PSYCHOSOCIAL ASPECT PSYCHOSOCIAL ASPECT OF DIABETIC FOOTOF DIABETIC FOOT

DR.ARUN BALDR.ARUN BALPRESIDENTPRESIDENT

DIABETIC FOOT SOCIETY OF DIABETIC FOOT SOCIETY OF INDIAINDIA

FOOT ULCERATION AND HIGHER LEVEL AMPUTATION RATE STILL UNACCEPTABLY HIGH INSPITE OF TECHNOLOGICAL ADVANCES

FOCUS ON PHYSICAL FACTORS HAS NOT REDUCED THE COMPLICATIONS OF DIABETIC FOOT

IT IS IMPORTANT TO ANALYSE THE PATIENT`S PERCEPTION AND THREATSPERCEIVED BY HIM REGARDING HIS PROBLEM

PRESCRIPTION OF PHYSICAL THERAPEUTIC MODALITIES LIKE OFFLOADING HAVE NO PSYCHOSOCIAL ASSESSMENT

QUALITY OF LIFE IS USUALLY NOT AN IMPORTANT COMPONENT OFTHERAPEUTIC MODALITIES IN DIABETIC FOOT COMPLICATION

WHY PSYCHOLOGICAL ASPECTSOF DIABETIC ARE IMPORTANT?

QUALITY OF LIFE IN QUALITY OF LIFE IN DIABETIC NEUROPATHYDIABETIC NEUROPATHY• WORSENING OF PHYSICAL & WORSENING OF PHYSICAL &

PSYCHOSOCIAL FUNCTIONINGPSYCHOSOCIAL FUNCTIONING• NEGATIVE IMPACFT ON QUALITY OF LIFENEGATIVE IMPACFT ON QUALITY OF LIFE• QUALITY OF LIFE IS NOT MERE HEALTH QUALITY OF LIFE IS NOT MERE HEALTH

STATUS BUT PT.`S PERCEPTION OF HIS STATUS BUT PT.`S PERCEPTION OF HIS HEALTHHEALTH

• WORSENING PHYSICAL WORSENING PHYSICAL ACTIVITY/AMPUTATION CAUSES REDUCTION ACTIVITY/AMPUTATION CAUSES REDUCTION IN SELF ESTEEM/SELF IMAGEIN SELF ESTEEM/SELF IMAGE

• CONCEPT OFNEUROPATHY QUALITY OF LIFECONCEPT OFNEUROPATHY QUALITY OF LIFE

QUALITY OF LIFE IN QUALITY OF LIFE IN DIABETIC NEUROPATHYDIABETIC NEUROPATHY• REASONS FOR REDUCED QUALITY OF REASONS FOR REDUCED QUALITY OF

LIFE: LIFE: • PAIN/PAIN/• LOSS OF SENSATIONLOSS OF SENSATION• UNSTEADINESSUNSTEADINESS• BEING TREATED DIFFERENTLYBEING TREATED DIFFERENTLY• DN SPECOFIC SCALE FOR QOL IS DN SPECOFIC SCALE FOR QOL IS

PREDICTOR OF EMOTIONAL BURDENPREDICTOR OF EMOTIONAL BURDEN

CONCEPT OF CONCEPT OF HEALTH RELATED HEALTH RELATED QUALITY OF LIFEQUALITY OF LIFE

PSYCHOSOCIAL FACTORS WHICH PSYCHOSOCIAL FACTORS WHICH LEAD TO REDUCED SELF FOOT LEAD TO REDUCED SELF FOOT CARECARE• PAST BELEIFS ABOUT SELF CAREPAST BELEIFS ABOUT SELF CARE• BELIEF ABOUT ABILITY TO PERFORMSELF BELIEF ABOUT ABILITY TO PERFORMSELF

CARECARE• CONCERRN ABOUT POTENTIAL RISK OF CONCERRN ABOUT POTENTIAL RISK OF

AMPUTATIONAMPUTATION• WILLINGNESS TO WEAR SPECIAL FOOT WILLINGNESS TO WEAR SPECIAL FOOT

WEARWEAR COSMETIC ACCEPTIBILITY,COSMETIC ACCEPTIBILITY, COSTCOST AVAILABILITYAVAILABILITY

PSYCHOLOGICAL EFFECTS PSYCHOLOGICAL EFFECTS OF ROUTINE FOOT OF ROUTINE FOOT EXAMINATIONEXAMINATION• REINFORCES IMPORTANCE OF CONCEPT OF REINFORCES IMPORTANCE OF CONCEPT OF

TISSUE INTEGRITYTISSUE INTEGRITY• REINFORCES PATIENTS AWARENES ABOUT REINFORCES PATIENTS AWARENES ABOUT

SENSORY DEFECITSENSORY DEFECIT• DEMONSTRATES AREAS OF REDUCED DEMONSTRATES AREAS OF REDUCED

SENSATION TO THE PATIENTSENSATION TO THE PATIENT• ACCEPTANCE OF THE CONCEPT OF SELF ACCEPTANCE OF THE CONCEPT OF SELF

CARE FOR DIABETIC FOOTCARE FOR DIABETIC FOOT• YEILDS LONG TERM PSYCHOLOGICAL YEILDS LONG TERM PSYCHOLOGICAL

BENEFITSBENEFITS

SOCIAL ASPECTS OF SOCIAL ASPECTS OF DIABETIC FOOT SURGERYDIABETIC FOOT SURGERY•MAJORITY ELDERLY PATIENTSMAJORITY ELDERLY PATIENTS•NUCLEAR FAMILIESNUCLEAR FAMILIES•LACK OF ACCOMODATIONLACK OF ACCOMODATION•LACK OF OPTIMAL SANITARY LACK OF OPTIMAL SANITARY

