1. PSYCHOSOCIAL ASPECT OF DIABETIC FOOT DR.ARUN BAL PRESIDENT DIABETIC FOOT SOCIETY OF INDIA

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. QUALITY OF LIFE IN DIABETIC NEUROPATHY WORSENING OF PHYSICAL & PSYCHOSOCIAL FUNCTIONING WORSENING OF PHYSICAL & PSYCHOSOCIAL FUNCTIONING NEGATIVE IMPACFT ON QUALITY OF LIFE NEGATIVE IMPACFT ON QUALITY OF LIFE QUALITY OF LIFE IS NOT MERE HEALTH STATUS BUT PT.`S PERCEPTION OF HIS HEALTH QUALITY OF LIFE IS NOT MERE HEALTH STATUS BUT PT.`S PERCEPTION OF HIS HEALTH WORSENING PHYSICAL ACTIVITY/AMPUTATION CAUSES REDUCTION IN SELF ESTEEM/SELF IMAGE WORSENING PHYSICAL ACTIVITY/AMPUTATION CAUSES REDUCTION IN SELF ESTEEM/SELF IMAGE CONCEPT OFNEUROPATHY QUALITY OF LIFE CONCEPT OFNEUROPATHY QUALITY OF LIFE

4. QUALITY OF LIFE IN DIABETIC NEUROPATHY REASONS FOR REDUCED QUALITY OF LIFE: REASONS FOR REDUCED QUALITY OF LIFE: PAIN/ PAIN/ LOSS OF SENSATION LOSS OF SENSATION UNSTEADINESS UNSTEADINESS BEING TREATED DIFFERENTLY BEING TREATED DIFFERENTLY DN SPECOFIC SCALE FOR QOL IS PREDICTOR OF EMOTIONAL BURDEN DN SPECOFIC SCALE FOR QOL IS PREDICTOR OF EMOTIONAL BURDEN

5. CONCEPT OF HEALTH RELATED QUALITY OF LIFE

6. PSYCHOSOCIAL FACTORS WHICH LEAD TO REDUCED SELF FOOT CARE PAST BELEIFS ABOUT SELF CARE PAST BELEIFS ABOUT SELF CARE BELIEF ABOUT ABILITY TO PERFORMSELF CARE BELIEF ABOUT ABILITY TO PERFORMSELF CARE CONCERRN ABOUT POTENTIAL RISK OF AMPUTATION CONCERRN ABOUT POTENTIAL RISK OF AMPUTATION WILLINGNESS TO WEAR SPECIAL FOOT WEAR WILLINGNESS TO WEAR SPECIAL FOOT WEAR COSMETIC ACCEPTIBILITY, COSMETIC ACCEPTIBILITY, COST COST AVAILABILITY AVAILABILITY

7. PSYCHOLOGICAL EFFECTS OF ROUTINE FOOT EXAMINATION REINFORCES IMPORTANCE OF CONCEPT OF TISSUE INTEGRITY REINFORCES IMPORTANCE OF CONCEPT OF TISSUE INTEGRITY REINFORCES PATIENTS AWARENES ABOUT SENSORY DEFECIT REINFORCES PATIENTS AWARENES ABOUT SENSORY DEFECIT DEMONSTRATES AREAS OF REDUCED SENSATION TO THE PATIENT DEMONSTRATES AREAS OF REDUCED SENSATION TO THE PATIENT ACCEPTANCE OF THE CONCEPT OF SELF CARE FOR DIABETIC FOOT ACCEPTANCE OF THE CONCEPT OF SELF CARE FOR DIABETIC FOOT YEILDS LONG TERM PSYCHOLOGICAL BENEFITS YEILDS LONG TERM PSYCHOLOGICAL BENEFITS

