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1362398458 psychosocial aspect of diabetic foot

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psychosocial aspect of diabetic foot

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1362398458 psychosocial aspect of diabetic foot

  1. 1. PSYCHOSOCIALPSYCHOSOCIAL ASPECT OF DIABETICASPECT OF DIABETIC FOOTFOOT DR.ARUN BALDR.ARUN BAL PRESIDENTPRESIDENT DIABETIC FOOT SOCIETY OFDIABETIC FOOT SOCIETY OF INDIAINDIA
  2. 2. 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 THREATS PERCEIVED BY HIM REGARDING HIS PROBLEM PRESCRIPTION OF PHYSICAL THERAPEUTIC MODALITIES LIKE OFF LOADING HAVE NO PSYCHOSOCIAL ASSESSMENT QUALITY OF LIFE IS USUALLY NOT AN IMPORTANT COMPONENT OF THERAPEUTIC MODALITIES IN DIABETIC FOOT COMPLICATION WHY PSYCHOLOGICAL ASPECTS OF DIABETIC ARE IMPORTANT?
  3. 3. QUALITY OF LIFE INQUALITY 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 HEALTHQUALITY OF LIFE IS NOT MERE HEALTH STATUS BUT PT.`S PERCEPTION OF HISSTATUS BUT PT.`S PERCEPTION OF HIS HEALTHHEALTH • WORSENING PHYSICALWORSENING PHYSICAL ACTIVITY/AMPUTATION CAUSESACTIVITY/AMPUTATION CAUSES REDUCTION IN SELF ESTEEM/SELF IMAGEREDUCTION IN SELF ESTEEM/SELF IMAGE • CONCEPT OFNEUROPATHY QUALITY OFCONCEPT OFNEUROPATHY QUALITY OF LIFELIFE
  4. 4. QUALITY OF LIFE INQUALITY OF LIFE IN DIABETIC NEUROPATHYDIABETIC NEUROPATHY • REASONS FOR REDUCED QUALITY OFREASONS FOR REDUCED QUALITY OF LIFE:LIFE: • PAIN/PAIN/ • LOSS OF SENSATIONLOSS OF SENSATION • UNSTEADINESSUNSTEADINESS • BEING TREATED DIFFERENTLYBEING TREATED DIFFERENTLY • DN SPECOFIC SCALE FOR QOL ISDN SPECOFIC SCALE FOR QOL IS PREDICTOR OF EMOTIONAL BURDENPREDICTOR OF EMOTIONAL BURDEN
  5. 5. CONCEPT OFCONCEPT OF HEALTH RELATEDHEALTH RELATED QUALITY OF LIFEQUALITY OF LIFE
  6. 6. PSYCHOSOCIAL FACTORS WHICHPSYCHOSOCIAL FACTORS WHICH LEAD TO REDUCED SELF FOOTLEAD TO REDUCED SELF FOOT CARECARE • PAST BELEIFS ABOUT SELF CAREPAST BELEIFS ABOUT SELF CARE • BELIEF ABOUT ABILITY TO PERFORMSELFBELIEF ABOUT ABILITY TO PERFORMSELF CARECARE • CONCERRN ABOUT POTENTIAL RISK OFCONCERRN ABOUT POTENTIAL RISK OF AMPUTATIONAMPUTATION • WILLINGNESS TO WEAR SPECIAL FOOTWILLINGNESS TO WEAR SPECIAL FOOT WEARWEAR COSMETIC ACCEPTIBILITY,COSMETIC ACCEPTIBILITY, COSTCOST AVAILABILITYAVAILABILITY
  7. 7. PSYCHOLOGICAL EFFECTSPSYCHOLOGICAL EFFECTS OF ROUTINE FOOTOF ROUTINE FOOT EXAMINATIONEXAMINATION • REINFORCES IMPORTANCE OF CONCEPTREINFORCES IMPORTANCE OF CONCEPT OF TISSUE INTEGRITYOF TISSUE INTEGRITY • REINFORCES PATIENTS AWARENES ABOUTREINFORCES PATIENTS AWARENES ABOUT SENSORY DEFECITSENSORY DEFECIT • DEMONSTRATES AREAS OF REDUCEDDEMONSTRATES AREAS OF REDUCED SENSATION TO THE PATIENTSENSATION TO THE PATIENT • ACCEPTANCE OF THE CONCEPT OF SELFACCEPTANCE OF THE CONCEPT OF SELF CARE FOR DIABETIC FOOTCARE FOR DIABETIC FOOT • YEILDS LONG TERM PSYCHOLOGICALYEILDS LONG TERM PSYCHOLOGICAL BENEFITSBENEFITS
  8. 8. SOCIAL ASPECTS OFSOCIAL ASPECTS OF DIABETIC FOOTDIABETIC FOOT SURGERYSURGERY • MAJORITY ELDERLYMAJORITY ELDERLY PATIENTSPATIENTS • NUCLEAR FAMILIESNUCLEAR FAMILIES • LACK OF ACCOMODATIONLACK OF ACCOMODATION • LACK OF OPTIMAL SANITARYLACK OF OPTIMAL SANITARY FACILITYFACILITY • COST OF THE TREATMENTCOST OF THE TREATMENT Dr.bal
