<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02994966</url>
  </required_header>
  <id_info>
    <org_study_id>AICE-201500873</org_study_id>
    <nct_id>NCT02994966</nct_id>
  </id_info>
  <brief_title>Diabetes Foot Care Clinical Pathway - Orpyx Medical Technologies</brief_title>
  <acronym>DFCCP-Orpyx</acronym>
  <sponsors>
    <lead_sponsor>
      <agency>University of Alberta</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Alberta Innovates Health Solutions</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Orpyx Medical Technologies Inc.</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Alberta</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      In 2011, the premiers of all Canadian provinces and territories selected diabetes foot care&#xD;
      as one of three significant targets for pan-provincial action. The Diabetes Foot Care&#xD;
      Clinical Pathway Project (DFCCPP) aims to optimize methods of early detection and treatment&#xD;
      of foot ulcers in an effort to reduce lower limb amputation (LLA) by 50%. The DFCCPP key&#xD;
      deliverables apply consistency in assessment, care, treatment and process standards, early&#xD;
      intervention and complex wound care management, while optimizing health outcomes. To achieve&#xD;
      these deliverables, High Risk Foot Teams (HRFTs) will be implemented across the province&#xD;
      starting with three pilot sites (Slave Lake, Brooks, and outpatient clinics at the Peter&#xD;
      Lougheed Hospital). The pilot site facilities were selected on the basis of their employing&#xD;
      staff with expertise and knowledge in diabetic foot care. The HRFT will assess and treat&#xD;
      patients with moderate and high-risk findings, and this care pathway will then be rolled out&#xD;
      to all clinicians who perform diabetic foot assessments (Primary Care, Home Care, Diabetes&#xD;
      Centers, First Nations Reserves, etc.). In conjunction with the DFCCPP, we will evaluate the&#xD;
      efficacy of a technological device developed by Alberta-based small-medium enterprise (SME)&#xD;
      to improve diabetic foot outcomes by preventing future wounds in high-risk patients who have&#xD;
      recently been treated for active foot ulcers. This technology is the SurroSense Rx® smart&#xD;
      insole system (Orpyx Medical Technologies Inc., Calgary AB), a device that provides dynamic&#xD;
      offloading guidance to patients, in addition to enabling ongoing adherence tracking by the&#xD;
      HRFT. It is hypothesized that early wound detection and treatment will ultimately lead to&#xD;
      improvements in wound prevalence, chronic wound care, and reduce the need for surgical&#xD;
      intervention, including LLA.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      The Canadian Institute of Health Information estimates that foot wounds (with diabetes as the&#xD;
      leading cause) are present in 4% of all hospital inpatients, 7% of homecare clients and 10%&#xD;
      of long-term care (LTC) residents. Of 210,000 people with diabetes in Alberta, 5,250 will&#xD;
      seek treatment of a foot ulcer annually. In Alberta in 2014-15 there were 425 LLAs performed&#xD;
      on 309 diabetic patients representing an increase of 89 LLA over 2010-11. Moreover, there is&#xD;
      a tremendous reduction in quality of life of the patients and attendant negative effects on&#xD;
      their families. The 5-year mortality rate after a new-onset diabetic foot ulcer is 43-55%,&#xD;
      and is as high as 74% for patients undergoing LLA.&#xD;
&#xD;
      Continuous monitoring of the diabetic foot and preventative foot care is of utmost importance&#xD;
      for patients with diabetes. This is especially the case in high risk patients who have&#xD;
      previously had foot ulcers. Improving and standardizing diabetic foot screening, early wound&#xD;
      detection and treatment will ultimately lead to improvements in wound prevalence, chronic&#xD;
      wound care, and the need for surgical intervention, including amputation.&#xD;
&#xD;
      Effective pressure offloading is a key tenet of diabetic ulcer prevention and care. The&#xD;
      effectiveness of offloading interventions is intimately linked to the skin reperfusion that&#xD;
      is seen when persistent external pressure is alleviated. Key modifiable parameters in&#xD;
