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ISSN 2347-8640 (Print)
2454-2660
(Online)
DOI: 10.52711/2454-2660.2021.00092
Vol. 09 |Issue-04|
October – December | 2021
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Available online at
www.anvpublication.org
International
Journal of Nursing Education and Research
Home page www.ijneronline.com
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RESEARCH ARTICLE
Effectiveness of Infrared Radiation, in healing of diabetic ulcer foot at MAPIMS
P. Tamilselvi1, Dr. G. Ramamurthy2
1Principal, Mailam Nursing College,
Mailam, Villupuram District,
Tamilnadu, India.
2Nursing Officer, JIPMER, Puducherry UT, India.
*Corresponding Author E-mail:
selvitamil79@gmail.com, ramu1178@gmail.com
ABSTRACT:
Introduction: Diabetes is the
non-communicable chronic health issue that affects people in the world wide. Studies
shows that India is the second largest
diabetes populated country
in the world. Long standing
uncontrolled diabetes leads to many systemic complications; diabetic
ulcer foot is one among them that result in loss
of foot or amputation and in severe cases even death. Objectives: this study investigated the pre and post test level would healing with infra-red
radiation and also compared pre and post test mean score and found the demographic influences of the diabetic
clients. Materials and methods: in a quantitative pre experimental one group pre-test post test design 75
diabetic ulcer foot clients who met the sampling criteria were included as sample. Consecutive sampling method was
used to select the sample as they report to OPD or admitted as inpatient. Following pre-test Infra-red
radiation was applied for 10 days and the post test was done seventh and tenth day. Result: The pre test
mean and standard deviation were 51.5067 and 4.21828 respectively and the post test mean and standard deviation
were 20.32 and 3.673 respectively. The” t” value was 68.352.
Client’s demographic variables
like education and occupation had significant influences in the wound healing process.
KEYWORDS: OPD, inpatient, diabetes mellitus, infra-red radiation, amputation, consecutive sample.
INTRODUCTION:
Health is considered as fourth important aspect in our human life after, food, water and shelter.
Health promotion is the process
of fostering the awareness, influencing attitudes and identifying
alternatives so that individuals can
make informed choices and change their behavior to achieve an optimal level of health1. ’Diabetes
Mellitus’’ is a metabolic disorder
characterized by glucose
intolerance. It is a systemic
disease caused by an imbalance between insulin supply and insulin demand. In diabetes mellitus,
either there is not enough insulin or the insulin
that produced is ineffective,
resulting in high blood glucose level2.
India is the home to the second highest number of people living with diabetes in the world after
China. India has estimated 77 million people with diabetes10. 1/6th people
in world with diabetes is from India. India will be the capital of Diabetics in the year 20254.
Uncontrolled diabetes results
in many immediate and long term complications. Diabetic foot ulcer is the one among them;
that’s the ulceration of foot distally from the ankle and or toes. In the world wide diabetic ulcer foot alone accounts around 11.3% among other ulcer
like burns, trauma, bed sore and
other surgical procedures3.
In India roughly 40000 limps are amputated every year, from that 75 percent are peripheral neuropathies
combined with infection these can preventable7. Diabetic
Received on 13.07.2021 Modified on 01.08.2021 Accepted
on 17.08.2021 © AandV Publications all right reserved Int. J. Nur. Edu. and Research. 2021; 9(4):398-402.
DOI: 10.52711/2454-2660.2021.00092
ulcer foot is very common and expected to affect 15 percent of all diabetic clients in their
life time. In that 15 to 20 percent clients
with foot ulcer under goes amputation. Almost 85 percent amputees proceeded
with
398
diabetes. There are many treatment and therapies like debridement, debridement, Topical Antimicrobials, Wound dressing, Polyhexamethylene biguanide, vacuum assisted oxygen therapy, skin grafting,
Infrared radiation, Insulin
Dressing, Metronidazole dressing so on is being under use to treat the ulcer foot6.
With the above fact we came to know that diabetes became the common health problem,
which can be prevented
even if it occurs that can be controlled without any further complications. If it complicate, there are many modalities available for the
treatment of diabetic ulcer8.
From the available literatures infrared radiation is one among the best therapy in the healing of diabetic ulcer foot5. With that evidence
to strengthen the finding the
investigator studied the effect of infra-red radiation therapy in the healing
of diabetes ulcer foot.
STATEMENT OF THE PROBLEM:
A study to assess the Effectiveness of Infrared Radiation, in healing of diabetic ulcer foot at MAPIMS
OBJECTIVES:
1
To assess the pre-test
condition of diabetic ulcer foot among patients
with Diabetes mellitus
2
To assess the post-test
condition of diabetic
ulcer foot among patients with Diabetes mellitus
3
To compare
the pre and post test condition of diabetic ulcer foot among patients with Diabetes mellitus
4
To associate
the effectiveness of intervention in healing of diabetic ulcer foot with the selected
demographic variables of the diabetic
ulcer foot clients
MATERIALS AND METHODS:
Hypotheses:
H1 – There will be significant improvement in healing of diabetic
ulcer foot with infra-red radiation
therapy.
