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What Happens When Patients Are Aware Their Use Of Prescription Shoes Is Being Monitored

Strong work as always from our Dutch and Australian colleagues! In a recently published randomized controlled trial in the Journal of Rehabilitation Medicine, Lutjeboer and coworkers studied 55 participants with a temperature sensor built into the medial arch of the left insole of their orthopaedic footwear.1 One group (n=25) knew that these sensors also monitored wear time and the other group (n=30) only knew of the collection of temperature data. This data revealed that those participants aware of the adherence monitoring wore their shoes for one hour more per day than those that did not. The authors also found this difference in wear time to be most pronounced in the subgroup of patients with diabetes. These patients, when aware of the additional layer of monitoring, wore their shoes for four hours more per day.1

With remote patient monitoring becoming more widely available, providers will soon find themselves with the ability to monitor many different key patient metrics. We at Keck School of Medicine of USC and the National Rehabilitation Institute at Rancho Los Amigos are already preparing to embark an NIH-sponsored study, which will compare irremovable offloading devices to standard removable ones and others that are identically removable, but with a smart watch-based system to encourage adherence and remind folks to wear their device. I think we are already seeing devices that encourage better “health economy,” if you will, similar to cars that might give feedback to help us achieve better fuel economy.

It is extremely important to form a collegial “team” relationship with patients so they understand the vital role they play in the success of their treatments. Remote patient monitoring (RPM) is an emerging, unique way to contribute to that type of relationship. 

One challenge, however, could be reimbursement for RPM. Funding is critical. If data exist to support that a device helps prevent complications, I believe this research could and should fall under blanket remote patient monitoring reimbursement with other devices tracking other organ systems.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 


1. Lutjeboer T, van Netten JJ, Posterma K, Hijmans JM. Effect of awareness of being monitored on wearing of orthopaedic footwear. J Rehab Med. 2020;52(11):1-8.

Editor’s note: This blog originally appeared at: . It is adapted with permission from the author.

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