ISSN        2347-8640 (Print)

2454-2660 (Online)

DOI: 10.52711/2454-2660.2021.00092

 

Vol. 09 |Issue-04|

October December | 2021

Available online at

www.anvpublication.org

International Journal of Nursing Education and Research

Home page www.ijneronline.com

 

 

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:

Sl. No	Demographic variables	Infrared Group
		Number	Percentage
1	Age in years
a.    25-35
b.   36-45
c.    46-55
d.   56 -65
e. 66 and above	
04
26
26
16
03	
05.30
34.70
34.70
21.30
04.00
2	Sex
a.	Male
b.	Female	
44
31	
58.70
41.30
3	Religion
a.	Hindu
b.	Muslim
c.	Christian
d.	Others	
41
07
20
07	
54.70
9.30
26.70
9.30
4	Education
a.	Uneducated
b.	Primary school
c.	High school
d.	Higher secondary
e.	Graduate and above	
14
05
18
20
18	
18.70
06.70
24.00
26.70
24.00
5	Occupation
a.	Unemployed
b.	Daily labor
c.	Private Employee
d.	Government Employee
e.	Professionals	
18
08
22
09
18	
24.00
10.00
29.30
12.00
24.00
6	Family income per month
a. Up to 5000
b. 5001-10000
c.   10001-20000
d.   Above 20000	
15
35
18
07	
20.00
46.70
24.00
09.30

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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sl.No.	Demographic variables	Infrared Group
		Number	Percentage
7	Marital status
a.	Married
b.	Unmarried
c.	Widowed/ Widower
d.	Divorced/Separated	
15
07
33
20	20.00
09.30
44.00
26.70
8	Sources of information on DM
a.	Health personnel
b.	Mass media	

30
18	
36.00
30.70
21.30

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

 

Sl.No.	Demographic variables	Infrared Group
		Number	Percentage
	c.	Friends
d.	Relatives
e.	others	21
06
00	10.70
01.30
00.00
9	Duration of Illness
a.	< 1 year
b.	1-2 years
c.	3-4 years
d.	5-6 years
e.	>6 years	
13
22
21
19
00	
17.30
29.30
28.00
25.30
00.00
10	Dietary Pattern
a.	Vegetarian
b.	Non-vegetarian	
31
44	
41.30
58.70
11	Residential Area
a.	Rural
b.	Urban
c.	Sub-urban	
47
21
07	
62.70
28.00
09.30
12	Family History of Diabetes
a.	Yes
b.	No
c.	Unknown	
29
26
20	
38.70
34.70
26.70
13	Duration of Foot Ulcer
a. < one year	
52	
69.30

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.

 

REFERENCES:

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

5.      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 Sciences, 2015, 14( 4), 06-11

7.      Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia. Lancet. 2010, 30;375(9712):408-18

8.      Shailesh K. Shahi M, Ashok Kumar, Sushil Kumar, Surya K Singh, Sanjeev K. Gupta, T.B Singh. Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patients From North India. The Journal of Diabetic Foot Complications, 2012; Volume 4, Issue 3, No. 4, Pages 83-91

9.      Shamima Akter a, M Mizanur Rahman b, Sarah Krull Abe b & Papia Sultanac Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey, Bulletin of the World Health Organization 2014;92:204-213

10.   www.diabetes encyclopedia

11.   www.emerson.com/infrared therapy.