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Abstrak :
Diabetic neuropathy is a complication of diabetes mellitus that is often overlooked, since there are often no subjective complaints during initial stages, and sensory deficit is often only found after objective examination. Diabetic neuropathy is defined by the San Antonio Concensus of 1988 as "clinical or subclinical neural disturbance that occurs in diabetes mellitus, with no signs of other peripheral neuropathy. Neuropathy may manifest on the somatic, peripheral, as well as autonomicic nervous systems." The incidence rate of diabetic neuropathy is reported to be 10-90%. Such high variation is due to differences in the diagnostic criteria or method to establish the diagnosis. Reports of peripheral neuropathy from various hospitals in Indonesia are as follows: Cipto Mangunkusumo Hospital / Jakarta (1989) 68.16%, Hasan Sadikin Hospital (1989) 12.2%, Dr. Sutomo Hospital / Surabaya (1990) 52.21%, Dr. Pirngadi Hospital / Medan (1996) 18.05%, Dr. Wahidin Sudirohusodo Hospital / Ujung Pandang (1997) 57.81%. Asril Bahar, Jakarta (1985), reported an incidence rate for parasympathetic autonomicic neuropathy of 11.9%, while Harsinen Sanusi, Ujung Pandang (1989) reported an incidence rate of 66.7%.

Abstrak :
Latar Belakang : Neuropati perifer merupakan manifestasi ekstraartikular pada Artritis Reumatoid AR yang sudah lama diketahui dan ditemukan pada sekitar 50-57,4 pasien AR dengan patogenesis yang belum jelas hingga saat ini. Nerve Growth Factor NGF, yang dilaporkan berhubungan dengan kejadian neuropati perifer pada pasien Diabetes Mellitus ditemukan dengan kadar yang lebih tinggi pada pasien AR dibandingkan orang normal. Berdasarkan hal tersebut, diperlukan penelitian yang bertujuan mengetahui hubungan antara kadar NGF dengan kejadian neuropati perifer pada pasien AR. Tujuan : Untuk mengetahui rata-rata kadar NGF darah dan ada tidaknya hubungan antara kadar NGF dengan kejadian Neuropati Perifer pada pasien AR. Metode : Penelitian potong lintang dengan metode consecutive sampling pada pasien AR rawat jalan di poli reumatologi Rumah Sakit Cipto Mangunkusumo dilakukan dalam kurun waktu Juli 2015-Maret 2016. Pemeriksaan laboratorium dan fisiologi yang dilakukan adalah NGF dan Elektromiografi-Kecepatan Hantar Saraf EMG-KHS. Subjek kemudian dikelompokkan menjadi 2 kelompok berdasarkan ada atau tidaknya neuropati perifer. Analisis bivariat kemudian dilakukan untuk melihat hubungan antara NGF dengan neuropati perifer diantara 2 kelompok. Data sekunder berupa usia, jenis kelamin, Laju Endap darah LED, C-Reactive Protein CRP, Disease Activity Score DAS 28 LED dan DAS 28 CRP didapat dari rekam medis sebagai data karakteristik dasar pasien. Hasil : Sebanyak 132 pasien diikutsertakan dalam penelitian ini dan didapatkan neuropati perifer sebanyak 45,5 60 orang selama Juli 2015-Maret 2016. Median kadar NGF pada pasien AR adalah 4,11 pg/mL 0,0-24,5 pg/mL. Median NGF pasien AR dengan neuropati perifer adalah 4,11 pg/mL 1,1-20,83 pg/mL, sementara median NGF pada pasien AR tanpa neuropati adalah 3,89 pg/mL 0,0-24,5 pg/mL. Jenis neuropati yang ditemukan pada pasien AR adalah polineuropati 29 subyek/21,97, mononeuropati multipleks 20 subyek/15,15 dan Carpal Tunnel Syndrome 15 subyek/11,36. Pada penelitian ini tidak didapatkan hubungan antara kadar NGF serum dengan kejadian neuropati perifer pada pasien AR p=0,716. Simpulan : Kadar NGF serum pasien AR didapatkan median sebesar 4 pg/mL dengan median NGF serum pada kelompok neuropati perifer 4,11 pg/mL dan kelompok tanpa neuropati 3,89 pg/mL. Tidak terdapat hubungan antara NGF serum dengan kejadian neuropati perifer pasien AR. ...... Background : Peripheral neuropathy is an extra articular manifestations in Rheumatoid Arthritis RA, which has been known and is found in approximately 50 to 57.4 of patients with RA with an unclear pathogenesis until now. In DM type 2 patients, Nerve Growth Factor NGF is associated with peripheral neuropathy. NGF level is also reported to be higher among RA patients than that of among healthy subjects. The correlation between NGF level and peripheral neuropathy among RA has not been concluded yet. Aim : To find out the mean levels of NGF blood serum and the relationship between the NGF serum levels and Peripheral Neuropathy among patients with RA. Methods : A cross sectional study using consecutive sampling method including patient of rheumatology clinic at Cipto Mangunkusumo hospital was performed between July 2015 to March 2016. The laboratory and physiology measurement incude NGF level and Electromyography Nerve Conduction Velocities EMG NCV were examined to the subjects. Patients were classified into 2 groups based on the diagnosis of Peripheral Neuropathy PN PN positive and PN negative. Bivariate analysis were done to investigate the relationship between NGF and PN among groups. Secondary data such as age, sex, Erythrocyte Sedimentation Rate ESR, CRP, Disease Activity Score DAS 28 ESR and CRP obtained from their medical record as a basic characteristic data of patients. Results : Among 132 subjects, PN was found in 60 subjects 45,5. The median level of NGF in RA patients was 4.11 pg mL 0.0 to 24.5 pg mL. The median NGF level of RA patients with peripheral neuropathy was 4.11 pg mL 1.1 to 20.83 pg mL, while the median of NGF level in RA patients without neuropathy was 3.89 pg mL 0.0 to 24.5 pg mL. Types of neuropathy among patients with AR were polyneuropathy 29 subjects 21.97, mononeuropathy multiplex 20 subjects 15.15 and Carpal Tunnel Syndrome 15 subjects 11.36. In this study we found no association between NGF serum level and peripheral neuropathy among patients with RA p 0.716. Conclusion : The median of NGF serum level among RA patients was 4 pg mL. The median of NGF serum level among peripheral neuropathy group was 4.11 pg mL while the median of NGF level in RA patients without neuropathy was 3.89 pg mL. There was no relationship between NGF serum level and peripheral neuropathy among patients with RA.

