HappierFeet-Disrupting the vicious cycle of healthcare decline in Diabetic Foot Ulceration through active prevention: The future of self-managed care

糖尿病足溃疡(DFU)是一种常见的慢性疾病，每年花费NHS 10亿GB。高达25%的糖尿病患者在他们的一生中发展为DFU。愈合缓慢，40%的患者会在12个月内再次溃疡。DFU经常复发并导致截肢和/或死亡，5年死亡率为40%。DFU在社会和经济上处于不利地位的人中更为常见。溃疡的身体和精神负担是相当大的：32%的人患有抑郁症，这与死亡风险增加了3倍有关。步态在这一群体中通常是不适应的，使脚的部分负荷过重，使运动变得痛苦/不安全，他们害怕运动。他们经常对未来感到绝望，因为目前还不可能预防DFU。其结果是减少运动、自我效能和情绪的向下恶性循环，这被认为对患者进行DFU预防行为的能力产生负面影响，并增加再次溃疡的机会，但也有可能增加受缺乏体力活动/情绪低落影响的其他疾病，如疼痛、心脏代谢紊乱和癌症。该项目建议建立和扩大目前的智能鞋垫技术，以检测糖尿病足部溃疡，利用基于多传感器的方法进行识别。一款集成了压力、温度、声学和传感器的智能鞋垫，可以测量人的走路方式，可以识别溃疡的早期指标，以及何时适合/不适合运动。智能鞋垫将对这些输入做出反应，并调整脚部，从而通过嵌入式执行器调整人的行走方式，以支持更好、安全和舒适的运动。智能鞋垫将通过智能手机提醒用户潜在的问题，实现自我管理；促进用户检查脚部并根据需要就医。虽然与云共享数据以促进社区自我管理并为临床决策提供信息超出了本项目的范围，但这项研究将为未来针对量子计算的进步证明高度敏感信息的安全性和隐私奠定基础。该项目将寻求了解并克服用户及其社交网络(朋友、家人等)在技术适应性、可接受性和采用率方面的障碍。这款智能鞋垫可以通过提高自我效能来自我管理糖尿病足部溃疡，从而打破恶性循环，变得更加活跃，从而影响对体力活动做出反应的多种疾病。

Diabetic foot ulcers (DFUs) are common, chronic and cost the NHS £1Billion annually. Up to 25% of patients with diabetes develop a DFU within their lifetime. Healing is slow and 40% of patients re-ulcerate within 12 months. DFUs frequently recur and lead to amputation and/or death, with a 40% mortality rate at 5 years. DFUs are more common in people who are socially and economically disadvantaged. The physical and emotional burden of ulceration is considerable: 32% are depressed and this is related to a 3-fold greater risk of mortality. Gait is often maladaptive in this group, overloading parts of the foot, making movement painful/unsafe, and they are scared of movement. They often feel hopeless about the future, as it's not currently possible to prevent DFUs. A consequence is a downward vicious cycle of reduced movement, self-efficacy and mood, which is thought to negatively impact patient ability to engage in preventative behaviours for DFUs and increase chances of re-ulceration, but also has significant potential to increase other disorders which are influenced by lack of physical activity/low mood, e.g. pain, cardio-metabolic disorders, and cancer. This project proposes to build and expand on current smart insole technologies for the detection of Diabetic Foot Ulcers, utilising a multiple sensor-based approach for their identification. A smart insole with integrated pressure, temperature, acoustic and sensors which measure how someone walks will identify early indicators of ulceration and when movement is appropriate/ inappropriate. The smart insole will respond to these inputs and adjust the foot, and hence the way someone walks, through embedded actuators, to support better, safe and comfortable movement. The smart insole will alert the user to potential problems, through a smartphone, enabling self-management; promoting users to check their foot and seek medical attention as required. Although data sharing with the cloud to facilitate community self-management and to inform clinical decision-making is beyond the scope of this project, this research will lay the foundations for future proofing the security and privacy of highly sensitive information against advancements in quantum computing. This project will seek to understand and overcome the barriers of technology adaptability, acceptability and adoption for users and their social networks (friends, family etc). This smart insole can break the vicious cycle by increasing self-efficacy to self-manage Diabetic Foot Ulcers and to be more active, thus impacting across multiple illnesses which respond to physical activity.