H2 There will be significant association of
post test score of diabetic ulcer foot with the selected
demographic variables of the
diabetic ulcer foot clients
Assumption:
Infrared radiation
may improve the healing of diabetic foot
ulcer
Research approach and design:
Quantitative approach
with pre-experimental one group pre-test post-test design was used in
this study.
Variables of the study:
Independent variable- Infra-red radiation
Dependent
variable- Healing of diabetic ulcer foot
Demographic Variables-age, sex, religion,
education, occupation,
monthly income of the family, marital status,
sources of information on diabetes, duration of Illness, dietary
pattern, residential area, family history
of diabetes mellitus
and foot ulcer duration
Study Setting:
The study was conducted in Melmaruvathur Adhiparasakthi Institute of Medical
Sciences and Research
Hospital (MAPIMS), Melmaruvathur, Kancheepuram district, Tamilnadu.
Population:
The study population comprises of all clients
with diabetic foot ulcer
Target population:
In this study target
population comprises of all the clients with diabetic
foot ulcer in Tamil Nadu
Accessible population:
In this study accessible population comprises of all the diabetic
clients with foot ulcer attended
in outpatient department and admitted in
surgery ward at MAPIMS.
Sample:
In this study samples are the
clients with diabetic ulcer foot and who fulfilled the sampling criteria.
Sampling criteria:
Inclusion criteria:
1.
Client should have diabetic
foot ulcer and ulceration in subcutaneous tissue
2. Client who is willing to participate in the study.
3.
Client who is able
to speak or understand Tamil
4.
Client should be attended
in surgical outpatient department and admitted in female and male surgical ward with foot ulcer.
Exclusion criteria:
1.
Client with mental disturbances
2. Client with allergic
history and other complications.
3.
Client should have
diabetic foot ulcer with involvement of bone
and arteries
Sampling technique:
Non-probability consecutive sampling technique was used
to select the samples
Sample size:
Sample of 75 ulcer foot clients
were included, sample
size was calculated by power analysis.
Development
and description of the tool Section A: Demographic Variables.
It consists of age, sex, religion, education, occupation, monthly income of the family, marital status,
sources of information on diabetes, duration
of Illness, dietary
pattern, residential area, family history
of diabetes mellitus
and foot ulcer duration.
Section B:
modified Bates-Jensen wound assessment tool.
It consists of size, Depth, Edges, undermining, necrotic tissue type, necrotic
tissue amount, exudates
type, exudates amount,
skin color surrounding wound, peripheral tissue edema, peripheral tissue induration, granulation tissue and epithelization.
Score 60-15 wound
degeneration
< 14 wound regeneration The wound healing score was 13 out of 65
Score Interpretation = Obtained score ´ 100 / total
score
<50%good 51%-75%fair
>75% poor
Validity and reliability of tool:
The tool was validated by various experts from nursing, Diabetology, general surgery and plastic surgery
and general physician;
reliability of the tool was determined by
using split half technique. The “r” value was 0.8.
radiation for the 15 minutes11 then saline dressing was done.
Infra red radiation application was done for 10 samples for ten days. Post assessment was done on 7th and tenth
day by using the same tool.
DATA ANALYSIS:
1
Descriptive statistics
like number and percentage was used
to analyze the demographic variables and Mean and standard deviation was used
to analyze the wound size
2
Inferential statistics
like Chi-square test was used to find
the association of demographic variables on wound healing
RESULT:
Table 1: Frequency
and Percentage Distribution of Clients with
Diabetic Ulcer Foot
Ethical Consideration:
Considering all the ethical aspects
of the investigator preceded
her study with ethical committee approval by
Melmaruvathur Adhiparasakthi Institute
of Medical Sciences and Research.
Data Collection Procedure:
After obtaining ethical committee approval Total of 75 diabetic
ulcer foot clients
were utilized by using consecutive sampling technique those fulfilled the sampling criteria.
Nature of the study, purposes,
investigator and participant’s
role, risk and benefits of the study, alternatives were explained,
anonymity and confidentiality also assured. After explaining the above
Table-1 continued Frequency and
Percentage
Distribution of
aspects informed consent was obtained from the study participants. Pre test was done by using
Bates-Jensen wound assessment tool.
Intervention:
After wound assessment, wound was cleansed
and exudates were removed
Clients were kept in comfortable position
and infra red lamp was placed 18 inches away
from the foot ulcer, foot ulcer was exposed by infrared
Clients with Diabetic
Ulcer Foot continued
|
Sl.No.
|
Demographic variables
|
Infrared Group
|
|
Number
|
Percentage
|
|
|
b.
One year
c.
Two year
d.