Abstrak :
Latar belakang: Diabetes melitus merupakan faktor risiko penting terjadinya aterosklerosis, aterosklerosis merupakan penyakit sistemik yang bisa terjadi di seluruh pembuluh darah baik pada mikrovaskular maupun makrovaskular. Adanya bukti iskemia akibat stenosis yang disebabkan aterosklerosis pada salah satu pembuluh darah, mengharuskan kita lebih waspada akan adanya proses aterosklerosis di tempat lain. NPD di kaki terjadi akibat komplikasi diabetes pada mikrovaskular yang akhirnya mengakibatkan kerusakan pada persarafan di kaki. Maka perlu mewaspadai proses ateroslerosis di tempat lain, baik pada pembuluh arteri makro maupun mikrovaskular di kaki. Pemeriksaan non invasif untuk melihat adanya ganguan makrovaskular di kaki menggunakan ABI dan TBI sedangkan untuk gangguan mikrovaskular dengan TcPO2. Penelitian ini dilakukan untuk dapat menilai hubungan derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan proses ateroskerosis dipembuluh darah kaki, baik yang makrovaskular dengan ABI dan TBI maupun mikrovaskular TcPo2 pada pasien DM tipe 2. Metode: Penelitian potong lintang dilakukan pada pasien DM tipe 2 dengan NPD dengan nilai TCSS >5 di Poliklinik Pelayanan Jantung Terpadu, poliklinik Endokrin dan Metabolik dan Poliklinik Ilmu Penyakit Dalam Umum RSCM. Data diperoleh dari wawancara, rekam medik, pemeriksaan ABI, TBI dan TcPO2. Variabel penelitian berupa derajat neuropati perifer, ABI, TBI dan TcPO2. Analisis bivariat terhadap masing-masing variable dengan menggunakan uji Spearman. Hasil: Sebanyak 36 subjek yang memenuhi kriteria pemilihan diikutkan dalam penelitian, rerata usia 62 tahun dengan 20 (55,6%) di antaranya perempuan dan median lama diabetes 12 tahun. Berdasarkan analisa bivariat dengan uji spearman penelitian ini mendapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasi sedang antara derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan ABI (r = -0,475, p = 0,003) dan TBI (r = -0,421, p = 0,010). Dan pada pemeriksaan TcPO2 juga di dapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasi sedang ( r = -0,399, p = 0,016) Simpulan : Terdapat korelasi negatif yang bermaksa secara statistik antara derajat neuropati perifer diabetik dengan ABI, TBI dan TcPO2. ......Background: Diabetes mellitus is important risk factor of atherosclerosis. Atherosclerosis is systemic disease that can occur in all blood vessels both microvascular and macrovascular. There is evidence of ischemia due to stenosis caused by atherosclerosis in one blood vessel, which requires us to be more aware with the process of atherosclerosis in other places. Diabetic peripheral neuropathy (DPN) in the lower extremity results from complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. Non-invasive examination to look macrovascular disorders in the lower extremity are using ankle brachial index (ABI) and toe brachial index (TBI) while for microvascular disorders with TcPO2. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ABI and TBI as well as microvascular TcPo2 in Patients with type 2 diabetes mellitus (DM) Methods: Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at RSCM. The Data were obtained from interviews, medical records, ABI, TBI and TcPO2 examinations. The research variables are the degree of peripheral neuropathy, ABI, TBI and TcPO2. Bivariate analysis of each variable was used the Spearman test. Results: Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, this study found a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010) . The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016) Conclusion : There is a statistically significant negative correlation between the degree of diabetic peripheral neuropathy with ABI, TBI and TcPO2 examinations.

