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"[LATAR BELAKANGPenyebab terbanyak Penyakit Arteri Perifer (PAP) pada usia diatas 40 tahun adalah aterosklerosis. Prevalensi penyakit aterosklerosis perifer meningkat pada kasus dengan diabetes melitus, dislipidemia, hipertensi dan perokok. Critical Limb Ischemia (CLI) merupakan manifestasi dari PAP berat, CLI dikaitkan dengan risiko kehilangan tungkai yang sangat tinggi. Pada pasien CLI tanpa adanya revaskularisasi, pasien biasanya akan dilakukan amputasi dalam hitungan minggu atau bulan. Revaskularisasi secara terbuka memiliki morbiditas yang cukup banyak. Seiring kemajuan teknologi, revaskularisasi secara terbuka perlahan-lahan digantikan dengan adanya intervensi endovaskuler dalam dua dekade terakhir. Revaskularisasi endovaskuler di Departemen Ilmu Bedah RSCM baru mulai dilakukan pada tahun 2012 dan di Indonesia saat ini belum ada studi yang menilai hasil dari tindakan revaskularisasi.METODEMetode yang diambil adalah analitik komparatif berpasangan dengan disain penelitian longitudinal pre-post study. Selama Agustus 2013 hingga Agustus 2014 didapatkan 16 pasien yang masuk kriteria inklusi. Dilakukan pengambilan data nilai ABI sebelum dan sesudah revaskularisasi endovaskuler. ABI digunakan sebagai penilaian efektivitas revaskularisasi.HASILHasil didapatkan nilai mean ABI sebelum tindakan 0,7±0,118 dan nilai mean ABI sesudah tindakan 0,844±0,127. Didapatkan peningkatan nilai ABI sesudah tindakan 0,14. Dari hasil uji T berpasangan didapatkan nilai p=0,001. Secara statististik didapatkan peningkatan yang signifikan antara nilai ABI sebelum tindakan dan sesudah tindakan.KESIMPULANDapat ditarik kesimpulan tindakan revaskularisasi endovaskuler terhadap pasien PAP efektif berdasarkan nilai ABI;BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI, BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI]"

"ABSTRAKLatar Belakang. Kejadian aterosklerosis, dilaporkan lebih sering pada pasien lupus eritematosus sitemik (LES) dibandingkan individu tanpa LES, salah satunya adalah penyakit arteri perifer (PAP). Klorokuin diduga memiliki efek protektif terhadap kejadian PAP melalui penekanan kadar sitokin proinflamasi dan efek menurunkan kadar kolesterol, namun beberapa penelitian lain menunjukkan bahwa klorokuin meningkatkan kadar sitokin proinflamasi. Hingga saat ini, penelitian mengenai pengaruh klorokuin belum pernah dilakukan pada populasi pasien LES di Indonesia.Tujuan Penelitian. Mengetahui pengaruh klorokuin terhadap kejadian PAP pada pasien LES wanita berusia 40 tahun ke bawah.Metode Penelitian. Studi kasus kontrol dilakukan terhadap pasien LES wanita berusia 40 tahun ke bawah di RS Cipto Mangunkusumo selama Juni-Agustus 2012 yang tidak menderita diabetes melitus ataupun hipertensi sebelum diagnosis LES ditegakkan. Pasien dengan penyakit autoimun selain LES dan gagal ginjal kronik dieksklusi dari penelitian. Pengaruh klorokuin terhadap PAP pada pasien LES dinyatakan dalam odds ratio (OR). Peran variabel perancu dinilai pada analisis regresi logistik berjenjang sehingga didapatkan adjusted OR.Hasil Penelitian. Dari 18 subjek yang menderita PAP (kelompok kasus), sebanyak 8 (44,4 %) menggunakan klorokuin dan dari 72 subjek yang tidak menderita PAP (kelompok kontrol), 20 (27,8 %) di antaranya menggunakan klorokuin. Setelah dilakukan adjustment terhadap variabel perancu (usia, lama menderita sakit, dislipidemia, dan aktivitas penyakit), tidak didapatkan hubungan yang bermakna antara penggunaaan klorokuin dengan kejadian PAP pada pasien LES wanita berusia di bawah 40 tahun (adjusted OR 2,44; IK95 % 0,76 sampai 7,87).Simpulan. Pengaruh klorokuin terhadap kejadian PAP pada pasien LES wanita berusia 40 tahun ke bawah belum dapat disimpulkan pada penelitian ini.