8. SOCIAL ASPECTS OF DIABETIC FOOT SURGERY MAJORITY ELDERLY PATIENTS MAJORITY ELDERLY PATIENTS NUCLEAR FAMILIES NUCLEAR FAMILIES LACK OF ACCOMODATION LACK OF ACCOMODATION LACK OF OPTIMAL SANITARY FACILITY LACK OF OPTIMAL SANITARY FACILITY COST OF THE TREATMENT COST OF THE TREATMENT Dr.bal

9. SOCIAL ASPECTS OF DIABETIC FOOT SURGERY DISPOSAL OF BIO HAZARDOUS WASTE DISPOSAL OF BIO HAZARDOUS WASTE LACK OF DOMICIALLARY DRESSING FACILITY LACK OF DOMICIALLARY DRESSING FACILITY LOSS OF JOB LOSS OF JOB PERMANENT DISABILITY PERMANENT DISABILITY LACK OF FOOTWEAR FACILITY LACK OF FOOTWEAR FACILITY Dr.bal

10. PSYCHOLOGICAL FACTORS ASSOCIATED WITH DIABETIC FOOT INCREASED INCREASED Depression Depression divorce rate divorce rate alcohol abuse alcohol abuse disruption in social,domestic environment disruption in social,domestic environment negative attitude negative attitude DECREASED DECREASED diabetic self care diabetic self care psychological adjustment to illness psychological adjustment to illness social/family support social/family support self esteem self esteem quality of life quality of life satisfaction with treatment satisfaction with treatment Dr.bal

11. FOOT ULCERS PSYCHOLOGICAL BEHAVIORAL FACTORS IDENTITY IDENTITY TIMELINE TIMELINE CONSEQUENCES CONSEQUENCES CAUSE CAUSE CONTROL CONTROL

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

13. MECHANISM OF DEPRESSION IN DIABETIC NEUROPATHY DIRECT DIRECT PTS REALIZATION THAT THE ILLNESS IS UNCHANGEABLE PART OF LIFE COMBINED WITH PAIN/UNSTEADINESS PTS REALIZATION THAT THE ILLNESS IS UNCHANGEABLE PART OF LIFE COMBINED WITH PAIN/UNSTEADINESS SENSE OF HELPLESSNESS DEPRESSION

14. MECHANISM OF DEPRESSION IN DIABETIC NEUROPATHY SELF PERCEPTION AS FAMILY BURDEN LOSS OF SELF ESTEEM AND CONFIDENCE INDIRECT INDIRECT PHYSICAL AND SOCIAL DYSFUNCTION DEPRESSION REDUCED SELF CARE ULCER

15. WHAT NEEDS TO BE DONE ? ROUTINE PSYCHOLOGICAL ASSESSMENT OF ALL DIABETIC FOOT PATIENTS ROUTINE PSYCHOLOGICAL ASSESSMENT OF ALL DIABETIC FOOT PATIENTS PSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BE MEMBER OF THE TEAM PSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BE MEMBER OF THE TEAM COMMUNICATION TRAINING FOR PARAMEDICS AND DOCTORS. COMMUNICATION TRAINING FOR PARAMEDICS AND DOCTORS. RESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIA RESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIA INVOLVEMENT OF DEPT.OF PSYCHOLOGY/SOCIALOGY FROM TEACHING INSTITUTES INVOLVEMENT OF DEPT.OF PSYCHOLOGY/SOCIALOGY FROM TEACHING INSTITUTES

16. MEDICOLEGAL ASPECTS OF DIABETIC FOOT SURGERY DO DO PT EDUCATION PT EDUCATION DOCUMENTATION DOCUMENTATION FOLLOW UP FOLLOW UP AGGRESSIVE TREATMENT AGGRESSIVE TREATMENT REFER TO EXPERTS REFER TO EXPERTS DONT DONT TREAT IF IN DOUBT TREAT IF IN DOUBT IF NOT WITHIN YOUR FIELD IF NOT WITHIN YOUR FIELD DELAY TREATMENT DELAY TREATMENT LET PT.GO UN TREATED LET PT.GO UN TREATED Dr.bal

17. THANK YOU