      mitigating tissue damage to the neuropathic foot are pressure and time. Exposures from 15 min&#xD;
      to one hour at pressures greater than 240 mmHg, and from two hours or more at pressures&#xD;
      greater than 67 mmHg, were found to cause cell death in rat muscle tissue. Despite this,&#xD;
      there is limited information regarding the efficacy of interventions aimed at preventing&#xD;
      pressure ulcers; a comprehensive review of the literature did not find enough evidence to&#xD;
      recommend a repositioning frequency. A consensus document from an international review on&#xD;
      pressure ulcer prevention states &quot;patients confined to wheelchairs should be taught to&#xD;
      reposition every 15 minutes&quot;.&#xD;
&#xD;
      While established pressure offloading interventions are able to statically reduce pressure on&#xD;
      the active ulcer, they provide no dynamic relief of pressure. Since neuropathy is&#xD;
      characterized by a loss of protective sensation (LOPS), the patient is often unaware of&#xD;
      sustained pressure on a specific anatomic region over time. Even with static offloading&#xD;
      instruments, it is conceivable that critical pressure and time thresholds can be dynamically&#xD;
      exceeded without the patient's knowledge or ability to address the problem. Taken together,&#xD;
      the literature provides support for a system that monitors pressure over time at key&#xD;
      locations, and provides alert-based feedback to guide as-needed, patient-based offloading for&#xD;
      use in patients with active ulceration.&#xD;
&#xD;
      Orpyx Medical Technologies Inc. (Orpyx), has developed a smart insole technology (the&#xD;
      &quot;SurroSense Rx®&quot;) that senses pressure points in the user'splantar foot. This is important&#xD;
      because pressure &quot;hot spots&quot; can lead to wound development that, if left untreated, can&#xD;
      progress to a foot ulcer and LLA. Individuals able to maintain lower in-shoe peak pressures&#xD;
      had 60% lower risk of foot ulcer recurrence. Unpublished studies with this device are&#xD;
      demonstrating an 83% relative risk reduction in plantar ulceration in active versus control&#xD;
      arms. This device provides dynamic offloading guidance to patients, in addition to enabling&#xD;
      ongoing adherence tracking. This device has been shown to be an effective treatment in the&#xD;
      management of diabetic foot patients at risk for ulcers, with respect to the care of active&#xD;
      ulcers, in addition to prevention of future recurrence. Wearers of the SurroSense Rx®&#xD;
      technology are provided with on demand cues for offloading, and should therefore have&#xD;
      enhanced responsiveness and self-control over their foot care, thereby leading to a reduction&#xD;
      in re-ulcerative events and thus, LLA.&#xD;
&#xD;
      The SurroSense Rx® system is a patent pending (US Publication 20120109013 and PCT&#xD;
      WO/2012/055029) footwear system intended to prevent first and recurrent plantar ulcers, and&#xD;
      to treat active ulcers in neuropathic patients. It comprises two pressure-sensing inserts and&#xD;
      a smartwatch display device. The device alerts the user when &quot;safe&quot; pressure and time&#xD;
      thresholds have been exceeded; the current thresholds are based on the results of a&#xD;
      comprehensive review of the literature, which indicates that a conservative threshold would&#xD;
      be &gt;30-50mmHg for &gt;15 minutes. As more plantar pressure and outcome data are collected over&#xD;
      time, these thresholds may be modified as need be. The device measures plantar pressures at&#xD;
      discrete points corresponding to bony prominences that would be considered to be at higher&#xD;
      risk for ulceration: the first metatarsal head (1), the lateral metatarsal heads (2), the&#xD;
      great toe (1), the lateral toes (1), the lateral foot (2), and the heel (1). These areas were&#xD;
      selected based on the inherent high risk of neuropathic ulceration at these anatomic&#xD;
      locations. This data is tracked, with analysis being performed on those that have been&#xD;
      collected over the last 15 minutes. If &gt; 95% of the measurements taken by a pressure sensor&#xD;
      over a 15-minute scanning window exceed 30-50 mmHg, an alert is sent to the user via the&#xD;