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ABSTRACTBackground. Atherosclerosis is enhanced in systemic lupus erythematosus (SLE) compared to general population, one of which is peripheral arterial disease (PAD). Chloroquine has protective effects in peripheral arterial disease through the suppression of proinflamatory cytokine levels and lipid lowering effect, although other studies have shown the increasing of cytokine levels by chloroquine. To date, no studies have ever been performed to investigate the effect of chloroquine on peripheral arterial disease in Indonesian lupus patients.Aims. To investigate the effects of chloroquine on peripheral arterial disease in patients with systemic lupus erythematosus aged forty-year-old and below.Methods. A case control study including female lupus patients aged forty year-old and younger in Cipto Mangunkusumo Hospital between June-August 2012, who do not suffer from diabetes mellitus and/or hypertension before the diagnosis of lupus is confirmed. Patients with other autoimmune disease than lupus and/or with chronic kidney disease were excluded from the study. Effect of chloroquine on peripheral arterial disease in lupus patients is expressed in odds ratio (OR). The role of confounding factors analyzed with multiple logistic regression to estimate the adjusted OR.Results. Eight (44.4 %) of the total 18 subjects contracting PAD (case group) and 20 (27.8 %) of the total 72 subjects without PAD (control group) were using chloroquine. After adjustments towards confounding factors (age, disease duration, dyslipidemia, and disease activity) were completed, the results showed there was no considerable relation between the use of chloroquine and PAD case in female SLE patients aged below forty-year-old (adjusted OR 2.44; 95 % CI 0.76 to 7.87).Conclusion. The effect of chloroquine usage on PAD case in female SLE patients aged forty-year-old and below can not be concluded from this study."

"ABSTRAKPenyebab PAD yang paling sering adalah atherosclerosis. PAD berhubungan dengan penyakit atherosklerosis lain seperti renal artery stenosis (RAS). Angka harapan hidup menurun pada pasien yang mengalami RAS, terutama yag stenosisnya diatas 60% namun belum sampai ke tahap gagal ginjal kronik. Dengan penatalaksanaan yang holistik diharapkan angka harapan hidup pasien semakin meningkat.Tujuan: Untuk mengetahui prevalensi RAS pada pasien PAD serta melihat hubungan antara Angio Score, riwayat hipertensi dan diabetes melitus terhadap derajat RAS yang terjadi.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo selama periode Februari hingga Mei 2019. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan diagnosis lower extremity PAD dan dari pemeriksaan CT Angiografi didapatkan stenosis pada pembuluh darah tungkai, serta tampak arteri renalis pada pemeriksaan CTA yang dilakukan pada pasien tersebut. Pengambilan sampel dilakukan dengan metode total sampling.Hasil: sampel terbanyak berjenis kelamin wanita (50,8%) sedangkan pria sebanyak 32 orang (49,2%). Sebanyak 90,8% pasien yang diteliti menderita diabetes sedangkan 61,5% dari sampel menderita hipertensi. RAS derajat 1 merupakan yang terbanyak ditemukan. Tidak ada hubungan ANGIO Score terhadap usia, jenis kelamin dan diabetes mellitus, namun ada terhadap hipertensi. Terdapat hubungan antara RAS dengan usia dan hipertensi, namun tidak terdapat hubungan terhadap diabetes mellitus dan jenis kelamin. ANGIO Score dan RAS terdapat hubungan yang bermakna (p<0,001).Simpulan: Perbandingan ANGIO Score berdasarkan derajat stenosis mendapatkan hasil uji Kruskall Wallis mendapatkan nilai p<0,001 dan dilanjutkan dengan uji Mann Whitney mendapatkan bahwa perbedaan sudah terjadi saat perbandingan derajat stenosis 0 dengan derajat 1 dan seterusnya (p<0,001). Semakin tinggi nilai ANGIO Score (cut off pada score 9), angka spesifitas semakin tinggi.