Abstrak :
Latar Belakang: Kontrol glikemik yang buruk merupakan kontributor utama terjadinya neuropati perifer diabetes (NPD), dan berkaitan dengan efikasi diri klien DM tipe 2. Penelitian ini bertujuan untuk mengetahui efektivitas model intervensi holistik terintegrasi cempaka terhadap efikasi diri, kontrol glikemik dan perbaikan NPD klien DM tipe 2. Metode: Disain penelitian ini menggunakan mix method dengan strategi pendekatan eksploratoris sekuensial yang dilakukan dalam dua tahap. Penelitian tahap satu menguraikan pengembangan model dan modul intervensi keperawatan. Penelitian tahap dua adalah uji efektivitas model dengan menggunakan desain quasi-experimental dengan pendekatan pretest-posttest kontrol group design melibatkan 92 responden. Uji efektivitas menggunakan Generalized Estimating Equations (GEE). Hasil: Hasil penelitian tahap satu menghasilkan model intervensi yang holistik terintegrasi dengan intervensi coching kesehatan, latihan mindfulness dan partisipasi keluarga. Hasil uji efektivitas menunjukan model intervensi cempaka efektif meningkatkan efikasi diri pada bulan ke-3 sebesar 9,89 dan bulan ke-6 sebesar 11,52; menurunkan nilai HbA1c pada bulan ke-6 sebesar 0,9%; dan meningkatkan perbaikan neuropati perifer pada bulan ke-3 sebesar 23,98 dan bulan ke-6 sebesar 24,25. Kesimpulan: Model intervensi Cempaka terbukti meningkatkan efikasi diri, kontrol glikemik, dan perbaikan neuropati perifer, sehingga model ini layak direkomendasikan untuk diterapkan secara luas pada populasi klien DM tipe 2 dengan NPD usia dewasa di Indonesia. ......Background: Poor glycemic control is a major contributor to diabetic peripheral neuropathy (NPD) and is related to the self-efficacy of type 2 DM clients. This study aims to determine the effectiveness of the Cempaka integrated holistic intervention model in improving self-efficacy, glycemic control, and peripheral neuropathy conditions in clients with type 2 diabetes mellitus. Methods: The design of this study used a mixed method with a sequential exploratory approach strategy carried out in two stages. Phase one study describes the development of nursing intervention models and modules, literature studies, preliminary studies, expert tests, and readability tests. The second phase of the study was to test the effectiveness of the model using a quasi-experimental design with a pretest-posttest control group design approach involving 92 respondents. Test effectiveness using Generalized Estimating Equations (GEE). Results: The first phase of the study resulted in a holistic intervention model integrated with health coaching interventions, mindfulness exercises and family participation. The results of the effectiveness test showed that the Cempaka intervention model was effective in increasing self-efficacy in the 3rd month by 9.89 and 11.52 in the 6th month; lowered the HbA1c value in the 6th month by 0.9%; and increased the improvement of peripheral neuropathy at the 3rd month of 23.98 and the 6th month of 24.25. Conclusion: The Cempaka intervention model has been proven to increase self-efficacy, and glycemic control, and improve peripheral neuropathy, so this model is worthy of being recommended for wide application in the adult population of type 2 DM clients with NPD in Indonesia.

