Proceeding Foot Exercise V1 New.docx

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

Application Of Foot Exercises To Treatment Of Diabetic Neuropathy Camalia1*Ida1*Nienieki1 1

Department of Pharmacy, Poltekkes Kemenkes Bandung. Jalan Prof. Eyckman No. 24 Bandung, Indonesia. ZIP code 40161

Abstract. Background : Background: One of the chronic complications of diabetes mellitus is diabetic neuropathy. The initial symptoms are paresthesia (tingling, tingling or increased sensitivity) and burning (especially at night). Foot exercises are activities or exercises carried out by patients with diabetes mellitus to prevent injuries and help blood circulation in the legs. Preliminary studies conducted on patients with Diabetes Mellitus revealed that they had never performed sports activities that could control blood sugar, such as DM or Foot Exercises. Objectives : 1) increased knowledge of health cadres about foot exercises; 2) reduce symptoms of diabetic neuropathy in diabetics. Location : Puskesmas Sindang Barang and Semplak of Bogor City. Method : Implementation of foot exercises through several stages, namely training cadres on foot exercises, examining diabetic neuropathic symptoms, checking blood sugar while and counseling about complications of DM. Then proceed with foot exercises for 10 times in 10 weeks in each Health Center. After completing foot exercises, a neuropathic symptom is reexamined and sugar palm is present. Results : The health cadre showed an increase knowledge about DM management, complications of DM and leg exercises, from an average of 67-73 to 80-93. This is supported by the fact that they are often exposed DM program and the level of education of health cadres are graduating from high school. After 10 times in 10 weeks of exercise, the neuropathic symptoms of DM patients decreased in mean foot sensation (8 to 4) and mean physical examination (4 to 2,5). This is because the benefits of foot exercises are to facilitate peripheral blood circulation,strengthen the muscles of the legs ang joints become supple Conclusion : Foot exercises training can improve health cadre knowledge; Foot exercises can reduce symptoms of diabetic neuropathy

Introduction Along the shifting patterns of the economy from agriculture to industry, the pattern of disease is also shifting from infectious diseases

(infection)

communicable

diseases

become

non-

(degenerative).

Another factor influencing the changing pattern of disease is lifestyle. Lifestyle of people today versatile instant to effective and efficient work included ingredients of food in consumption, activities that do not spend a lot of energy as well as the psychological burden that extends that can increase a person catecholamines (Wahyudi, 2008). Increased catecholamines may increase the breakdown of glycogen in

the liver into glucose, thereby increasing blood sugar or hyperglycemia can lead to Diabetes Mellitus (Elizabeth, 2009). Based on the results of health research (Riskesdas) in 2007, a degenerative disease increased from 41.7% in 1995 to 59.5% in 2007. The International Diabetes Association predicts the number of people with diabetes mellitus is more than 200 million people in 2010 and more than 300 people in 2025. According to wHO, in 2008 Indonesia ranks 4th in the number of people with diabetes mellitus in the world, in 2006 the number diabetasi in Indonesia is estimated to reach 14 million people who are aware of only 50% have it and only 30% are

*

Corresponding author: [email protected]

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

coming regular treatment (Kristina F, 2012). In

increased sensitivity) and burning (especially at

Indonesia, the prevalence of diabetes ranges

night). With increasing legs felt numbness

from 12.8 per cent of the population over the

neuropathy (numbness). The decrease of the

age of 15 years. Meanwhile, according to the

pain

Bogor City Health Department, in 2007, the

neuropathy patients at risk for injury and

prevalence of diabetes mellitus clients in Bogor

infection of the feet without being noticed

City is about 3.

(Smeltzer and Bare, 2002).

Diabetes mellitus is a heterogeneous

and

temperature

sensibility

make

The prevalence of diabetic neuropathy

group of disorders characterized by increased

in

patients

levels of glucose in the blood or hyperglycemia.

approximately 66%, 8% of whom are already

Normal glucose circulating in a certain amount

suffering from neuropathy at time of diagnosis

in the blood. Glucose is formed in the liver from

of

the food consumed. Insulin is a hormone

neuropathy after 25 years of diabetes mellitus,

produced by the pancreas, to control glucose

45% of neuropathy in patients with NIDDM and

levels in the blood to regulate the production

54% in patients with IDDM (FP Thomas, Joint

and storage (Smeltzer and Bare, 2002).