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ABSTRACTBackground: The most common cause of PAD is atherosclerosis. PAD is associated with other atherosclerosis diseases such as renal artery stenosis (RAS). Life expectancy decreases in patients who experience RAS, especially those with stenosis above 60% but have not yet reached the stage of chronic renal failure. With holistic management, it is expected that the patient's life expectancy will increase.Objective: To determine the prevalence of RAS in PAD patients and to see the relationship between Angio Score, history of hypertension and diabetes mellitus to the degree of RAS that occurred.Method: The design used is a cross-sectional design. This research was conducted at RSUPN Dr. Cipto Mangunkusumo during the period February to May 2019. The study was conducted at RSUPN Dr. Cipto Mangunkusumo with a diagnosis of lower extremity PAD, which obtained an ABI score of <0.9, severe ischemia until both unilateral and bilateral limb necrosis and CT angiography examination found stenosis in the leg veins, and the appearance of the renal artery on CTA examination performed on patients that is. Sampling is done by the total sampling method.Results: the most samples were female (50.8%) while men were 32 (49.2%). As many as 90.8% of patients studied had diabetes while 61.5% of the samples suffered from hypertension. 1st degree RAS is the most found. There is no relationship between ANGIO Score with age, gender and diabetes mellitus, but there is a hypertension. There is a relationship between RAS and age and hypertension, but there is no relationship to diabetes mellitus and gender. ANGIO Score and RAS have a significant relationship (p <0.001).Conclusion: The comparison of ANGIO Score based on the degree of stenosis obtained the results of the Kruskall Wallis test obtained a p value of <0.001 and continued with the Mann Whitney test found that the difference had occurred when the ratio of stenosis degrees was 0 with degrees 1 and so on (p <0.001). The higher the ANGIO score (cut off at score 9), the higher the specificity."

"Latar belakang: Chronic limb threatening ischemia (CLTI) merupakan bentuk terparah peripheral arterial disease. Pasien kaki diabetik dengan CLTI memiliki risiko amputasi mayor dan mortalitas paska revaskularisasi dan dipengaruhi beberapa faktor seperti usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi. Indonesia belum memiliki data amputasi mayor dan mortalitas kaki diabetik dengan CLTI setelah revaskularisasi dan faktor-faktor yang berpengaruh. Penelitian ini bertujuan mengetahui angka amputasi mayor dan mortalitas satu tahun pasca revaskularisasi beserta faktor-faktor yang memengaruhi di Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Kohort retrospektif pasien kaki diabetik dengan CLTI setelah revaskularisasi di RSCM Januari 2010 – Desember 2020. Pengambilan data rekam medis. Luaran utama amputasi mayor dan mortalitas satu tahun setelah revaskularisasi. Dilakukan analisis bivariat dengan uji Kai Kuadrat, jika persyaratan tidak terpenuhi maka menggunakan Fischer-exact, variabel bermakna diuji lebih lanjut dengan regresi logistik. Hasil: Penelitian melibatkan 150 subjek. Amputasi mayor dan mortalitas satu tahun setelah revaskularisasi sebesar 27,3% dan 24,7%. Tidak didapatkan hubungan yang bermakna antara faktor-faktor yang diteliti dengan amputasi mayor dan mortalitas satu tahun.Kesimpulan: Didapatkan angka amputasi mayor dan mortalitas 1 tahun pasca revaskularisasi. Usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi bukan merupakan faktor yang memengaruhi angka amputasi dan mortalitas satu tahun.

