evidence that adherence is better with devices that are more effective (better healing) and efficient (easier to wear, lighter weight, waterproof). The recommendations derived from this study includes: Patients are encouraged to use offloading devices all the time indoors and outdoors, as associated with better healing. Offloading devices should be included in national health insurance as they form integral part of management of diabetic foot patients. Offloading devices should be manufactured according to better standard providing lighter weight, easier putting on and taking off, waterproof, while maintain stability and offloading properties. The SINBAD scoring system is a simple score for assessment of diabetic foot ulcers, and should be considered to be routinely applied in our diabetic foot clinic.