      smartwatch to guide them to appropriately offload that area.&#xD;
&#xD;
      The SurroSense Rx® device will be used as an adjunct in the treatment pathway following&#xD;
      closure of diabetic foot wounds. It is widely acknowledged that, following wound healing,&#xD;
      50-100% of diabetic foot ulcers recur over a five-year period. What is more, it is estimated&#xD;
      that after 18 months, 42% of ulcers recur, with half of those recurring in the first six&#xD;
      months. Thus, it is the first six months following wound healing that is the most sensitive&#xD;
      time for recurrence of ulceration. It is this critical patient population that will be fitted&#xD;
      with the SurroSense Rx® device for secondary prevention of ulceration.&#xD;
&#xD;
      Taken together, diabetes patients with foot wounds are at an elevated risk of infection and&#xD;
      LLA. Therefore, there is a need for an effective tool for the prevention and management of&#xD;
      the diabetic foot.&#xD;
&#xD;
      Research Question and Objectives:&#xD;
&#xD;
      Does improving and standardizing foot screening for diabetes patients through the DFCCP&#xD;
      concurrently with the use of the SurroSense Rx® smart insole system reduce the proportion of&#xD;
      foot ulcer recurrence compared to patients who are receiving standard care? The objective of&#xD;
      this proposal is to demonstrate that when combined with the DFCCP, the SurroSense Rx® smart&#xD;
      insole system device is an effective modality that is superior to the current standard of&#xD;
      care for preventing the recurrence of healed pressure ulcerations on the feet of subjects&#xD;
      with diabetic peripheral neuropathy of the lower extremities. It is hypothesized that the use&#xD;
      of the device will lead to a reduction in the risk of pressure ulcer recurrence in the&#xD;
      Intervention group and to improve those subjects' foot self-care, when compared to subjects&#xD;
      in the Control group. Over the longer term we anticipate that use of the technology in&#xD;
      concert with the DFCCP will result in better foot health for diabetic patients. The ability&#xD;
      to test the efficacy of the SurroSense Rx® device in parallel with the DFCCP implementation&#xD;
      will allow the evaluation in a real-world setting where patients also have access to HRFT for&#xD;
      prescription of the device. High Risk Foot Teams will be implemented across the province&#xD;
      starting with three pilot sites (Slave Lake, Brooks, and the Diabetic Foot and Limb&#xD;
      Preservation Centre at the Peter Lougheed Hospital), These pilot sites will be selected as&#xD;
      facilities have existing staff with expertise and knowledge in diabetic foot care. The HRFT&#xD;
      will assess and treat patients with moderate and high-risk findings. The AICE-funded project&#xD;
      is a sub-study. All patients are clinically assessed in a standardized manner using the&#xD;
      Alberta Foot Risk Assessment Form (AFRAF), which incorporates a standardized wound assessment&#xD;
      and treatment approach.ces, ongoing assessment and embedded evaluation.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">November 2016</start_date>
  <completion_date type="Actual">February 26, 2020</completion_date>
  <primary_completion_date type="Actual">February 26, 2020</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Prevention</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Foot ulcer recurrence</measure>
    <time_frame>12 months</time_frame>
    <description>hazard ratio</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Time to re-ulceration</measure>
    <time_frame>12 months maximum</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Patient satisfaction</measure>
    <time_frame>Last visit to High Risk Foot Team (maximum 12 months)</time_frame>
    <description>Survey</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Patient compliance</measure>
    <time_frame>Last visit to High Risk Foot Team (maximum 12 months)</time_frame>
    <description>Survey</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Clinical adoption</measure>
    <time_frame>12 months</time_frame>
    <description>Interviews with clinicians</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Cost effectiveness</measure>
    <time_frame>12 months</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Complications rates</measure>