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Background: Chronic limb threatening ischemia (CLTI) is the most severe form of peripheral arterial disease. Diabetic foot patients with CLTI have major amputation and mortality risk after revascularization and affected by factors such as elderly, chronic kidney disease (CKD), cardiac morbidity and hypertension. In Indonesia there are no data regarding diabetic foot major amputation and mortality with CLTI after revacularization and influencing factors. Study aims to determine one year major amputation and mortality and factors that can affect diabetic foot pastients with CLTI after revascularization.

Methods: Retrospective cohort study on diabetic foot patients with CLTI undergoing revascularization at Cipto Mangunkusumo National Hospital from January 2010 to December 2020. The primary outcome was one-year major amputation and mortality after revascularization. Factors included were age, CKD, cardiac comorbidity and hypertension. We conducted bivariate analysis using Chi Square or Fisher-exact test. Variables were further tested using multivariate test.

Result: 150 subjects were enrolled. One-year major amputation and mortality was 27.3% and 24.7%. There are not significant correlations between factors with major amputation and mortality.

Conclusion: Major amputation and mortality rate one year after revascularization at RSCM are gained. Elderly, CKD, cardiac comorbidity and hypertension are not factors affecting one-year major amputation and mortality."

"Latar Belakang. Prevalensi penyakit arteri perifer (PAP) pada pasien diabetes melitus lebih tinggi dibandingkan populasi umum. Penyakit arteri perifer dapat meningkatkan mortalitas dan morbiditas terutama akibat penyakit kardiovaskular pada pasien diabetes melitus tipe 2 (DM tipe 2). Tidak semua pasien dengan PAP dapat terdeteksi dengan pengukuran ankle brachial index (ABI) istirahat, sehingga diperlukan pemeriksaan ABI treadmill. Pemeriksaan ABI treadmill dapat mendeteksi PAP pada fase awal, sehingga profil pasien pada kelompok ini berbeda dengan klompok PAP yang dideteksi dengan ABI istirahat. Diketahuinya profil pasien PAP ini penting untuk membantu meningkatkan kewaspadaan pasien, khususnya pasien DM tipe 2. Tujuan. Mengetahui profil pasien DM tipe 2 dengan PAP yang dideteksi dengan ABI treadmill. Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Metabolik Endokrin dan Kardiologi, Departemen Ilmu Penyakit Dalam, Rumah Sakit Cipto Mangunkusumo pada Februari sampai April 2016 dengan metode sampling konsekutif. Subjek dengan nilai ABI istirahat normal/ perbatasan menjalani treadmill dengan protokol Bruce yang digunakan juga sebagai protokol uji latih jantung treadmill. Diagnosis PAP ditegakkan bila terdapat penurunan nilai ABI lebih dari 20% dibandingkan ABI istirahat. Hasil. Sebanyak 92 subjek dianalisis untuk mengetahui profil pasien DM tipe 2 dengan PAP yang dideteksi dengan ABI treadmill. Lima belas subjek (16,3%) didiagnosis PAP. Kelompok PAP memiliki persentase subjek dengan durasi diabetes ≥ 10 tahun sebanyak 53,3%; dislipidemia sebanyak 73,3%; penyakit ginjal kronik (PGK) sebanyak 33,3%; perokok sebanyak 40%; komplikasi neuropati sebanyak 53,3%; albuminuri sebanyak 53,3%; retinopati sebanyak 40%; dan respons iskemia jantung positif/sugestif positif sebanyak 40% subjek. Sedangkan kelompok tanpa PAP memiliki subjek dengan durasi diabetes ≥ 10 tahun sebanyak 33,8%; dislipidemia sebanyak 57,1%; PGK sebanyak 19,5%; perokok sebanyak 32,5%; komplikasi neuropati sebanyak 37,7%; albuminuri sebanyak 26,4%; retinopati sebanyak 28,6%; respons iskemia jantung positif/sugestif positif sebanyak 28,5% subjek. Kesimpulan. Prevalensi PAP yang dideteksi dengan ABI treadmill pada pasien DM tipe 2 adalah 16,3% (IK 95%: 8-23%). Kelompok PAP yang dideteksi dengan ABI treadmill memiliki subjek dengan durasi DM ≥ 10 tahun, dislipidemia, perokok, PGK, neuropati, albuminuria, retinopati dan respons iskemia jantung positif/sugestif positif lebih banyak daripada subjek tanpa PAP.

