Adesão, satisfação e segurança no uso do software "SOPeD" de exercícios personalizados para pés e tornozelos por pessoas com diabetes em risco alto de lesão nos pés: relato de casos

Abstract

Introduction: Diabetic foot (DF) refers to the disease of the foot of a person with diabetes mellitus (DM). It is a recurring cause of hospitalization, resulting in amputations, increased morbidity and mortality and healthcare costs. DF arises from diabetic peripheral neuropathy (DPN), a complication of DM that generates loss of sensitivity and biomechanical changes, increasing the risk of foot ulcers, which lead to reduced functional capacity and worsened quality of life. eHealth, such as the Diabetic Foot Guidance System (SOPeD) software, is a promising tool for offering remote interventions to people with DM, promoting self-management of care and minimizing the burden on Healthcare Systems. Validated for a population with DPN at low or moderate risk of foot ulceration, there is a gap regarding the feasibility and subjective aspects of adherence, satisfaction and safety regarding the use of SOPeD in populations at high risk of foot ulceration. In the present study, these aspects were explored objectively and subjectively in the use of this software by this population. Method: Case report of patients from a public hospital in Belo Horizonte/MG who followed the SOPeD customized foot-ankle exercise program. Structured questionnaires were applied to quantitatively assess satisfaction and safety and semi-structured interviews were carried out to address these aspects and adherence to the resource. The data was analyzed quantitatively, observing the percentage of adherence based on the number of sessions carried out, as well as the number of positive responses to questions about satisfaction and safety. Thematic Content Analysis was used in order to analyze the qualitative data from the interviews. Results: The average percentage of adherence to the use of SOPeD was 54.3%. High satisfaction with the software was observed, with scores of 4-5 on the Likert scale in the satisfaction questionnaire. Regarding safety, 93.1% of responses were positive in the respective questionnaire. The perception of general improvement in the feet and self-motivation for self-care were identified as facilitators for adherence. The return to work and instrumental activities of daily living, as well as limited internet access, were highlighted as barriers to adherence. In terms of satisfaction, there was a perception of improvement in foot health after completing the exercise program, especially joint mobility, foot muscle strength, DPN symptoms and functional mobility. The participants demonstrated satisfaction with the professional support permeated by a close and attentive approach. Dissatisfactions with technical problems in standardizing the presentation of the exercises were noted. Regarding safety, ease of access and use and the understanding of family support as necessary to prevent falls and injuries to the ulcerated lower limb and as a motivating factor for continuing the exercises were highlighted. Conclusion: The aspects of adherence, satisfaction and safety related to the use of SOPeD by individuals with diabetes at high risk of foot ulceration permeate occupations, personal and environmental factors. Quantitatively and qualitatively exploring the use of SOPeD by this population is important to consistently understand their demands and perceptions and provide qualified assistance.