Balance confidence challenges affecting the activities of non-amputee diabetic neuropathy patients with foot ulcers: Association study

Abstract

Background: Patients with diabetes mellitus develop neuropathy and associated foot ulcers as the disease progresses. They experience difficulties with balance confidence in undertaking functional activities contributing to mobility deficits.

Objective: To find association between balance confidence level and mobility with diabetic foot ulcers among non-amputee diabetic patients.

Methodology: An analytical cross sectional study was conducted on 197 patients from January to May 2023. Data was collected from public and private teaching hospitals in Sialkot. The epi-tool software and convenient sampling techniques was used to obtain the sample size. The Activities Specific Balance Confidence Scale (ABC) was used as outcome measuring tool, Time Up & Go test (TUG) was used as clinical mobility test. Diabetic neuropathic patients with diagnosed grade 0-4 foot ulcers (Meggitt Wagner classification); without foot amputation aged 40-70 years were included whereas individuals with metabolic syndrome, diabetic foot ulcers with extensive gangrene of grade 5 and amputations, congenital and autoimmune diseases were excluded from the study. Data was analyzed using SPSS version 22. The chi-square test was used to find the association between variables.

Results: Out of 197 participants the mean age of the participants was 54.80 ± 9.03 years; (N=118, 59.9%) were male and (N=79, 40.1%) were females. Most of participants (N=61,31.0%) had deep foot ulcer with abscesses and (N=100, 50.8%) had ulceration on ‘forefoot’. The mean completion time for TUG test was 19.55 ± 11.65 seconds. The mean score of (ABC) scale was 49.1±24.0 %.Chi-square test showed grades of diabetic foot ulcers and TUG had high significant association with balance confidence level among participants (p ≤ 0.01). Whereas balance confidence level had no association with ulceration areas (p >0.05).

Conclusion: Grades of diabetic foot ulcers and mobility was associated with low balance confidence level whereas ulceration areas had no association with balance confidence among diabetic neuropathic patients.

Keywords: Balance, confidence, Diabetic foot ulcers.