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Background. The prevalence of peripheral arterial disease (PAD) among diabetes patients was higher compared to general population. PAD increases morbidity and mortality, especially due to cardiovascular disease, in type 2 diabetes mellitus patients (T2DM). Not all patients having PAD could not be detected by resting ankle brachial index (ABI) measurement, hence it is required treadmill ABI examination. The examination enable to detect PAD in the earlier phase, therefore patients profile would different with PAD patient detected from resting ABI examination. The profiles are important to raise the awareness of T2DM patients.

Aim. To identify profile T2DM patients with PAD detected by treadmill ABI.

Methods. A cross-sectional study was carried out in Metabolic Endocrine and Cardiology Outpatient Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital during February-April 2016. The study used consecutive sampling method. Subject having normal or borderline resting ABI value is examine using Bruce protocol treadmill. The protocol is also used as a cardiac treadmill exercise test protocol. The patients diagnose as PAD if there is a reducing ABI value more than 20% compared to resting ABI.

Result. The profile of PAD patients detected by treadmill ABI were obtain from 92 subjects. Fifteen subjects (16,3%) were diagnosed having PAD. In the group with PAD, the percentage of subject with diabetes duration ≥ 10 years was 53,3%; dyslipidemia was 73.3%; chronic kidney disease (CKD) was 33.3%; smokers was 40%; complications of neuropathy was 53.3%; albuminuri was 53.3%; retinopathy was 40%; positive / positive suggestive cardiac ischemia response was 40% . Meanwhile the group without PAD, the percentage of subjects with diabetes duration ≥ 10 years was 33.8%; dyslipidemia was 57.1%; CKD was 19.5%; smokers was 32.5%; complications of neuropathy was 37.7%; albuminuri was 26.4%; retinopathy was 28.6%; positive / positive suggestive cardiac ischemia response was 28.5%.

Conclusion. The prevalence of PAD that detected by treadmilll ABI in T2DM patients is 16,3% (95% CI: 8-23%). The Group with PAD detected by ABI treadmill which have duration of diabetes ≥ 10 years, dyslipidemia, smokers, CKD, neuropathy, albuminuria, retinopathy, and the positive result on treadmill exercise test have more subjects than group without PAD."

"Diabetes melitus merupakan penyakit degeneratif yang ditandai dengan gejala hiperglikemia akibat defisiensi insulin maupun resitensi insulin. Kejadinnya terus meningkat terutama di perkotaan yang disebabkan karena adanya perubahan gaya hidup seperti pola makan tidak sehat, kurang aktivitas, merokok, konsumsi alkohol, dan stress. Penulisan ini bertujuan untuk menganalisis asuhan keperawatan pada pasien diabetes melitus. Salah satu intervensi yang diberikan yaitu senam kaki diabetes. Intervensi senam kaki diabetes dilakukan selama lima hari, pasien menunjukkan merasa lebih nyaman dan sensitivitas kaki meningkat. Dengan demikian, senam kaki diabetes perlu dilakukan pada pasien diabetes melitus baik di rumah sakit maupun di rumah untuk mengurangi risiko komplikasi ulkus kaki diabetik.

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Diabetes mellitus is a degenerative disease characterized by hyperglycemia due to insulin deficiency or insulin resistant. The incidence of diabetes mellitus rapidly increase through years, especially in urban areas due to the change in lifestyle such as unhealthy diet, less activity, smoking, alcohol consumption, and stress. This paper aimed to analyze the result of foot exercise intervention in diabetes mellitus patient. Foot exercise was given for five days. The result showed an increase foot sensitivity and patient felt more comfortable. Therefore, diabetic foot exercise must be done by diabetic patients either in the hospital or at home to reduce the risk of ulcus diabetic foot."