Abstrak :
Latar Belakang: Neuropati perifer merupakan salah satu komplikasi neurologis yang banyak ditemui pada pasien HIV. Hal ini dapat disebabkan oleh infeksi HIV tersebut ataupun sebagai akibat efek samping terapi antiretroviral, khususnya stavudin. Manifestasi klinis neuropati sangat beragam, salah satunya ialah adanya keluhan nyeri, yang dapat mempengaruhi kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui pengaruh neuropati perifer terhadap kualitas hidup pasien HIV dalam terapi antiretroviral non-stavudin. Metode Penelitian: Penelitian ini merupakan studi komparatif potong lintang yang melibatkan pasien HIV di RS Cipto Mangunkusumo pada bulan September 2016 hingga September 2017. Kriteria inklusi subjek ialah pasien HIV dewasa dalam terapi antiretroviral non-stavudin selama minimal 12 bulan yang akan dibagi menjadi dua kelompok, berdasarkan brief peripheral neuropathy screening tool BPNST , yaitu kelompok dengan neuropati perifer dan tanpa neuropati perifer. Penilaian depresi dengan Hamilton depression rating scale HDRS dan evaluasi kualitas hidup dengan short form-36 health survey SF-36 . Kuesioner SF-36 mencakup domain kesehatan fisik dan kesehatan mental dengan rentang skor 0-100. Skor yang lebih tinggi menunjukkan kualitas hidup yang lebih baik. Data dianalisis dengan SPSS 20.0. Hasil: Didapatkan subjek sebanyak 29 orang pada kelompok neuropati perifer dan 58 orang pada kelompok tanpa neuropati perifer. Rentang usia subjek ialah 23-59 tahun dengan median kadar sel limfosit T CD4 yang lebih rendah 406 sel/mm3 vs. 540 sel/mm3 dan persentase riwayat terapi isoniazid yang lebih tinggi 62,1 vs. 37,9 pada kelompok neuropati perifer. Karakteristik demografis usia, jenis kelamin, pendidikan terakhir, pekerjaan, status pernikahan dan karakteristik klinis jumlah sel limfosit CD4 terakhir tidak mempengaruhi kualitas hidup pada kedua kelompok, baik dengan maupun tanpa neuropati perifer. Tidak didapatkan perbedaan skor SF-36 yang bermakna pada kedua kelompok. Tampak median skor SF-36 yang lebih rendah pada subjek dengan nyeri neuropatik pada ekstremitas bawah skor kesehatan fisik 77,5 vs. 85,31 dan depresi skor kesehatan fisik 80 vs. 94,37 dan skor kesehatan mental 75 vs 89,68 untuk kelompok neuropati, skor kesehatan fisik 78,75 vs. 90,31 dan skor kesehatan mental 70,72 vs 88,75 untuk kelompok tanpa neuropati . Viral load RNA HIV berkorelasi negatif terhadap skor SF-36 pada kelompok dengan neuropati perifer skor kesehatan fisik, rs = -0,376 dan skor kesehatan mental, rs = -0,308. Kesimpulan: Neuropati perifer tidak mempengaruhi kualitas hidup pasien HIV dalam terapi antiretroviral non-stavudin.Kata Kunci: antiretroviral non-stavudin, HIV, kualitas hidup, neuropati perifer.

