{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:48:43Z","timestamp":1782388123467,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK131303"],"award-info":[{"award-number":["R01DK131303"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T35DK074390"],"award-info":[{"award-number":["T35DK074390"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Foot and Ankle Research"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic foot ulcers require offloading for healing. However, adherence with removable offloading devices is often poor. Prior objective measures of adherence yielded important behavioral insights, despite substantial methodological limitations. This study sought to address these limitations by developing a method to track offloading adherence during walking and standing paired with tracking contralateral therapeutic footwear (shoe\u2010lift) use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty healthy adults wore a removable cast walker (RCW) and contralateral shoe\u2010lift. Accelerometers were placed on both and unilaterally on participants' thighs. Participants performed activities in the laboratory that were logged by investigators, after which monitoring continued for 24\u00a0h with participants logging footwear use in a diary. Walking and standing episodes were quantified via the thigh worn monitor. A custom algorithm was developed to classify RCW and shoe\u2010lift adherence during walking and standing based on sample\u2010to\u2010sample variance thresholds. Algorithm accuracy was determined by comparing its adherence metrics with log entries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final algorithm resulted in &gt;\u00a099% accuracy in detecting steps and standing while using the RCW and shoe\u2010lift during in\u2010lab testing. In 24\u2010h, community monitoring, algorithm\u2010derived adherence showed excellent agreement with diary\u2010based adherence (ICC\u00a0&gt;\u00a00.96,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01). Error rates (misclassifications) were &lt;\u00a03%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A method to objectively quantify RCW and contralateral shoe\u2010lift adherence use was developed and validated. Strong agreement with lab observations and user diaries support its use for monitoring real\u2010world offloading behavior. This method will allow for enhanced assessments of adherence in future trials and may eventually be incorporated into clinical practice for patient monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jfa2.70170","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:36:26Z","timestamp":1780544186000},"source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of an Algorithm to\u00a0Objectively Quantify Adherence to Offloading Interventions"],"prefix":"10.1002","volume":"19","author":[{"given":"Sai V.","family":"Yalla","sequence":"first","affiliation":[{"name":"Center for Lower Extremity Ambulatory Research (CLEAR) Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science  North Chicago Illinois USA"},{"name":"Department of Podiatric Medicine &amp; Surgery Rosalind Franklin University of Medicine &amp; Science  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanam N.","family":"Jhaveri","sequence":"additional","affiliation":[{"name":"Center for Lower Extremity Ambulatory Research (CLEAR) Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahir S.","family":"Negron\u2010Fernandez","sequence":"additional","affiliation":[{"name":"Center for Lower Extremity Ambulatory Research (CLEAR) Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan T.","family":"Crews","sequence":"additional","affiliation":[{"name":"Center for Lower Extremity Ambulatory Research (CLEAR) Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science  North Chicago Illinois USA"},{"name":"Department of Podiatric Medicine &amp; Surgery Rosalind Franklin University of Medicine &amp; Science  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah J.","family":"Rosenblatt","sequence":"additional","affiliation":[{"name":"Center for Lower Extremity Ambulatory Research (CLEAR) Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science  North Chicago Illinois USA"},{"name":"Department of Podiatric Medicine &amp; Surgery Rosalind Franklin University of Medicine &amp; Science  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3654"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13\u20102176"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1615439"},{"key":"e_1_2_13_5_1","volume-title":"National Diabetes Statistics Report","author":"Control, C.F.D. and Prevention","year":"2017"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13973"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc18\u20101380"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892\u2010004\u20100049\u2010x"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3647"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2019.12.006"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3650"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08\u20100771"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/preaccept\u20101625842250131620"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.19.8.818"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2011.03.010"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.6.1019"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.9.2595"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15\u20102373"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc\u20102021\u2010002640"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/s23031648"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/s23094423"},{"key":"e_1_2_13_22_1","article-title":"Offloading Adherence for Appearance Sake?","author":"Crews R. T.","journal-title":"Journal of the American Podiatric Medical Association"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.7547\/0980100"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10\u20101224"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/1932296819849092"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc17\u20102584"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1123\/jmpb.2021\u20100053"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000230392.83607.c5"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000486392"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.110647"},{"issue":"1","key":"e_1_2_13_31_1","first-page":"37","article-title":"What are the Treatment Experiences, Motivations and Barriers to Concordance in Patients Treating Their Diabetic Foot Disease With a Removable Aircast Walker?","volume":"22","author":"Yan A. Y. L.","year":"2019","journal-title":"Diabetic Foot"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/diabetology6090098"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2024.0151"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3769"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.3390\/s25144490"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2012.03.006"}],"container-title":["Journal of Foot and Ankle Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jfa2.70170","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jfa2.70170","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jfa2.70170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:12:35Z","timestamp":1782385955000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jfa2.70170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/jfa2.70170"],"URL":"https:\/\/doi.org\/10.1002\/jfa2.70170","archive":["Portico"],"relation":{},"ISSN":["1757-1146","1757-1146"],"issn-type":[{"value":"1757-1146","type":"print"},{"value":"1757-1146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"article-number":"e70170"}}