"ABSTRAK

Diabetes melitus merupakan penyakit kronik yang dapat menyebabkan berbagai komplikasi. Salah satu komplikasi yang banyak ditemukan adalah neuropati perifer. Neuropati perifer menyebabkan perubahan pada biomekanik pasien sehingga terjadi keterbatasan mobilitas fisik yang dapat menurunkan kemampuan melakukan aktivitas fisik pasien diabetes melitus tipe 2 dengan neuropati perifer. Penelitian ini bertujuan untuk mengetahui faktor-faktor penghalang yang berhubungan dengan aktivitas fisik pasien diabetes melitus tipe 2 dengan neuropati perifer. Penelitian ini merupakan penelitian analisis korelatif dengan desain cross sectional pada 77 orang sampel di Poliklinik Rumah Sakit Umum Daerah Pasar Minggu DKI Jakarta. Uji statistik yang digunakan untuk melihat hubungan dua variabel adalah chi square dan uji multivariat dengan logistik berganda untuk melihat faktor yang paling dominan. Hasil penelitian ini menunjukkan tidak terdapat hubungan antara nyeri neuropati, sensasi kaki, dan deformitas kaki dengan aktivitas fisik jalan kaki dan peregangan statis. Malas dan pengetahuan berhubungan dengan aktivitas fisik peregangan statis pada responden, dimana malas merupakan faktor dominan. Sedangkan pengetahuan, status fungsional, dan rasa takut berhubungan dengan aktivitas fisik jalan kaki responden, dimana status fungsional merupakan faktor dominan. Aktivitas fisik jalan kaki dan peregangan statis merupakan jenis aktivitas fisik yang direkomendasikan pada pasien diabetes melitus tipe 2 dengan neuropati perifer, dimana jalan kaki merupakan aktivitas fisik yang paling banyak dilakukan pasien karena sederhana, tidak membutuhkan alat, mudah, dan dapat dilakukan kapan saja.

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ABSTRACT

 

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Diabetes mellitus is a chronic disease that can cause various complications. One of complication that commonly found is peripheral neuropathy. Peripheral neuropathy causes changes in the biomechanics, resulting limited physical mobility which can reduce the ability to perform physical activity in type 2 diabetes melitus patients with peripheral neuropathy. This study aimed to determine the barriers related to physical activity in type 2 diabetes mellitus with peripheral neuropathy. This study was a correlative analysis study with a cross sectional design in 77 people sampled at government hospital of Pasar Minggu Jakarta. The statistical test used to see the relationship between two variables is chi square and multivariate test with multiple logistics to see the most dominant factors. The results indicate that there is no relationship between neuropathic pain, foot sensation, and foot deformity with physical activity of walking and static stretching. Laziness and knowledge are related to the physical activity of static stretching, which laziness is the dominant factor. While knowledge, functional status, and fear are related to the physical activity of walking, which functional status is the dominant factor. Physical activity of walking and static stretching are type of physical activity that recommended in type 2 diabetes mellitus with peripheral neuropathy, where walking is a the most frequent of physical activity in patients as it is simple, no tools requirement,  easy, and can be done at any time.

 