    <time_frame>12 months</time_frame>
    <description>new ulceration, ulcer extension, infection, surgical intervention, amputation, hospitalization documented</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Determinants of ulcer formation</measure>
    <time_frame>12 months</time_frame>
    <description>Pressure and adherence parameters compared with area of ulceration</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">120</enrollment>
  <condition>Diabetic Foot Ulcer</condition>
  <arm_group>
    <arm_group_label>Surrosense</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Subjects randomized to this group will receive standard care, including appropriate off-loading and footwear as well as wear SurroSense Rx® in-shoe pressure-sensing arrays, which provide visual and auditory/vibratory feedback alerts (relating to high plantar pressures) and offloading guidance to a watch display intended to assist in the recurrence of diabetic foot ulcers. They will also be advised to perform daily self-checks of their feet for redness, callous and wounds. A daily checklist will be provided to participants to evaluate compliance.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Standard care</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Subjects randomized to this group will receive standard care, including appropriate off-loading and footwear. They will also be advised to perform daily self-checks of their feet for redness, callous and wounds. A daily checklist will be provided to participants to evaluate compliance.</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Surrosense</intervention_name>
    <arm_group_label>Surrosense</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Standard care</intervention_name>
    <arm_group_label>Standard care</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  History of diabetic foot ulcer that has resolved within the past twelve (12) months&#xD;
&#xD;
               -  Sensory abnormality with no skin breakdown/ulcer&#xD;
&#xD;
               -  Diabetes (according to AAFP diagnostic criteria (8))&#xD;
&#xD;
               -  Absent sensation to 10 g monofilament exam at 1 or more sites&#xD;
&#xD;
               -  Age &gt;18y&#xD;
&#xD;
               -  One or more pedal pulses palpable or doppler-able on each foot (dorsalis pedis &amp;&#xD;
                  posttibialis)&#xD;
&#xD;
               -  Ability to understand the use of the technology&#xD;
&#xD;
               -  Life expectancy greater than the duration of the study&#xD;
&#xD;
               -  Subject is willing and able to maintain the required offloading (as applicable&#xD;
                  for the location of the ulcer)&#xD;
&#xD;
               -  Subject or responsible caregiver is willing to adhere to the routine calibration&#xD;
                  schedule required for the proper ongoing functioning of the device (i.e., going&#xD;
                  through a monthly two minute procedure)&#xD;
&#xD;
               -  Has footwear that is compatible with the Orpyx device: diabetic shoes, running&#xD;
                  shoes, walking shoes; either lace-up or Velcro; must have a removable insert or&#xD;
                  orthotic&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Weight &gt; 325 lb (147 kg)&#xD;
&#xD;
          -  Uncorrected visual impairment&#xD;
&#xD;
          -  Active plantar ulceration or skin breakdown&#xD;
&#xD;
          -  Presence of severe schema (absence of palpable or dopplerable foot pulses)&#xD;
&#xD;
          -  Active Infection&#xD;
&#xD;
          -  Abnormal toe, ankle and/or foot range of motion that would preclude the patient's&#xD;
             ability to offload pressure alerts&#xD;
&#xD;
          -  Gross foot deformity that would impact anatomical plantar pressure distribution (i.e.,&#xD;
             including Charcot foot deformity, and/or previous partial or complete foot or ray&#xD;
             amputation)&#xD;
&#xD;
          -  Insoles or orthotics with a hard plastic, or uneven, undersurface&#xD;
&#xD;
          -  Patient is being cared for exclusively via Telehealth (i.e. there is no opportunity&#xD;
             for hands-on or face-to-face interaction between the patient and the caregiving team)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Brooks Home Care</name>
      <address>