Louis, 2013). Diabetic neuropathy or nerve

diabetes

with

diabetes

mellitus.

50%

mellitus

is

menagalami

In diabetes mellitus body's ability to

damage is a serious complication of diabetes.

respond to insulin can decline, or pancreas can

Diabetic neuropathy associated with problems

stop the production of insulin. This situation

of blood supply to the feet can lead to foot ulcers

canresulting in increased blood sugar levels,

and slow wound healing. This infection can lead

and may cause damage to blood vessels,

to amputation wound, 40-70% of all lower

nerves and other internal structures. Especially

extremity amputations are caused by diabetes

the blood supply to peripheral areas further

mellitus (Sudoyo, 2006). To overcome the

hampered,

mellitus

above mentioned complications, need to be

patients would be impaired blood circulation in

done in an integrated handling of either

the peripheral areas, especially his leg and will

medication, diet and daily activities.

resulting

in

diabetes

undergo acute and chronic complications (Smeltzer

and

Bare,

2002).

Management

of

Diabetes

Mellitus

Long-term

comprising: first pharmacological treatment

complications or chronic complications can

which includes administration of oral anti-

affect every organ system of the body, these

diabetic drugs and insulin injections. Both non-

complications include diabetic neuropathy.

pharmacological treatment includes lifestyle

Diabetic neuropathy is nerve damage

changes by adjusting diet known as medical

caused by an increase in blood glucose,

nutrition therapy, increasing physical activity,

resulting in decreased blood circulation to the

and education of various issues related to

cells and nerve cell function decreases.

diabetes that is done continuously. Physical

Neuropathy Diabetic neuropathy teridiri of

activity or sports for the management of

sensory,

Sensory

diabetes mellitus who do is a sport measured,

neuropathy often on the distal portion of the

organized, controlled and sustainable. The

nerve fibers, particularly the nerves of the lower

recommended frequency is 3-5 times per week.

limb. Symptoms beginnings are paresthesias

The recommended intensity of 40-70% (mild to

(prickling sensation tingling, numbness or

moderate). One type of sport, which is

motor

and

autonomic.

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

recommended is gymnastics feet (Bamers,

occurred or not can be used Michigan

2012).

Neuropathy Screening Instrument (MNSI) by Gymnastics foot is an activity or

assessing the state of sensation legs and do a

exercise performed by patients with diabetes

physical assessment at the foot of patients with

mellitus to prevent injury and help blood

diabetes mellitus (WH Herman, 2014).

circulation of the foot. The aim of this leg

Research on gymnastic legs have also

exercises to improve blood circulation so that

been carried out in the Hospital Marzoeki Bogor

nutrients

smoothly,

in 2015 on the Influence of Gymnastics Legs Of

strengthen the small muscles, calf muscles and

Medicine Neuropathy Diabetic At penderta

thigh muscles, and overcomes the limitations of

diabetes mellitus whose results are gymnastics

motion that is often experienced by patients

leg affects the value of the sensation of the feet

with diabetes mellitus. Gymnastics these legs

and physical assessment foot of patients

can be given to all patients with diabetes

diabetic neuropathy in the intervention group

mellitus type 1 and 2. However, the patient

after exercise legs , Gymnastics feet affect the

should be given since being diagnosed with

treatment of diabetic neuropathy in patients with

diabetes mellitus as early preventive action.

diabetes mellitus (Camalia, 2015).

to

the

tissues

more

Gymnastics effect for your legs to improve blood circulation (Widianti, 2010). Gymnastics foot is highly recommended for diabetics who

Experimental Section Materials

adapted to the conditions and the body's ability

Cetirizine 10 mg oral tablet were obtained from Bayer (Incidal OD® 10 mg), Mefenamic Acid Tablet were obtained from Pfizer (Ponstan® 500 mg), acetic acid 0.7% (Mercks), CMC Sodium, Alcohol 70%, and aquadest.

