Study protocol for a randomized controlled trial on the effect of the Diabetic Foot Guidance System (SOPeD) for the prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial I

J S S P Ferreira, R H Cruvinel Junior, E Q Silva, J L Veríssimo, R L Monteiro, D S Pereira, E Y Suda, C D Sartor, I C N Sacco, J S S P Ferreira, R H Cruvinel Junior, E Q Silva, J L Veríssimo, R L Monteiro, D S Pereira, E Y Suda, C D Sartor, I C N Sacco

Abstract

Background: This study is part of a series of two clinical trials. Taking into account the various musculoskeletal alterations of the foot and ankle in people with diabetic peripheral neuropathy (DPN) and the need for self-care to avoid more serious dysfunctions and complications, a self-manageable exercise protocol that focuses on strengthening the foot muscles is presented as a potentially effective preventive method for foot and gait complications. The aim of this trial is to investigate the effect of a customized rehabilitation technology, the Diabetic Foot Guidance System (SOPeD), on DPN status, functional outcomes and gait biomechanics in people with DPN.

Methods/design: Footcare (FOCA) trial I is a randomized, controlled and parallel two-arm trial with blind assessment. A total of 62 patients with DPN will be allocated into either a control group (recommended foot care by international consensus with no foot exercises) or an intervention group (who will perform exercises through SOPeD at home three times a week for 12 weeks). The exercise program will be customized throughout its course by a perceived effort scale reported by the participant after completion of each exercise. The participants will be assessed at three different times (baseline, completion at 12 weeks, and follow-up at 24 weeks) for all outcomes. The primary outcomes will be DPN symptoms and severity classification. The secondary outcomes will be foot-ankle kinematics and kinetic and plantar pressure distribution during gait, tactile and vibration sensitivities, foot health and functionality, foot strength, and functional balance.

Discussion: As there is no evidence about the efficacy of rehabilitation technology in reducing DPN symptoms and severity or improving biomechanical, clinical, and functional outcomes for people with DPN, this research can contribute substantially to clarifying the therapeutic merits of software interventions. We hope that the use of our application for people with DPN complications will reduce or attenuate the deficits caused by DPN. This rehabilitation technology is freely available, and we intend to introduce it into the public health system in Brazil after demonstrating its effectiveness.

Trial registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Keywords: Diabetic foot; Foot-related exercises; Musculoskeletal function; Preventive care; Rehabilitation technology; Self-management; eHealth.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram flow chart illustrating the process of the Footcare (FOCA) trial I. DM diabetes mellitus, DPN diabetic peripheral neuropathy
Fig. 2
Fig. 2
Layout of the Diabetic Foot Guidance System (SOPeD). (a) Self-assessment of common foot problems with diabetes mellitus and diabetic peripheral neuropathy. (b) Report of the assessment. (c) The foot physical examination
Fig. 3
Fig. 3
Diabetic Foot Guidance System (SOPeD). (a) perceived effort scale to be filled after each exercise completion. (b) Layout of the exercises page with a video, audio and written instructions for each exercise
Fig. 4
Fig. 4
Diabetic Foot Guidance System (SOPeD) interface. (a) Game rules. (b) Exercise page in game format
Fig. 5
Fig. 5
Diabetic Foot Guidance System (SOPeD) interface. (a) Section for communication with specialists. (b) Communication forum

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