        <city>Brooks</city>
        <state>Alberta</state>
        <zip>T1R 1B7</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Peter Lougheed Centre</name>
      <address>
        <city>Calgary</city>
        <state>Alberta</state>
        <zip>T1Y 6J4</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Slave Lake Family Care Clinic</name>
      <address>
        <city>Slave Lake</city>
        <state>Alberta</state>
        <zip>T0G 2A2</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Canada</country>
  </location_countries>
  <verification_date>June 2022</verification_date>
  <study_first_submitted>December 9, 2016</study_first_submitted>
  <study_first_submitted_qc>December 13, 2016</study_first_submitted_qc>
  <study_first_posted type="Estimate">December 16, 2016</study_first_posted>
  <last_update_submitted>June 3, 2022</last_update_submitted>
  <last_update_submitted_qc>June 3, 2022</last_update_submitted_qc>
  <last_update_posted type="Actual">June 8, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Diabetic Foot</mesh_term>
    <mesh_term>Foot Ulcer</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02994966
org study id: AICE-201500873
nct id: NCT02994966
lead sponsor: 
collaborator: 
collaborator: 
has dmc: No
In 2011, the premiers of all Canadian provinces and territories selected diabetes foot care
      as one of three significant targets for pan-provincial action. The Diabetes Foot Care
      Clinical Pathway Project (DFCCPP) aims to optimize methods of early detection and treatment
      of foot ulcers in an effort to reduce lower limb amputation (LLA) by 50%. The DFCCPP key
      deliverables apply consistency in assessment, care, treatment and process standards, early
      intervention and complex wound care management, while optimizing health outcomes. To achieve
      these deliverables, High Risk Foot Teams (HRFTs) will be implemented across the province
      starting with three pilot sites (Slave Lake, Brooks, and outpatient clinics at the Peter
      Lougheed Hospital). The pilot site facilities were selected on the basis of their employing
      staff with expertise and knowledge in diabetic foot care. The HRFT will assess and treat
      patients with moderate and high-risk findings, and this care pathway will then be rolled out
      to all clinicians who perform diabetic foot assessments (Primary Care, Home Care, Diabetes
      Centers, First Nations Reserves, etc.). In conjunction with the DFCCPP, we will evaluate the
      efficacy of a technological device developed by Alberta-based small-medium enterprise (SME)
      to improve diabetic foot outcomes by preventing future wounds in high-risk patients who have
      recently been treated for active foot ulcers. This technology is the SurroSense Rx® smart
      insole system (Orpyx Medical Technologies Inc., Calgary AB), a device that provides dynamic
      offloading guidance to patients, in addition to enabling ongoing adherence tracking by the
      HRFT. It is hypothesized that early wound detection and treatment will ultimately lead to
      improvements in wound prevalence, chronic wound care, and reduce the need for surgical
      intervention, including LLA.
The Canadian Institute of Health Information estimates that foot wounds (with diabetes as the
      leading cause) are present in 4% of all hospital inpatients, 7% of homecare clients and 10%
      of long-term care (LTC) residents. Of 210,000 people with diabetes in Alberta, 5,250 will
      seek treatment of a foot ulcer annually. In Alberta in 2014-15 there were 425 LLAs performed
      on 309 diabetic patients representing an increase of 89 LLA over 2010-11. Moreover, there is
      a tremendous reduction in quality of life of the patients and attendant negative effects on
      their families. The 5-year mortality rate after a new-onset diabetic foot ulcer is 43-55%,
      and is as high as 74% for patients undergoing LLA.

      Continuous monitoring of the diabetic foot and preventative foot care is of utmost importance
      for patients with diabetes. This is especially the case in high risk patients who have
      previously had foot ulcers. Improving and standardizing diabetic foot screening, early wound
      detection and treatment will ultimately lead to improvements in wound prevalence, chronic
      wound care, and the need for surgical intervention, including amputation.