penederita. DM leg exercises can be done by

Animals

moving the legs and joints of the feet, for

Thirty six of male Swiss-Webster albino mice (20–25 g) obtained from Institut Teknologi Bandung were used for the experiments. The animals were maintained in standard environmental conditions and housed in a light-controlled room at a room temperature, fed on a standard diet with water ad libitum.

experience a reduction of circulating blood disorders and neuropathy in the legs, but

example standing with both heels out, lift and lower legs. Movement can be a movement to bend, straighten, lifting, turning out or in and gripping toes (Soegondo, 2011). Gymnastics

leg

carried

out

continuously for 8 weeks with a frequency of three times a week. Duration leg exercises for 30 minutes at moderate to high intensity exercise (70% - 80% DNM). Foot gymnastic movements performed by the respondent 10 times each movement and the right foot in terms

of

left repeated

3

times.

Before

gymnastics foot of patients with diabetes mellitus should be reviewed in advance whether it happens or not complications of neuropathy. The instrument used to determine whether the complications of diabetic neuropathy has

Methods Thirty six Swiss-Webster albino mice were divided into 6 groups. The first and second group served as normal and positive control and was given normal saline. Groups III received standard drug (mefenamic acid 1,3 mg/20 g), meanwhile group IV, V, and VI received cetirizine 0,013 mg/20 g, 0,026 mg/20 g, and 0,052 mg/20 g, respectively. Thirty minutes later, each mouse was injected with 0.7% acetic acid, i.p. The number of abdominal constriction for each mice was observed every five minutes after injection of acetic acid for a period of 90 minutes. Percent protection to pain stimulation was calculated using the formula :

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

The results of the experiments were expressed as Mean ± S.D. The mean values of control groups were compared with the mean value of treated groups using one way ANOVA. Results were considered significant at. P < 0.05.

cadre of health centers. The training method is the lecture. Brainstorming, discussion, question and answer and simulation

exercises

legs.

Each

puskesmas was attended by 10 cadres

Results and Discussion

and 1 PJ PTM. To measure the

A. Event Results

success of the pre-test training begins,

The results that have been achieved in this community service activities until August is as follows:

Community

service

second session of the provision of

activities

have

received permission from the Head of State Kesbangpol Bogor and Bogor City Health Office Head. Then proceed with the delivery of programs IbM to Head Center

and

Health

Center

Semplak Sindang Goods, and has received permission puskesmas head. By Kepela PHC directed to contact the person in charge of Communicable Diseases (PTM)

PTM Health Center and Health Center Semplak

Sindang

Goods,

for

the

implementation of activities IbM which consists of several activities, namely the training of cadres, cadres caring about gymnastics leg and foot exercises implementation for patients with DM

workers who will join the cadre training on leg exercises in patients with diabetes mellitus. Inviting Kader Kader for implementation pelatihaan

volunteers

on

of foot

the

of the provision of material on leg exercises. The fourth session giving examples of the implementation and practice gymnastics gymnastics leg legs and preparation counseling to people with diabetes by cadres. After the training of cadres, cadres appointed two representatives from

of

Gymnastics

in

items

of

DM

disease,

complications and penangannnya and leg exercises. The material will be delivered by volunteers made simpler so that can be understood by people with diabetes. The cadres were briefed in advance how to submit material, both

foot gymnastics. Then simulation how to teach gymnastics leg with leg exercise video guide. At the time of teaching cadre was no trouble because

material about the DM, which is still the difficulty is to memorize the foot gymnastic movements so that the

Training of cadres on foot gymnastics dilaksakan in health centers and health Semplak

submit

the volunteers had ever received

training

Patients with DM

centers

and its complications. The third session

on the material DM and about steps

3. PJ PTM give the names of health

Implementation

material about the disease of diabetes

each community health centers to

2. Coordinate with the responsible section

4.