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"Latar Belakang. Pasien diabetes melitus (DM) berisiko mengalami komplikasi pada sistem vaskular dan persyarafan, khususnya pada bagian perifer, yang jika tidak tertangani dengan baik dapat berimbas pada terjadinya luka kaki diabetes. Buerger Allen Exercise (BAE) merupakan salah satu pilihan terapi konservatif yang terbukti efektif dalam menangani Peripheral Artery Disease (PAD). Sayangnya beberpa penelitian sebelumnya belum membuktikan efektivitasnya. Pada penelitian ini akan BAE akan dikombinasikan dengan latihan Range of Motion (ROM) kaki untuk melihat efektivitasnya pada vaskularisasi dan neuropati perifer. Tujuan. Penelitian ini bertujuan untuk mengidentifikasi efektivitas latihan kombinasi BAE dan ROM kaki terhadap perbaikan vaskularisasi dan neuropati perifer pada pasien DM tipe 2. Metode. Desain penelitian yang digunakan adalah quassi experiment with pre test-post test two goups dengan total 72 orang pasien DM tipe 2 sebagai responden. Responden dibagi rata secara acak ke dalam kelompok intervensi dan kelompok kontrol. Kelompok intervensi mendapatkan latihan kombinasi BAE dan ROM kaki, sedangkan kelompok kontrol mendapatkan latihan tunggal BAE. Setiap kelompok melaksanakan latihan kaki selama dua minggu dengan 2 siklus latihan perhari dan total durasi 30 menit. Sebelum dan setelah latihan, responden dikaji nilai Ankle Brachial Index (ABI) untuk menilai vaskularisasi dan nilai Michigan Neuropathy Screening Instruments (MNSI) untuk menilai neuropati. Hasil. Latihan kombinasi BAE dan ROM kaki lebih efektif dalam meningkatkan nilai ABI daripada latihan tunggal BAE (pvalue 0,00). Latihan kombinasi BAE dan ROM kaki juga lebih efektif dalam menurunkan nilai MNSI daripada latihan tinggal BAE (pvalue 0,00). Kesimpulan Latihan kombinasi BAE dan ROM kaki efektif dalam memperbaiki vaskularisasi dan neuropati perifer melalui perbaikan nilai ABI dan MNSI.

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Background. Patients with diabetes mellitus (DM) are at risk of experiencing complications in the vascular and nervous system, especially in the peripheral areas. These complications can lead to even worse complication without proper intervention such as diabetic foot wounds. Buerger Allen Exercise (BAE) is a conservative therapy option that has been proven effective in treating Peripheral Artery Disease (PAD). Unfortunately, the effect of BAE on neuropathy has not been clearly proven. In this study, BAE will be combined with foot Range of Motion (ROM) exercises to see its effectiveness on vascularization and peripheral neuropathy. Objective. This study aims to identify the effectiveness of combined BAE and foot ROM exercises to improve vascularization and peripheral neuropathy in type 2 DM patients. Methods. Quasi experiment with pre test-post test two groups design was conducted on total of 72 type 2 DM patients. Respondents were divided randomly into intervention and control group. The intervention group received a combination of BAE and foot ROM exercises, while the control group received single BAE exercises. Each group carried out leg training for two weeks with 2 training cycles per day and a total duration of 30 minutes. Before and after exercise Ankle Brachial Index (ABI) score and the Michigan Neuropathy Screening Instruments (MNSI) score were assessed. Results. Combination BAE and foot ROM exercise was more effective in increasing ABI score than BAE-only exercise (pvalue 0.00). The combination of BAE and foot ROM combination was also more effective in reducing the MNSI score than BAE-only exercise (pvalue 0.00). Conclusion: Combination exercise of BAE and foot ROM is effective in improving vascularization and peripheral neuropathy as shown by improved ABI and MNSI score."

"[ABSTRAKDiabetes melitus (DM) yang telah diderita selama bertahun-tahun dapat mengarahke berbagai komplikasi, diantaranya yaitu terjadinya peripheral arterial disease(PAD). Salah satu indikator terjadinya PAD pada pasien DM tipe 2 yaitu adanyapenurunan nilai ankle brachial index (ABI) pada ekstremitas bawah pasien. Jika halini terus dibiarkan, maka bisa terjadi neuropati yang dapat memicu munculnyaulkus kaki diabetik. Intervensi yang dapat diberikan untuk meningkatkan nilai ABIyaitu dengan melakukan foot massage atau latihan ROM ankle dorsofleksi. Tujuanpenelitian ini adalah untuk mengetahui efektivitas pemberian kombinasi footmassage dan latihan ROM ankle dorsofleksi terhadap nilai ABI pada pasien DMtipe 2. Penelitian ini merupakan penelitian quasi experiment dengan metode pre andpost test without control yang terdiri dari 2 kelompok intervensi dengan besarsampel 20 responden. Hasil penelitian ini menunjukkan bahwa terdapat hubunganyang signifikan antara pemberian kombinasi latihan ROM ankle dorsofleksi danfoot massage terhadap peningkatan nilai ABI (p value = 0,033 untuk ekstremitaskanan dan p value = 0,001 untuk ekstremitas kiri). Rekomendasi penelitian ini yaituagar para perawat dapat memberikan intervensi kombinasi latihan ROM ankledorsofleksi dan foot massage dalam rangka mencegah terjadinya PAD pada pasienDM tipe 2.

