Diabetic foot ulcers (DFUs) affect millions in the United States, negatively impacting physical function, quality of life, healthcare utilization, and costs. These ulcers frequently lead to adverse limb outcomes, major amputation, and even mortality. Although relieving foot pressure (i.e., offloading) is vital for DFU healing, many patients struggle to adhere to recommended offloading treatments. An innovative approach to these challenges is the Lifestyle Redesign® approach to occupational therapy (LR-OT), an activities-focused intervention that tailors self-care regimens to daily demands. This study aims to evaluate the feasibility of integrating a lifestyle-focused occupational therapy intervention into diabetic limb care, aiding patients in developing self-care routines that consistently support offloading and foot care.

This interdisciplinary, multiple-PI proposal has two aims over one year. Aim 1 focuses on co-developing a tailored LR-OT intervention that can be integrated into the workflow of DFU care to address self-management for prescribed DFU offloading. Aim 2 will establish the acceptability and feasibility of incorporating a tailored LR-OT into comprehensive DFU offloading management using mixed-methods. Anticipated direct impacts on offloading management include improvements in autonomy, problem-solving, psychosocial support, offloading acceptance, and access to quality devices. This study will provide preliminary data on this patient-centered approach to enhance DFU healing, prevent limb loss, and improve care for this high-risk population. The results will lay the foundation for the submission of larger scale external grants, aiming to rigorously evaluate the effectiveness and cost-effectiveness of the LR-OT intervention through a randomized controlled clinical trial. The ultimate goal of this present pilot proposal is to solidify a new research collaboration between the Chan Division of Occupational Science and Occupational Therapy and Department of Surgery (MPIs Drs. Schepens Niemiec and Tan), demonstrating a record of successful collaboration as a multidisciplinary investigative team.

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