{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:52:18Z","timestamp":1791485538456,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases","award":["1R01124789-01A1"],"award-info":[{"award-number":["1R01124789-01A1"]}]},{"name":"National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases","award":["24-2261-A0001"],"award-info":[{"award-number":["24-2261-A0001"]}]},{"name":"PhRMA Foundation","award":["1R01124789-01A1"],"award-info":[{"award-number":["1R01124789-01A1"]}]},{"name":"PhRMA Foundation","award":["24-2261-A0001"],"award-info":[{"award-number":["24-2261-A0001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Diabetic foot ulcers (DFUs) are a serious complication of diabetes, associated with high recurrence and amputation rates. Adherence to offloading devices is critical for wound healing but remains inadequately monitored in real-world settings. This study evaluates the SmartBoot edge-computing system\u2014a wearable, real-time remote monitoring solution integrating an inertial measurement unit (Sensoria Core) and smartwatch\u2014for its validity in quantifying cadence and step count as digital biomarkers of frailty, and for detecting adherence. Twelve healthy adults wore two types of removable offloading boots (\u00d6ssur and Foot Defender) during walking tasks at varied speeds; system outputs were validated against a gold-standard wearable and compared with staff-recorded adherence logs. Additionally, user experience was assessed using the Technology Acceptance Model (TAM) in healthy participants (n = 12) and patients with DFU (n = 81). The SmartBoot demonstrated high accuracy in cadence and step count across conditions (bias &lt; 5.5%), with an adherence detection accuracy of 96% (\u00d6ssur) and 97% (Foot Defender). TAM results indicated strong user acceptance and perceived ease of use across both cohorts. These findings support the SmartBoot system\u2019s potential as a valid, scalable solution for real-time remote monitoring of adherence and mobility in DFU management. Further clinical validation in ongoing studies involving DFU patients is underway.<\/jats:p>","DOI":"10.3390\/s25144490","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T08:47:14Z","timestamp":1753087634000},"page":"4490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["SmartBoot: Real-Time Monitoring of Patient Activity via Remote Edge Computing Technologies"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1985-1772","authenticated-orcid":false,"given":"Gozde","family":"Cay","sequence":"first","affiliation":[{"name":"Digital Health and Access Center (DiHAC), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Department of Computer Engineering, Izmir Katip Celebi University, Izmir 35620, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8546-5613","authenticated-orcid":false,"given":"Myeounggon","family":"Lee","sequence":"additional","affiliation":[{"name":"Digital Health and Access Center (DiHAC), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Center for Advanced Surgical & Interventional Technology (CASIT), Department of Surgery, University of California, Los Angeles, CA 90095, USA"},{"name":"Institute on Aging, Seoul National University, Seoul 01000, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-9175","authenticated-orcid":false,"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0320-8101","authenticated-orcid":false,"given":"Bijan","family":"Najafi","sequence":"additional","affiliation":[{"name":"Digital Health and Access Center (DiHAC), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Center for Advanced Surgical & Interventional Technology (CASIT), Department of Surgery, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,19]]},"reference":[{"key":"ref_1","unstructured":"Boulton, A.J.M., and Whitehouse, R.W. (2000). The Diabetic Foot, MDText.com, Inc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic Foot Ulcers and Their Recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_3","first-page":"123","article-title":"Defining Loss of Protective Sensation in the Diabetic Foot","volume":"11","author":"Wunderlich","year":"1998","journal-title":"Adv. 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