>Two year
|
23
00
00
|
30.70
00.00
00.00
|
Table-2: Comparison of pre test and
post-test score of infrared radiation in healing of diabetic foot ulcer
|
Sl. No.
|
Infrared radiation
|
No
|
Mean
|
Standard
Deviation
|
|
2
|
Pre-Test
Post-Test
|
75
75
|
51.5067
20.3200
|
4.2183
3.6729
|
P< 0.00001
The above table depicts that the pre test and post scores of the Infra red radiation group. At the
pre test mean and standard deviation
were respectively 51.5067
and 4.21828. At the post test
mean and standard deviation were respectively 20.32 and 3.673.
The” t” value
was
68.352 it is more than table value. It shows a high level of significance
statistically at p<0.00001 level.
Table-3: Comparison of wound means score
between pre test and post-test
|
Infrared group assessment and evaluation
|
Paired Differences
|
t
|
df
|
|
Mean
|
Std. Deviation
|
Std. Error
Mean
|
95% Confidence Interval of the Difference
|
|
Lower
|
Upper
|
|
Pair 1
|
assessment - evaluation
|
31.187
|
3.951
|
.456
|
30.278
|
32.096
|
68.352*
|
74
|
|
|
|
|
|
|
|
|
|
*P<0.00001
The above table 3
compares the mean score
between assessment and evaluation in the infrared
group. The mean score was 31.187 and the standard
deviation 3.95 and the “t” value were
68.35.This shows that there is significance
improvement in the healing of diabetic ulcer
foot with infrared radiation.
Association
of post test score of infrared radiation in healing of diabetic foot ulcer with the selected
demographic variables:
The clients’ education and occupation had statistically significant association at P<0.05
level. Age, gender,
marital status like other demographic variables did not have any
influences in healing of diabetic
ulcer foot.
DISCUSSION:
At the pre test mean score was 51.5067, standard
deviation 4.21828 and in the post test mean and standard deviation
were respectively 20.32 and 3.673. The” t” value
was 68.35 it is more than table value. It shows a high level of significance statistically at p<0.00001 level. The calculated value was greater than
the table value shows that the
infrared radiation was effective on healing
of diabetic foot ulcer. This finding is supported by the study conducted by Lubart R et al (2011) in their randomized double blind study evaluated the effectiveness of broad band light device on healing
of
diabetes foot ulcer. Total of 16 subjects, 10 were kept in the treatment group and remaining were in
the control group received placebo.
They proved that nine out of ten client’s
wound were healed in the treatment group5. In the placebo group two out of six wound
were healed. 89 and 54 percent wound
size was reduced in treatment and control group respectively. The “t” value was 68.35 which is greater than the table
value. Based on the “t” test result the hypothesis H1, which stated earlier that H1
– There will be significant improvement in healing of diabetic ulcer foot at the post test was retained
In the infrared radiation group among all demographic variables
the client like age, sex, religion, education, occupation, monthly income of the family, marital status, sources of information on diabetes,
duration of Illness, dietary pattern,
residential area, family history of diabetes
mellitus and foot ulcer duration only education and occupation had statistically significant association on healing of diabetic ulcer foot at
P<0.05 level. This finding is
supported by the study conducted by Salami M
et al (2011) in their randomized clinical trial evaluated the effectiveness of low level laser therapy
on healing of diabetic foot ulcer. In their study education and the duration
of foot ulcer had moderate
association on healing
of diabetic foot ulcer. The hypothesis H2 stated earlier
that there will be significant association of post
test score on healing of diabetic ulcer foot with the selected
demographic variables among diabetic foot ulcer
clients was retained9.
CONCLUSION:
The study concluded that infrared radiation application was the most effective means of treatment
in healing the diabetic ulcer foot. Client’s
demographic variable education and occupation had significant influences.
RECOMMENDATIONS:
1.
A similar
study can be replicated in public and private sector.
2.
Infra-red radiation
with different doses can be tried
3.
Comparative study may
be conducted between infra- red
radiation, insulin dressing, and vacuum dressing and or hyper baric
oxygen therapy may be tried.
4.
Gender
differentiated study with same dose of infra-
red radiation may be considered.
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1.
A, Potter and Perry,
Fundamentals of nursing, 6th edition, 2005, Mosby publication, Missouri.
2.
Brunner and Suddarth. Text Book of Medical and Surgical Nursing.
J.B. Lippincott company.
Philadelphia. . 10th edition.2010.1377-1429
3. http://en.wikipedia.org/epidemiology of diabetes
4.
http://diabetic wikipedia
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Landau Z1, Migdal M, Lipovsky A, Lubart R.Visible
light- induced healing
of diabetic or venous foot ulcers: a placebo- controlled double-blind study. Photomed
Laser Surg. 2011,
29(6):399-404.
6.
Naveen Kumar M1, Pavan
B.M 2, Srinivas Arava, Kiran Kumar KM,
A Comparative Study of Topical Phenytoin Vs Conventional Wound Care in Diabetic Ulcer, IOSR Journal
of Dental and Medical
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Ramachandran A, Ma RC,
Snehalatha C. Diabetes in Asia. Lancet. 2010, 30;375(9712):408-18
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Shailesh K. Shahi M, Ashok Kumar, Sushil Kumar, Surya K Singh,
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www.emerson.com/infrared therapy.