Evaluation of the effectiveness of rehabilitation for diabetic foot syndrome

Abstract

Diabetic foot syndrome is an increasingly serious public health problem in both developed and developing countries. Many patients with diabetes complicated by ineffectively treated foot ulcer undergo limb amputation which leads to disability. Therefore, finding and applying effective methods of treating diabetic ulcers in clinical practice is an urgent task. According to recent research, the most effective and complementary to known treatment approaches are rehabilitation methods, but not all of them have been sufficiently studied.

Aim: to study the effectiveness of the treatment for diabetic foot syndrome in patients with diabetes when implementing the use of polarizing light with a Bioptron device and kinesiotherapy exercises according to the Buerger–Allen method into the treatment process.

Materials and methods. 35 patients with diabetes mellitus complicated with diabetic foot syndrome were examined. The patients were divided into two groups: the main group (MG) (n = 17) received standard treatment in accordance with the protocol for providing medical care to patients with diabetic foot syndrome, whereas the comparison group (CG) (n = 18) received light therapy procedures with the Bioptron device in addition to the protocol treatment and kinesiotherapy exercises according to the Buerger–Allen method.

To choose treatment tactics and predict the course of the disease, the bone-brachial index was determined. The ulcer area was determined by means of the imitoMeasure application for the Android operating system. Quality of life was assessed using the SF-36 questionnaire. Analysis and processing of clinical trial statistics were performed on a personal computer using Statistica 10 and MS Excel 2016 application packages.

Results. Our results have shown that a single-day reduction of a wound defect in the MG was approximately 1 % per day, and in the patients of the CG who, in addition to the standard therapy, received polarized light therapy and kinesiotherapy exercises according to the Buerger–Allen method, from 3 % to 4 % per day. Using the Bayesian formula, the probability of complete ulcer healing in the CG was calculated, that was 0.3 compared to the MG – 0.06, indicating greater treatment effectiveness with the inclusion of additional non-drug rehabilitation methods. An assessment of the quality of life indicators in diabetic patients with diabetic foot syndrome after using different treatment schemes has confirmed the effectiveness of the new method based on the obtained significant difference between the studied indicators in the MG and CG according to the Mann-Whitney criterion (Р ˂ 0.05) with regard to the following components: physical functioning, role functioning, pain, general health, and emotional functioning. According to the obtained statistical results, the best effect was observed in the CG with the additional use of polarizing light and kinesiotherapy.

Conclusions. The proposed complex treatment of diabetic patients with diabetic foot syndrome, including light therapy procedures with polarizing light and kinesiotherapy exercises according to the Buerger–Allen method, significantly influences the rate of the ulcer area reduction and the quality of life of patients compared to the standard treatment (P < 0.05). The additional effectiveness of the new technique is confirmed by the Bayesian formula, in particular, the probability of complete ulcer healing in the comparison group is 0.3 compared to the main group – 0.06, indicating greater treatment effectiveness with the inclusion of additional non-drug rehabilitation methods.