      Effective pressure offloading is a key tenet of diabetic ulcer prevention and care. The
      effectiveness of offloading interventions is intimately linked to the skin reperfusion that
      is seen when persistent external pressure is alleviated. Key modifiable parameters in
      mitigating tissue damage to the neuropathic foot are pressure and time. Exposures from 15 min
      to one hour at pressures greater than 240 mmHg, and from two hours or more at pressures
      greater than 67 mmHg, were found to cause cell death in rat muscle tissue. Despite this,
      there is limited information regarding the efficacy of interventions aimed at preventing
      pressure ulcers; a comprehensive review of the literature did not find enough evidence to
      recommend a repositioning frequency. A consensus document from an international review on
      pressure ulcer prevention states "patients confined to wheelchairs should be taught to
      reposition every 15 minutes".

      While established pressure offloading interventions are able to statically reduce pressure on
      the active ulcer, they provide no dynamic relief of pressure. Since neuropathy is
      characterized by a loss of protective sensation (LOPS), the patient is often unaware of
      sustained pressure on a specific anatomic region over time. Even with static offloading
      instruments, it is conceivable that critical pressure and time thresholds can be dynamically
      exceeded without the patient's knowledge or ability to address the problem. Taken together,
      the literature provides support for a system that monitors pressure over time at key
      locations, and provides alert-based feedback to guide as-needed, patient-based offloading for
      use in patients with active ulceration.

      Orpyx Medical Technologies Inc. (Orpyx), has developed a smart insole technology (the
      "SurroSense Rx®") that senses pressure points in the user'splantar foot. This is important
      because pressure "hot spots" can lead to wound development that, if left untreated, can
      progress to a foot ulcer and LLA. Individuals able to maintain lower in-shoe peak pressures
      had 60% lower risk of foot ulcer recurrence. Unpublished studies with this device are
      demonstrating an 83% relative risk reduction in plantar ulceration in active versus control
      arms. This device provides dynamic offloading guidance to patients, in addition to enabling
      ongoing adherence tracking. This device has been shown to be an effective treatment in the
      management of diabetic foot patients at risk for ulcers, with respect to the care of active
      ulcers, in addition to prevention of future recurrence. Wearers of the SurroSense Rx®
      technology are provided with on demand cues for offloading, and should therefore have
      enhanced responsiveness and self-control over their foot care, thereby leading to a reduction
      in re-ulcerative events and thus, LLA.

      The SurroSense Rx® system is a patent pending (US Publication 20120109013 and PCT
      WO/2012/055029) footwear system intended to prevent first and recurrent plantar ulcers, and
      to treat active ulcers in neuropathic patients. It comprises two pressure-sensing inserts and
      a smartwatch display device. The device alerts the user when "safe" pressure and time
      thresholds have been exceeded; the current thresholds are based on the results of a
      comprehensive review of the literature, which indicates that a conservative threshold would
      be >30-50mmHg for >15 minutes. As more plantar pressure and outcome data are collected over
      time, these thresholds may be modified as need be. The device measures plantar pressures at
      discrete points corresponding to bony prominences that would be considered to be at higher
      risk for ulceration: the first metatarsal head (1), the lateral metatarsal heads (2), the
      great toe (1), the lateral toes (1), the lateral foot (2), and the heel (1). These areas were
      selected based on the inherent high risk of neuropathic ulceration at these anatomic
      locations. This data is tracked, with analysis being performed on those that have been
      collected over the last 15 minutes. If > 95% of the measurements taken by a pressure sensor
      over a 15-minute scanning window exceed 30-50 mmHg, an alert is sent to the user via the
      smartwatch to guide them to appropriately offload that area.

      The SurroSense Rx® device will be used as an adjunct in the treatment pathway following
      closure of diabetic foot wounds. It is widely acknowledged that, following wound healing,
      50-100% of diabetic foot ulcers recur over a five-year period. What is more, it is estimated
      that after 18 months, 42% of ulcers recur, with half of those recurring in the first six
      months. Thus, it is the first six months following wound healing that is the most sensitive
      time for recurrence of ulceration. It is this critical patient population that will be fitted
      with the SurroSense Rx® device for secondary prevention of ulceration.