FACILITYFACILITY•COST OF THE TREATMENTCOST OF THE TREATMENT

Dr.bal

SOCIAL ASPECTS OF SOCIAL ASPECTS OF DIABETIC FOOT SURGERYDIABETIC FOOT SURGERY• DISPOSAL OF BIO HAZARDOUS DISPOSAL OF BIO HAZARDOUS

WASTEWASTE• LACK OF DOMICIALLARY LACK OF DOMICIALLARY

DRESSING FACILITYDRESSING FACILITY• LOSS OF JOBLOSS OF JOB• PERMANENT DISABILITYPERMANENT DISABILITY• LACK OF FOOTWEAR FACILITYLACK OF FOOTWEAR FACILITY

Dr.bal

PSYCHOLOGICAL FACTORS PSYCHOLOGICAL FACTORS ASSOCIATED WITH DIABETIC ASSOCIATED WITH DIABETIC FOOTFOOT • INCREASEDINCREASED• DepressionDepression• divorce ratedivorce rate• alcohol abusealcohol abuse• disruption in disruption in

social,domestic social,domestic environmentenvironment

• negative attitudenegative attitude

• DECREASEDDECREASED• diabetic self carediabetic self care• psychological psychological

adjustment to illnessadjustment to illness• social/family supportsocial/family support• self esteemself esteem• quality of lifequality of life• satisfaction with satisfaction with

treatmenttreatment

Dr.bal

FOOT ULCERSFOOT ULCERSPSYCHOLOGICAL BEHAVIORAL PSYCHOLOGICAL BEHAVIORAL FACTORSFACTORS

•IDENTITYIDENTITY•TIMELINETIMELINE•CONSEQUENCESCONSEQUENCES•CAUSECAUSE•CONTROLCONTROL

REDUCING REDUCING DISSATISFACTION IS DISSATISFACTION IS MORE IMPORTANT MORE IMPORTANT THAN INCREASING THAN INCREASING SATISFACTION FOR SATISFACTION FOR IMPROVING QUALITY IMPROVING QUALITY OF LIFEOF LIFE

MECHANISM OF MECHANISM OF DEPRESSION IN DIABETIC DEPRESSION IN DIABETIC NEUROPATHYNEUROPATHY•DIRECTDIRECT PTS REALIZATION THAT THE PTS REALIZATION THAT THE

ILLNESS IS UNCHANGEABLE PART OF ILLNESS IS UNCHANGEABLE PART OF LIFE COMBINED WITH LIFE COMBINED WITH PAIN/UNSTEADINESSPAIN/UNSTEADINESS

SENSE OF HELPLESSNESS

DEPRESSION

MECHANISM OF MECHANISM OF DEPRESSION IN DIABETIC DEPRESSION IN DIABETIC NEUROPATHYNEUROPATHY

SELF PERCEPTION AS FAMILY BURDEN

LOSS OF SELF ESTEEM AND CONFIDENCE

•INDIRECTINDIRECTPHYSICAL AND SOCIAL DYSFUNCTION

DEPRESSION REDUCED SELF CARE

ULCER

WHAT NEEDS TO BE DONE ?WHAT NEEDS TO BE DONE ?• ROUTINE PSYCHOLOGICAL ASSESSMENT OF ALL ROUTINE PSYCHOLOGICAL ASSESSMENT OF ALL

DIABETIC FOOT PATIENTSDIABETIC FOOT PATIENTS• PSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BE PSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BE

MEMBER OF THE TEAMMEMBER OF THE TEAM• COMMUNICATION TRAINING FOR PARAMEDICS COMMUNICATION TRAINING FOR PARAMEDICS

AND DOCTORS.AND DOCTORS.• RESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIARESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIA• INVOLVEMENT OF DEPT.OF INVOLVEMENT OF DEPT.OF

PSYCHOLOGY/SOCIALOGY FROM TEACHING PSYCHOLOGY/SOCIALOGY FROM TEACHING INSTITUTESINSTITUTES

MEDICOLEGAL ASPECTS MEDICOLEGAL ASPECTS OF DIABETIC FOOT OF DIABETIC FOOT SURGERYSURGERY• DODO• PT EDUCATIONPT EDUCATION• DOCUMENTATIONDOCUMENTATION• FOLLOW UPFOLLOW UP• AGGRESSIVE AGGRESSIVE

TREATMENTTREATMENT• REFER TO EXPERTSREFER TO EXPERTS

• DONTDONT• TREAT IF IN DOUBTTREAT IF IN DOUBT• IF NOT WITHIN IF NOT WITHIN

YOUR FIELDYOUR FIELD• DELAY TREATMENTDELAY TREATMENT• LET PT.GO UN LET PT.GO UN

TREATEDTREATED

Dr.bal

THANK YOUTHANK YOU