Brain storming about DM disease, complications and penangannnya, the

1. Permit the public devotion

Health

and ends with post testtdilanjutkan with

Sindang

Goods,

consisting of four sessions for each

cadres equipped with foot gymnastics and video content via mobile phones. table 5.1

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

Characteristics of Health Cadre

score of knowledge of health cadres

Based on Age

Partners II before training was 67 and

characteristic

partner

partner

s

sI

sI

Average Age

48

50

after training was 81. 5. Foot Gymnastics Event Before the activities began gymnastics

Of the 10 health volunteers Sindang

at the first leg health volunteers assisted

Barang Bogor City Health Center

by PJ PTM Health Center collects

(Partners I) mean age 48 years, while

Prolanis participants who suffer from

10 people Semplak Puskesmas health

Diabetes Mellitus, one Prolanis activity

worker (Mitra II) a mean age of 50

is gymnastics health. Gymnastics health

years.

in Puskesmas Sindang Goods held table 5.2

once a week every Friday, at the health

Characteristics of Health Cadres

center Semplak, gymnastics Prolanis

According to Education

held every Saturday. Participants at the

Education

partners

partners

foot gymnastics health centers Goods

I

II

sindang 20 people and in Puskesmas

n

%

N

%

Semplak

20

SD

2

20

2

20

collected prior DM patients examined

SMP

2

20

6

60

his foot to determine the ratings

High

6

60

2

20

neuropaty diabetic participants.

School PT

0

0

0

0

Total

10

100

10

100

Table 5.2 shows that more than half of the first partners 60% of his final high school education (6). In the second partner most of his final junior high education 60%

people.

foot

Setelahntuk

gymnastics

Diabetic

neuropaty

assessment was conducted before and after exercise leg will be held 10 to 12 times. MNSI designed to describe the state of diabetic neuropathy. MNSI covertwo separate judgments, the first screening instrument consists of 15 kinds of

(6)

questions with the answer "yes" "no" of

table 5.3

sensation in the feet which include pain,

Knowledge of Health Cadre Training

numbness and temperature. answer'Yes'

Before and After Kader knowledge about diabetes manageme nt and Complicatio ns Average

partners

partners

I

II

Score

Score

to questions 1-3, 5-6, 8-9, 11-12, 14-15 were each given a score of 1. Answer

pr

Po

pr

Po

e

st

e

st

73

93

67

81

'No' to questions 7 and 13 each given a score of 1. Question 4 considered to be the size of circulatory disorders and question 10 common asthenia size. Total score ≥ 7 is considered abnormal or

From Table 5.3, it can be seen that the

neuopati. The second part of MNSI is a

mean score of knowledge of health

physical

volunteers Partners I before training

Herman,

was 73 and after training is 93. The

assessment 2014).

on

Tesebut

foot

(WH

physical

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

assessment

includes

that aim to prevent or treat diabetic

examinationdistance to deformity, dry

neuropaty as one of the complications of

skin, calluses, infection and crannies.

diabetes mellitus. During the cadres can

Each leg of the disorder was given a

deliver material assistance counseling

score of 1. Each leg is also examined for

smoothly and many participants are

ulcers and leg ulcers each if there are

asked to volunteer. After the extension

abnormalities were each given a score of

was agreed timing of leg exercises held

1. An examination of the ankle reflex, if

every satukali a week for 10-12 times

reflex does not exist, the patient is asked

after exercise kegaiatan Prolanis.

to perform maneuvers Jendrassic and, if

Implementation of the foot gymnastics at

No,

health

these

reflexes

implied

by

centers

and

health

centers

strengthening so was given a score of

Sindang Goods Semplak implemented

0.5. If the reflex does not exist with

dive 10 times in 10 weeks every Friday at

Jendrassic maneuver, otherwise there is

PHC Sindang Goods and every Saturday

no such reflexes and given a score of 1.

