Effects Of Comprehensive Nursing Intervention With Protection Motivation Theory On Reducing Plantar Pressure In Type 2 Diabetic Patients

Objective To study the parameters and the distribution of plantar pressure of diabetic patients, and analyze their influencing factors.The effects of comprehensive nursing intervention with Protection Motivation Theory on reducing plantar pressure in type 2 diabetic patients were tested.Methods This research was performed in two consecutive phases.In the first phase,319 type 2 diabetes were investigated in 2 communities of Shanghai with general information questionnaire, diabetes foot protect questionnaire, diabetes foot self-care questionnaire, diabetes foot self-efficacy scale and Footscan system.In the second phase, the patients of first phase who met the inclusion criterion of second phase were random selected.49 patients were selected in intervention group and 49 patients in control group.There were no statistically significant difference in demographic data and diabetes foot related information between the two groups(P> 0.05).The subjects in the intervention group received a 6-month comprehensive nursing intervention while the control group patients received only routine care. Each patient in the intervention group received four times of collective education sessions, one time of patients' meeting, five to six times of individual guidances, one to two times of telephone-consultations. The effects of the intervention were evaluated by diabetes foot protect knowledge, diabetes foot self-care, diabetes foot self-efficacy and plantar pressure at 1 month,3months and 6 months later. The the parameters of plantar pressure were included impulse, max force and peak pressure.Results The results in the first phase were as follows.①The mean score of diabetes foot protect questionnaire was 21.33±3.21.The mean score of diabetes foot self-care questionnaire was 78,05±10.63.The mean score of diabetes foot self-efficacy scale was 11.20±3.24.②86.83% diabetic patients had abnormal plantar pressure with left foot, and 89.34% with right foot.The sum impulse of left foot was 604.73±261.39N-S,and 580.08±224.02N-S in the right foot. The sum max force of left was 742.77±163.35N,and 728.62±168.09N in the right foot.The sum peak pressure of left foot was 26.62±12.18N/cm2, and 27.17±12.42N/cm2 in the right foot.③The regions with the highest impulse were Mid Foot, Heel Medial,Heel Lateral, Metatarsal 2,Hallux.④There were statistically significant differences between different gender, age, education levels, BMI, result of lOg Semmes-Weinstein Monofilament examination, ABI, type of shoes, type of heel, diabetic foot protection knowledge, self-care, self-efficacy, with or with not with callus.⑤With plantar pressure in three parameters namely, average sum impulse, average sum max force, average sum peak pressure as dependent variable and the statistically significant factors in single-factor analysis as independent variables, multivariate linear regression was analyzed. BMI, gender, foot self-efficacy, diabetic foot protection knowledge, age, callus, education level, foot self-care behavior, result of lOg Semmes-Weinstein Monofilament examination were contributed to the average sum impulse,which can explain 36.9 percent of its variance. BMI, gender, diabetic foot protection knowledge, result of lOg Semmes-Weinstein Monofilament examination, type of heel, callus, foot self-efficacy, foot self-care behavior, ABI were contributed to the average sum max force, which can explain 48.7 percent of its variance. Gender, ABI, type of shoes, diabetic foot protect knowledge were contributed to the average sum peak pressure, which can explain 12.3 percent of its variance. In the second phase,①The mean score of diabetes foot protect questionnaire in the intervention group significantly increased compared with the control group 1 month later after intervention(P< 0.001).②Analysis of variance of repeated measure showed the mean score of diabetes foot self-care questionnaire in the intervention group significantly increased compared with the control group(P<0.05).Multivariate analysis of variance showed the total score of diabetes foot self-care questionnaire had no statistically significant between the two group after 3 months(P>0.05).6 months later there was statistically significant between the two group(P<0.001).③Analysis of variance of repeated measure and multivariate analysis-of variance showed the scores of diabetes foot self-efficacy in the intervention group significantly increased compared with the control group(P<0.05).④Analysis of variance of repeated measure and multivariate analysis of variance showed impluse, max force, peak pressure were in the intervention group significantly reduced compared with the control group(P<0.001).These parameters of plantar pressure had a trend of changing with time, and the trend were different in different group(P<0.001).Conclusion Many type 2 diabetic patients in the community have abnormal plantar pressure. The influencing factors were included BMI, callus, type of shoes, diabetic foot protect knowledge, self-care, self-efficacy, etc. According to influencing factors, community comprehensive nursing intervention with protection motivation theory reduced plantar pressure effectively in diabetic patients, through improving foot protection knowledge, changing foot self-care and increasing foot self-efficacy.