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ABSTRACTThe chronic diabetes mellitus has the potential to cause several complicationsincluding peripheral arterial disease (PAD). A parameter indicating PAD amongstType 2 diabetes mellitus patients is the decline in the ankle brachial index (ABI) ontheir lower extremity. Once this condition persists, it can cause neuropathy leadingto the occurrence of leg diabetic ulcer. An intervention believed to overcome thisproblem is conducting foot massage or ankle dorsiflexion range of motion (ROM)exercises. This research aimed at investigating the effectiveness of exercisecombination of foot massage and ankle dorsiflexion ROM on ABI scores amongtype 2 diabetes mellitus patients. This study used quasi-experiment method with preand post-test without control design, and consisted two intervention groupsinvolving 20 participants. The study revealed that there was distinctive correlationbetween the exercise combination of foot massage and ankle dorsiflexion ROM andthe increase of ABI scores of the patients (p value = 0.033 for the right extremitiesand p value = 0.001 for the left extremities).The findings suggest that suchintervention can be considered or even be provided by nurses taking care of type 2diabetes mellitus patients to prevent them from the possible deterioratingcomplication, the peripheral artery disease.;The chronic diabetes mellitus has the potential to cause several complicationsincluding peripheral arterial disease (PAD). A parameter indicating PAD amongstType 2 diabetes mellitus patients is the decline in the ankle brachial index (ABI) ontheir lower extremity. Once this condition persists, it can cause neuropathy leadingto the occurrence of leg diabetic ulcer. An intervention believed to overcome thisproblem is conducting foot massage or ankle dorsiflexion range of motion (ROM)exercises. This research aimed at investigating the effectiveness of exercisecombination of foot massage and ankle dorsiflexion ROM on ABI scores amongtype 2 diabetes mellitus patients. This study used quasi-experiment method with preand post-test without control design, and consisted two intervention groupsinvolving 20 participants. The study revealed that there was distinctive correlationbetween the exercise combination of foot massage and ankle dorsiflexion ROM andthe increase of ABI scores of the patients (p value = 0.033 for the right extremitiesand p value = 0.001 for the left extremities).The findings suggest that suchintervention can be considered or even be provided by nurses taking care of type 2diabetes mellitus patients to prevent them from the possible deterioratingcomplication, the peripheral artery disease., The chronic diabetes mellitus has the potential to cause several complicationsincluding peripheral arterial disease (PAD). A parameter indicating PAD amongstType 2 diabetes mellitus patients is the decline in the ankle brachial index (ABI) ontheir lower extremity. Once this condition persists, it can cause neuropathy leadingto the occurrence of leg diabetic ulcer. An intervention believed to overcome thisproblem is conducting foot massage or ankle dorsiflexion range of motion (ROM)exercises. This research aimed at investigating the effectiveness of exercisecombination of foot massage and ankle dorsiflexion ROM on ABI scores amongtype 2 diabetes mellitus patients. This study used quasi-experiment method with preand post-test without control design, and consisted two intervention groupsinvolving 20 participants. The study revealed that there was distinctive correlationbetween the exercise combination of foot massage and ankle dorsiflexion ROM andthe increase of ABI scores of the patients (p value = 0.033 for the right extremitiesand p value = 0.001 for the left extremities).The findings suggest that suchintervention can be considered or even be provided by nurses taking care of type 2diabetes mellitus patients to prevent them from the possible deterioratingcomplication, the peripheral artery disease.]"