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Original Article
Article history: Objective: To evaluate the compliance with lower extremity exercise and blood circulation
Received 12 March 2015 in the feet of elderly diabetics following a combination of music media therapy and a lower
Received in revised form extremity exercise regimen.
11 June 2015 Method: The 72 elderly diabetic patient subjects were divided into two groups: control group
Accepted 30 July 2015 (n 38) and intervention group (n 34). Both groups were exposed to the same compre-
Available online 7 August 2015 hensive therapy to control glucose levels. While the control group was given the lower
extremity exercise, the intervention group received the extremity exercise in addition to
Keywords: the music media.
Diabetes mellitus Result: After three months of intervention, the adherence to the lower extremity exercise
Elderly regimen in the intervention group was significantly higher than that of the control group
Lower extremity exercise (p < 0.05). Additionally, following six months of treatment, both the dorsal artery peak
Nursing values and ankle-brachial indices (ABIs) showed significant differences between the con-
Music media trol and intervention groups (p < 0.05).
Conclusion: Music media treatment combined with lower extremity exercise can both
significantly increase the extent of exercise compliance of elderly patients suffering from
diabetes mellitus, as well as improve blood circulation in their feet.
Copyright 2015, Chinese Nursing Association. Production and hosting by Elsevier
(Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
*
This study is a program, named Shanghai Geriatrics Clinical Trials Registry. Its number is 13DZ2260700.
*
Corresponding author.
E-mail address: bjj163163@163.com (J.-J. Bai).
Peer review under responsibility of Chinese Nursing Association.
http://dx.doi.org/10.1016/j.ijnss.2015.07.008
2352-0132/Copyright 2015, Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
244 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 2 ( 2 0 1 5 ) 2 4 3 e2 4 7
scale was composed of five items, with each item assigned a 3.2. The difference between the lower limb exercise adher-
score between one and five. The lower scores indicated greater ence was significant between the experimental and
extent of adherence to the exercise regimen. The method control groups following three treatment (t 9.155,
assessing the scale was the same as the knowledge ques- p < 0.001) (Table 2).
tionnaire about the lower extremity exercise. The scale's 3.3. There was a statistical significant difference between
Cronbach's a coefficient was 0.851 and the CVI was 0.905. the ankle-brachial index (ABI) of the two treatment
groups following six months (t 2.540, p 0.013) (Table
2.5.2. Knowledge of the lower extremity exercise 3).
The extent of each patient's knowledge of the exercise 3.4. The peak velocity of the dorsal artery was significantly
regimen was measured using a knowledge questionnaire different between the two groups following 6 months of
designed by the researchers. The questionnaire included ten treatment (t 5.244, p 0.000) (Table 4).
items, each receiving a score between one and five according
to the Likert 5. The total score ranged between ten and 50, with
higher numbers indicating better knowledge. The question-
naire's validity was assessed by five professors, including two
diabetic education experts, two diabetic clinical nursing spe- 4. Discussion
cialists and one clinical endocrinologist. The Content Validity
Index (CVI) was 0.921 and the Cronbach's alpha coefficient was 4.1. Music media improves the compliance with elderly
0.871. diabetics to lower extremity exercise regimens
2.5.3. Peak velocity of dorsal artery Following three months intervention, the average score of the
This index was measured using the ES-1000SPM Doppler Flow patients exposed to a combination of music media and exer-
Detector. cise therapy was 18.55 1.13, significantly higher than those
exposed to only the exercise therapy (p < 0.05). Following six
2.5.4. Ankle-brachial index (ABI) months, the exercise compliance with the intervention group
The ankle-brachial index (ABI) was evaluated using the two- improved further, revealing an average score of 21.18 1.03.
way Doppler blood-flow detector (ES-1000SPM, Hadeco, These results suggest that musical media may significantly
Japan). Analysis was carried out following a 5-min minimum improve the exercise compliance with elderly diabetic pa-
rest in the supine position, with the upper body remaining as tients. The better the exercise compliance of the diabetic pa-
flat as possible. The ABI was calculated as a ratio comparing tients are, the lower the incidence of complications is [11].
the higher systolic blood pressure among the posterior tibial Considering that diabetes mellitus is a chronic disease that
artery and dorsalis pedis artery to the higher of the brachial causes several health complications, it was not surprising that
blood pressures in the arms. The ABI levels were classified as this study's patient subjects tended to lose confidence and
the following according to the ABI value: a normal value for even become too anxious or depressed to cooperate with the
the lower extremity artery was between 0.9 and 1.30, mild treatment. The musical effect on exercise tolerance is likely
vascular lesions between 0.70 and 0.89, moderate vascular attributable to affecting sympathetic nerve excitability,
lesions between 0.40 and 0.69, and severe vascular lesions slowing heart rate and breathing, and ultimately influencing
with ABI < 0.40 [10]. The lower ABI value was then used for the patients' nerve and muscle systems, which further
analysis. improved awareness and engagement with activities [2,12].
All measurements were evaluated prior to the interven- This musical therapy is primarily applied to patients in order
tion. The ABI, peak velocity of the dorsal artery and the to relieve pain, depression and muscle spasms, to improve
adherence to the diabetic lower extremity exercise were neurological deficits, and to promote recovery of motor
assessed following the intervention of the musical media for function [13e17]. A Chinese control trial compared patients
three and six months in Hua Dong Hospital, which is affiliated between an exercise group (n 52) and exercise combined
with Fudan University. with music-therapy group (n 52) and revealed that music
could improve motor function, depression and the rate of
2.6. Statistical methods exercise attendance in the elderly [18], similar to the report
3.1. The general characteristics of the participants are dis- t Value 0.154 9.155 18.421
p Value 0.878 <0.001 <0.001
played in Table 1.
246 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 2 ( 2 0 1 5 ) 2 4 3 e2 4 7
waveform should be employed to precisely assess the status [12] Yamamoto T, Ohkuwa T, Itoh H, Kitoh M, Terasawa J,
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Research Foundation (FNF201223) of Fudan University and the
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Conflict of interest instrumental music performance on endurance level, self-
perceived fatigue level, and self-perceived exertion of
inpatients in physical rehabilitation. J Music Ther
Authors declared no conflict of interests for this article.
2011;48(2):124e48.
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