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Background Peripheral neuropathy is one of the most common neurologic complications in patients with HIV, which is caused by the HIV infection itself or as the side effect of antiretroviral therapy ART , particularly the usage of stavudine. Patients with neuropathy might complain various clinical manifestations, including pain, which could significantly affect patients quality of life. Aim of this study was to evaluate the role of peripheral neuropathy to quality of life of patients with HIV receiving non stavudine antiretroviral therapy. Materials and Method This was a cross sectional internal comparison study which were done to HIV patients in Cipto Mangunkusumo Hospital during September 2016 to September 2017. Inclusion criteria were HIV adult patients with non stavudine antiretroviral therapy for minimum of 12 months which will be divided into two groups, based on brief peripheral neuropathy screening tool BPNST , as neuropathy group and non neuropathy group. Diagnosis of depression by Hamilton depression rating scale HDRS , and evaluation of quality of life was based on 36 item short form survey SF 36 . The SF 36 assessed physical health PH and mental health MH domain with score ranged from 0 to 100, in which higher score represents better quality of life. Data was analyzed using SPSS 20.0. Results There were 29 subjects with peripheral neuropathy and 58 subjects without peripheral neuropathy. Age of the subjects was ranging from 23 to 59 years old, with lower median of CD4 lymphocyte count 406 cells mm3 vs. 540 cells mm3 and higher percentages of isoniazid therapy 62.1 vs. 37.9 in neuropathy group. Demographic characteristics age, sex, education level, employment, marital status and clinical characteristic CD4 lymphocyte count was not affecting the quality of life, both in neuropathy group and non neuropathy group. No significant difference was found from SF 36 score in both groups. There were lower SF 36 score median in subjects with neuropathic pain in lower extremities PH score 77.5 vs. 85.31 and depression PH score 80 vs. 94.37 and MH score 75 vs 89.68 in neuropathy group, PH score 78.75 vs. 90.31 and MH score 70.72 vs 88.75 in non neuropathy group. Viral load was negatively correlated with SF 36 score in subjects with peripheral neuropathy PH score, rs 0,376 and MH score, rs 0,308. Conclusion Peripheral neuropathy did not affect the quality of life of HIV patients receiving non stavudin antiretroviral therapy.

Abstrak :
Seorang pekerja laki-laki 38 tahun mengalami gejala gangguan saraf tepi dan di diagnosis neuropati perifer. Pekerja tersebut memiliki riwayat bekerja sebagai operator mesin Spinning di pabrik pembuatan rayon selama 10 tahun dengan riwayat paparan CS2 melebihi nilai ambang batas secara inhalasi. Tujuan dari laporan kasus berbasis bukti ini adalah untuk mendapatkan jawaban yang tepat tentang hubungan antara paparan karbon disulfida kerja melalui inhalasi dengan neuropati perifer di antara pekerja industri rayon. Pencarian artikel dilakukan melalui PubMed, Scopus, Medline, Embase dan handsearching. Kriteria inklusi adalah Tinjauan Sistematis, Meta-Analisis, Studi Kohort, Studi Kasus-kontrol, Studi potong lintang, pekerja dengan paparan CS2 secara inhalasi di lingkungan kerja, hasil diagnosis neuropati perifer atau hasil tes konduktifitas saraf sebagai alat diagnostik baku neuropati perifer ( MNCV dan SNCV ). Kemudian ditelaah secara kritis menggunakan kriteria CEBM oxford untuk studi etiologi . Dari hasil pencarian artikel didapatkan 4 jurnal penelitian. Terdapat satu artikel studi kohort prospektif dan tiga artikel studi potong lintang. Hasil telaah kritis 4 studi penelitian belum cukup kuat menunjukkan hubungan antara paparan CS2 inhalasi dengan neuropati perifer. Namun nilai penurunan konduktivitas saraf tepi dikatakan bermakna jika kecepatan konduktivitas saraf tepi ekstremitas atas < 50 m/s dan ekstremitas bawah jika < 40 m/s. ......Carbon disulfide (CS2) is widely used in various industries as a raw material for the manufacture of goods such as rayon, cellophane, and carbon tetrachloride. Currently, the largest user of this chemical is the rayon fibre industry. This evidence-based case report aims to obtain precise answers regarding the relationship between occupational carbon disulfide exposure through inhalation and peripheral neuropathy among rayon industry workers. A 38-year-old male worker had peripheral nerve disorder symptoms and was diagnosed with peripheral neuropathy. The worker had a history of working as a spinning machine operator in a rayon manufacturing factory for 10 years with a history of exposure to CS2 exceeding the threshold value through inhalation. An article search was conducted through PubMed, Scopus, Medline, Embase, and manual searching. The articles were then critically appraised using Oxford's CEBM criteria for etiological studies. The article searches resulted in one prospective cohort study and three cross-sectional studies. Based on the patient's condition, the findings from the 4 research studies were insufficient to establish a link between inhalation exposure to CS2 and peripheral neuropathy. Further studies with a stronger association level are needed to establish the relationship between inhaled CS2 exposure and peripheral neuropathy.

Abstrak :
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.

 

Abstrak :
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. ......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.