at Puskesmas Semplak. During the

Testing the vibrations through the thumb

execution of gymnastics led by the

test using 128-Hz tuning fork. In general,

cadres, and assisted by students. The

the examiner should be able to feel the

participants

vibrations in his hand for 5 seconds

gymnastics leg and foot exercises to

longer than the patient's thumb. The

follow the spirit of the last session. After

results are considered the most good if

completion of the foot gymnastics IbM

the vibration felt by the thumb of the

team, helped the students carried back

examiner < 10 seconds longer than the

foot examinations in diabetic patient and

thumb of the patient is given the value 0.

random blood sugar tests

were

Decreasing or neuropathy occurred if the

quite

enthusiastic

table 5.4

examiner feel the vibrations for ≥ 10

Characteristics of Patients with DM

seconds and given a value of 0.5, and if

According to Education and Age

the patient does not feel the vibrations

Characteristic

given value1. PemeriksaanTotal possible

s

score is 8 points and, if scoring is obtained,

≥

2.5

is

considered

partner sI

partner s II

Average

SD 16

SD 12

Education

(80%)

People

abnormal(Herman WH, 2014). Diabetic neuropaty examination was conducted

(60%) 55 of

60

14

years

Then do random blood sugar tests.

people

16

After examination neuropaty diabetic

(60%)

(70%)

by a team IbM assisted by students.

mean age

health workers provide health education

From table 5.4 it can be seen that most

on

DM

of the recent education DM patients

Compilation and leg exercises to people

both in Mitra I and Partners II is a

with diabetes. Patients with DM are

primary school, while the mean age of

introduced to gymnastics leg movements

patients with DM in partner I was 55

the

management

of

DM,

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

years as many as 14 people (600%) and

training activities seen an increase in

in the Partner II 60 Years of 16 people (

knowledge

70%).

diabetes, complications of diabetes and

the

management

of

table 5.5

Gymnastics Legs. This is evident from the

Average Score Neuropaty Diabetic and

increase in mean score of knowledge. This

Blood Sugar When Patients with DM

is supported because the cadres are often

Score Neuropaty Diabetic Patients with DM

partners I

Score pre

Pos

partners

exposed on DM materials so they already

II

know some of the DM, which they do not

Score

know is about gymnastics legs. Then also

pre

t Mean

8

4

8

Pos

supported by their educational background

t

where Mitra I mostly cadres terakhinya

6

education is high school and in the Partner

Street

II mostly graduated from high school. For the

Sensation

ability to provide counseling mostly cadres

Physical

4

1.5

4

2.5

still capable and confident, this is because

Examinati

the experience is still lacking in outreach.

on

There is only 1 or 2 people who can deliver

Mean

properly instructed ministers from each

Street When

17

blood

1

156

20

175

0

sugar

B.

about

Partner. IbM team still provide guidance, motivation and mentoring so that the volunteers can provide counseling well.

From Table 5.4 mean score inspection

The diabetic patient before carrying out

sensation known foot on the first Partners is

gymnastic

8 feet before exercise and after exercise foot

neuropaty diabetic complications have been

4, whereas the mean score of thrill II

hit by what is not, namely by performing a

partners before gymnastics leg legs after

physical examination sensation of the foot

exercise is 8 feet 6. For the mean score on

and leg. from data analysis obtained an

the toe physical examination Partners I

average diabetic patient has been exposed

before exercise after exercise foot is 4 feet

to neuropaty diabetic, where the average

1.5, for Partners II mean score of physical

value of partners leg sensations I and II is 8

examination gymnastics leg legs before and

and the value of a physical examination

after exercise is 4 feet is 2.5. As for the

partner legs I and II partners mean 4. This is

random blood glucose values mean score

because since the diabetic patient is already

Mitra one before exercise foot is 171 mg%

more than 10 years of suffering from

and after exercise foot 156 mg%, to

diabetes. Coupled with the mean age of

Partners II mean random blood glucose

patients with diabetes over 55 years. They

values before exercise foot is 200 mg% and

also

after exercise foot 175 mg%.