      Taken together, diabetes patients with foot wounds are at an elevated risk of infection and
      LLA. Therefore, there is a need for an effective tool for the prevention and management of
      the diabetic foot.

      Research Question and Objectives:

      Does improving and standardizing foot screening for diabetes patients through the DFCCP
      concurrently with the use of the SurroSense Rx® smart insole system reduce the proportion of
      foot ulcer recurrence compared to patients who are receiving standard care? The objective of
      this proposal is to demonstrate that when combined with the DFCCP, the SurroSense Rx® smart
      insole system device is an effective modality that is superior to the current standard of
      care for preventing the recurrence of healed pressure ulcerations on the feet of subjects
      with diabetic peripheral neuropathy of the lower extremities. It is hypothesized that the use
      of the device will lead to a reduction in the risk of pressure ulcer recurrence in the
      Intervention group and to improve those subjects' foot self-care, when compared to subjects
      in the Control group. Over the longer term we anticipate that use of the technology in
      concert with the DFCCP will result in better foot health for diabetic patients. The ability
      to test the efficacy of the SurroSense Rx® device in parallel with the DFCCP implementation
      will allow the evaluation in a real-world setting where patients also have access to HRFT for
      prescription of the device. High Risk Foot Teams will be implemented across the province
      starting with three pilot sites (Slave Lake, Brooks, and the Diabetic Foot and Limb
      Preservation Centre at the Peter Lougheed Hospital), These pilot sites will be selected as
      facilities have existing staff with expertise and knowledge in diabetic foot care. The HRFT
      will assess and treat patients with moderate and high-risk findings. The AICE-funded project
      is a sub-study. All patients are clinically assessed in a standardized manner using the
      Alberta Foot Risk Assessment Form (AFRAF), which incorporates a standardized wound assessment
      and treatment approach.ces, ongoing assessment and embedded evaluation.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Prevention
masking: None (Open Label)
measure: Foot ulcer recurrence
time frame: 12 months
description: hazard ratio
measure: Time to re-ulceration
time frame: 12 months maximum
measure: Patient satisfaction
time frame: Last visit to High Risk Foot Team (maximum 12 months)
description: Survey
measure: Patient compliance
time frame: Last visit to High Risk Foot Team (maximum 12 months)
description: Survey
measure: Clinical adoption
time frame: 12 months
description: Interviews with clinicians
measure: Cost effectiveness
time frame: 12 months
measure: Complications rates
time frame: 12 months
description: new ulceration, ulcer extension, infection, surgical intervention, amputation, hospitalization documented
measure: Determinants of ulcer formation
time frame: 12 months
description: Pressure and adherence parameters compared with area of ulceration
arm group label: Surrosense
arm group type: Experimental
description: Subjects randomized to this group will receive standard care, including appropriate off-loading and footwear as well as wear SurroSense Rx® in-shoe pressure-sensing arrays, which provide visual and auditory/vibratory feedback alerts (relating to high plantar pressures) and offloading guidance to a watch display intended to assist in the recurrence of diabetic foot ulcers. They will also be advised to perform daily self-checks of their feet for redness, callous and wounds. A daily checklist will be provided to participants to evaluate compliance.
arm group label: Standard care
arm group type: Active Comparator
description: Subjects randomized to this group will receive standard care, including appropriate off-loading and footwear. They will also be advised to perform daily self-checks of their feet for redness, callous and wounds. A daily checklist will be provided to participants to evaluate compliance.
intervention type: Device
intervention name: Surrosense
arm group label: Surrosense
intervention type: Other
intervention name: Standard care
arm group label: Standard care
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
facility: 
facility: 
facility: 
country: Canada
responsible party type: Sponsor
mesh term: Diabetic Foot
mesh term: Foot Ulcer
sharing ipd: No