Mobility advice to help prevent re-ulceration in diabetes.
Mobility advice to help prevent re-ulceration in diabetes.
复制标题
活动建议有助于预防糖尿病复发。
DOI：
10.1002/dmrr.3259
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Mueller,MichaelJ
中科院分区：
文献类型：
--
作者：
Mueller,MichaelJ
临床医生和患者面临着一个两难境地，在理解如何最好地恢复行走后愈合的糖尿病神经性溃疡。这篇简短综述的目的是：为患者的健康和活动状态提供背景;提出5条建议，以安全有效地促进足部溃疡愈合后的活动;并考虑未来研究的主题，以改善这一领域的护理。糖尿病足创伤后溃疡复发率和死亡率高，活动性低。医疗和康复方法强调保护不敏感、脆弱的脚，希望防止随后对脚和人的伤害。特别是，伤口卸载和“愈合”后的1-2个月具有溃疡复发的最大风险。虽然应该强调早期保护，但越来越多的证据表明，过度保护足部和限制行走可能是有害的，可能是因为长期不动和压力保护的负面影响。最近的多项研究报告，运动和步行的能力对各种糖尿病足的结果有积极的影响，而不会造成额外的伤害。关于溃疡的脚在伤口愈合后如何恢复行走，人们知之甚少。本综述整合了现有的指南、证据和预防措施，就如何最好地恢复和改善溃疡复发高危人群的步行提出建议。
Clinicians and patients face a dilemma in understanding how best to resume walking after a healed diabetic neuropathic ulcer. The objectives of this brief review are to: provide context for the patient's health and mobility status; propose 5 suggestions to safely and effectively progress mobility following a healed foot ulcer; and to consider topics for future research to improve care in this area. Rates of ulcer recurrence and mortality are high, and activity is low following a diabetic foot wound. Medical and rehabilitation approaches have emphasized protection of the insensitive, fragile foot with the hope to prevent subsequent harm to the foot and person. In particular, the 1–2 months following wound unloading and “healing” have the greatest risk for ulcer recurrence. While early protection should be emphasized, a growing body of evidence suggests that over‐protection of the foot and limited walking can be harmful, presumably because of the negative effects of prolonged immobility and stress protection. Multiple recent studies report the ability of exercise and walking to have a positive effect on various diabetic foot outcomes without additional harm. Much less is known about how an ulcerated foot can resume walking after the wound is healed. This review integrates available guidelines, evidence, and precautions to suggest advice on how best to resume and progress walking in this population at high risk for ulcer recurrence.