especially

Discussion

complications. If neuropaty not addressed

From the results of data analysis team is

will cause diabetic Diabetic wounds and

doing during IbM activities, from cadre

increase the incidence of amputation in

lack

legs

checked

education

first

about

Neuropaty

whether

diabetes, diabetic

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

patients with DM. The average blood sugar

Factors supporting the success of this

levels in partner I was 171mg% and 200

activity is the active role of patients with DM

mg% II partners. Blood sugar in diabetic

who follow gymnastics legs and motivation

patient always controlled in both partners,

of health cadres, PJ PTM and Physicians

they regularly check their blood sugar every

Health Center so that people with diabetes

month. Monitoring is carried out by health

routinely perform leg exercises. Perceived

workers, and counseling is often given by

barriers are still some people who do not

nurses and doctors clinic.

regularly participate foot gymnastics, no

After

the

implementation

foot

new participants who took part in every leg

gymnastics for 10 times in 10 weeks IbM

exercise activity a week, so the team IbM

team

sensation

somewhat difficult to monitor the progress of

examination and physical examination legs.

the impact or benefits of walking exercise

and

of

carried out routinely. The solution provided

sensation foot examination and physical

is to motivate participants to join gymnastics

inspection of the feet. An analysis get the

routine foot and give poster leg exercises to

average

be undertaken at home, although

checked

showed

value

back

there

in

is

the

of

foot

the

impairment

leg

sensations

examination after exercise feet first partner

not able

to come to the health center.

is the partner II 4 and 6 and a physical examination after gymnastics leg legs mean

Conclusion

the mita I adalah1,5 and on the mita II 2.5.

1.

Health workers in health centers Sindang

There is a decrease in the average value of

Barang all female gender, average age 48

the sensation of the foot and toe physical

years, the majority of education is high school

examination.

foot

graduates (60%). Health workers in health

complaints such as tingling, numbness,

centers Semplak all female gender, average age

burning sensation, etc., decreased. This is

50 years, most of his education is junior high

because the benefits of gymnastics leg is

school graduates (60%).

neuropaty

diabetic

improving blood circulation in the peripheral

2. The results of the training of health cadres

areas, strengthen the leg muscles, joints

cadres there is increasing knowledge on the

become more flexible. The results are

management of diabetes, complications of

consistent with the results IbM camalia

diabetes and gymnastics leg, from average 73

study (2015) that shows there are significant

to 93 for Kader Health Center West Sindang.

sensation foot against foot gymnastics and

Kader PHC knowledge value Semplak increase

physical examination neuropaty diabetic

from the average of 67 to 81.

foot patients (P = 0.000, α = 0.05). For blood

3. Patients with diabetes mellitus who follow

sugar levels, a decline in the average in the

gymnastics women's legs all is well in the health

first Partner to 156 mg% and in the Partner

center and health center Sindang Goods

II to 175 mg%. If seen GDS values are within

Semplak. Last Education majority of primary

normal limits, because the patient actively

school graduates. Age DM patients in health

exercise each week and maintain the diet

centers Goods Sindang average of 55 years

and routine control of the health clinic.

(60%) and in health centers Semplak 60 years (70%).

Proceeding of The 1st International Conference on Interprofessional Health Collaboration and Community Empowerment Bandung, 7-8 December 2018

4. Before gymnastics leg starts mean value in both diabetic patient sensation foot Health Center is 8, the value of the physical examination is the fourth leg in both health centers, the patient has been exposed neuropaty DM diabetic. The average value of blood sugar in diabetic patient when Sindang Goods Health Center is 171 mg% and the health center is 200 mg% Semplak 5. After doing gymnastics leg for 10 times in 10 weeks, then get the average value of the sensation of leg results DM patients in health centers is Sindang Goods Semplak 4 in the health center is 6, the average value of a physical examination foot health center patients with DM in Sindang Goods was 1.5 in PHC Semplak is 2.5. Apabiala seen from the average value of the above then there is a reduction or improvement of symptoms of diabetic neuropaty of all people with diabetes in both the health center. Likewise, when blood sugar levels decreased their mean that in Puskesmas Sindang Barang to 156 mg% in PHC Semplak to 175 mg%.

Competing Interest The authors of this paper have no competing interest to report.

Acknowledgement The authors of this paper have no acknowledgement to report.

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