  9. 9. SOCIAL ASPECTS OFSOCIAL ASPECTS OF DIABETIC FOOTDIABETIC FOOT SURGERYSURGERY • DISPOSAL OF BIO HAZARDOUSDISPOSAL OF BIO HAZARDOUS WASTEWASTE • LACK OF DOMICIALLARYLACK OF DOMICIALLARY DRESSING FACILITYDRESSING FACILITY • LOSS OF JOBLOSS OF JOB • PERMANENT DISABILITYPERMANENT DISABILITY • LACK OF FOOTWEAR FACILITYLACK OF FOOTWEAR FACILITY Dr.bal
  10. 10. PSYCHOLOGICAL FACTORSPSYCHOLOGICAL FACTORS ASSOCIATED WITH DIABETICASSOCIATED WITH DIABETIC FOOTFOOT • INCREASEDINCREASED • DepressionDepression • divorce ratedivorce rate • alcohol abusealcohol abuse • disruption indisruption in social,domesticsocial,domestic environmentenvironment • negative attitudenegative attitude • DECREASEDDECREASED • diabetic self carediabetic self care • psychologicalpsychological adjustment to illnessadjustment to illness • social/family supportsocial/family support • self esteemself esteem • quality of lifequality of life • satisfaction withsatisfaction with treatmenttreatment Dr.bal
  11. 11. FOOT ULCERSFOOT ULCERS PSYCHOLOGICAL BEHAVIORALPSYCHOLOGICAL BEHAVIORAL FACTORSFACTORS • IDENTITYIDENTITY • TIMELINETIMELINE • CONSEQUENCESCONSEQUENCES • CAUSECAUSE • CONTROLCONTROL
  12. 12. REDUCINGREDUCING DISSATISFACTION ISDISSATISFACTION IS MORE IMPORTANTMORE IMPORTANT THAN INCREASINGTHAN INCREASING SATISFACTION FORSATISFACTION FOR IMPROVING QUALITYIMPROVING QUALITY OF LIFEOF LIFE
  13. 13. MECHANISM OFMECHANISM OF DEPRESSION IN DIABETICDEPRESSION IN DIABETIC NEUROPATHYNEUROPATHY • DIRECTDIRECT PTS REALIZATION THAT THE ILLNESSPTS REALIZATION THAT THE ILLNESS IS UNCHANGEABLE PART OF LIFEIS UNCHANGEABLE PART OF LIFE COMBINED WITH PAIN/UNSTEADINESSCOMBINED WITH PAIN/UNSTEADINESS SENSE OF HELPLESSNESS DEPRESSION
  14. 14. MECHANISM OFMECHANISM OF DEPRESSION IN DIABETICDEPRESSION IN DIABETIC NEUROPATHYNEUROPATHY SELF PERCEPTION AS FAMILY BURDEN LOSS OF SELF ESTEEM AND CONFIDENCE • INDIRECTINDIRECTPHYSICAL AND SOCIAL DYSFUNCTION DEPRESSION REDUCED SELF CARE ULCER
  15. 15. WHAT NEEDS TO BE DONE ?WHAT NEEDS TO BE DONE ? • ROUTINE PSYCHOLOGICAL ASSESSMENT OF ALLROUTINE PSYCHOLOGICAL ASSESSMENT OF ALL DIABETIC FOOT PATIENTSDIABETIC FOOT PATIENTS • PSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BEPSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BE MEMBER OF THE TEAMMEMBER OF THE TEAM • COMMUNICATION TRAINING FOR PARAMEDICSCOMMUNICATION TRAINING FOR PARAMEDICS AND DOCTORS.AND DOCTORS. • RESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIARESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIA • INVOLVEMENT OF DEPT.OFINVOLVEMENT OF DEPT.OF PSYCHOLOGY/SOCIALOGY FROM TEACHINGPSYCHOLOGY/SOCIALOGY FROM TEACHING INSTITUTESINSTITUTES
  16. 16. MEDICOLEGAL ASPECTSMEDICOLEGAL ASPECTS OF DIABETIC FOOTOF DIABETIC FOOT SURGERYSURGERY • DODO • PT EDUCATIONPT EDUCATION • DOCUMENTATIONDOCUMENTATION • FOLLOW UPFOLLOW UP • AGGRESSIVEAGGRESSIVE TREATMENTTREATMENT • REFER TOREFER TO EXPERTSEXPERTS • DONTDONT • TREAT IF IN DOUBTTREAT IF IN DOUBT • IF NOT WITHINIF NOT WITHIN YOUR FIELDYOUR FIELD • DELAY TREATMENTDELAY TREATMENT • LET PT.GO UNLET PT.GO UN TREATEDTREATED Dr.bal
  17. 17. THANK YOUTHANK YOU

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