Syabariyah Sitti, Nurachmah Elly, Widjojo Budiman Darmo, Prasetyo Sabarinah, Sanada Hiromi, Nakagami Gojiro, Kardiatun Tutur, Hisan Urfa Khairatun
Department of Medical Surgical Nursing, University of Aisyiyah Bandung, West Java 40264, Indonesia.
Department of Medical Surgical Nursing, University of Indonesia, Depok, West Java 16424, Indonesia.
Healthcare (Basel). 2023 Jan 9;11(2):191. doi: 10.3390/healthcare11020191.
Diabetic foot ulcers are a common complication that occurs in approximately 15 percent of patients with diabetes mellitus. Over 60% of diabetic foot ulcers are caused by underlying neuropathy. Former studies on diabetic animals with foot wounds found that vibration platforms significantly accelerate wound healing by catalyzing epithelization, promoting angiogenesis, and enhancing muscle bulk. This result suggests that there is evidence that vibrations may accelerate diabetic neuropathic ulcer healing in human patients. However, to the best of our knowledge, the effect of vibration on the enhancements of diabetic foot ulcer healing in human patients is rarely investigated. Hence, in this work, we conducted an experimental study with human subjects to investigate whether vibration therapy, as a complement to the standard wound treatment, can accelerate the wound healing rate of diabetic neuropathic foot ulcers. In this prospective experimental study, 80 participants diagnosed with Wagner grades I−III diabetic neuropathic foot ulcers were randomly distributed to experimental (n = 40) and control groups (n = 40). Patients in the intervention group received standard wound treatment and vibration wound therapy (VWT), whereas patients in the control group retrieved only standard wound treatment. The results (p = 0.024, α = 0.05) show notable differences in the median healing rate between the intervention group (25 days, 95% CI: 20.3−29.7) and control group (33 days, 95% CI: 25.6−40.4), with the effect-size r, Cohen’s d, Glass’s Δ, and Hedges’ g, respectively, being 0.810, 2.764, 2.311, and 2.772. Moreover, the nitric oxide (NO) level, wound closure area, and wound healing score after intervention significantly differed between the two groups (p < 0.05), putting the intervention group on a higher level than the control group. Furthermore, positive associations were found between the NO level and wound healing closure rates. These findings suggested that VWT enhances diabetic neuropathic foot ulcer healing in terms of healing rate, wound closure area, healing score, and elevated NO level. Considering that no clinically adverse effects were found in the patients induced with vibration intervention, VWT can be regarded as a complementary therapy to the existing ones to accelerate the healing of DFUs.
糖尿病足溃疡是一种常见的并发症，约15%的糖尿病患者会出现该症状。超过60%的糖尿病足溃疡是由潜在的神经病变引起的。以往对足部有伤口的糖尿病动物的研究发现，振动平台通过促进上皮形成、促进血管生成和增加肌肉量，显著加速伤口愈合。这一结果表明，有证据显示振动可能会加速人类糖尿病神经病变性溃疡的愈合。然而，据我们所知，很少有人研究振动对人类糖尿病足溃疡愈合的促进作用。因此，在本研究中，我们对人体进行了一项实验研究，以调查振动疗法作为标准伤口治疗的补充，是否能加快糖尿病神经病变性足部溃疡的伤口愈合速度。在这项前瞻性实验研究中，80名被诊断为瓦格纳分级I - III级糖尿病神经病变性足部溃疡的参与者被随机分为实验组（n = 40）和对照组（n = 40）。干预组患者接受标准伤口治疗和振动伤口治疗（VWT），而对照组患者仅接受标准伤口治疗。结果（p = 0.024，α = 0.05）显示，干预组（25天，95%CI：20.3 - 29.7）和对照组（33天，95%CI：25.6 - 40.4）的中位愈合率存在显著差异，效应量r、科恩d值、格拉斯Δ值和赫奇斯g值分别为0.810、2.764、2.311和2.772。此外，两组干预后的一氧化氮（NO）水平、伤口闭合面积和伤口愈合评分存在显著差异（p < 0.05），干预组高于对照组。此外，NO水平与伤口愈合闭合率之间存在正相关。这些发现表明，VWT在愈合速度、伤口闭合面积、愈合评分和升高的NO水平方面，可促进糖尿病神经病变性足部溃疡的愈合。鉴于在接受振动干预的患者中未发现临床不良反应，VWT可被视为现有治疗方法的一种补充疗法，以加速糖尿病足溃疡的愈合。
