الفهرس 
Peripheral arterial diseaseOnly 14 pages are availabe for public view
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Abstract
Chronic lower limb ischemia (CLI) is a nearly pandemic condition that has the potential to cause loss of limb or even loss of life. CLI manifests as insufficient tissue perfusion initiated by existing atherosclerosis acutely compounded by either emboli or thrombi. So; all patients with CLI must have their feet evaluated at least at yearly intervals for the presence of the predisposing factors for ulceration and amputation.
Aim of the study:
The aim of this study was to evaluate the effect of educational program on compliance of patients with lower limb ischemia regarding therapeutic regimen through the following:-
1- Assessing of patient compliance level regarding therapeutic regimen of lower limb ischemia
2- Developing and implementing educational program based on patient assessment needs.
3- Evaluating the effect of educational program on compliance of patient with lower limb ischemia regarding therapeutic regimen.
Operational definitions:
1. chronic limb ischemia: is a chronic impairment of blood flow. Criteria for chronic limb ischemia include either one of the following (1) more than two weeks of recurrent foot pain at rest requires that regular use of analgesics (2) a non healing wound or gangrene of the foot or toes.
2. Therapeutic regimen: systemic plan of treatment often include (pharmacotherapy, nutrition, foot care, pain management, nutrition and flow up).
Research Hypothesis:
The current study hypothesized that:
An educational program will has positive improvement effect on compliance for patient with chronic lower limb ischemia.
Research design:
A quasi-experimental research design has been utilized to conduct this study. The selection of this research design because, the studied sample selected based upon selection criteria (nonrandomized study), use it pre-post intervention and there is no control group
Methodology:
Subjects and methods will include the following four
items:
I- Technical design
II- Operational design
III- Administrative design
IV- Statistical design
(I): Technical design:
The technical designs of the present study will include the;
setting, subjects and tools for data collections.
a- Setting:
The present study was conducted in the general surgery department- ward 7 which addresses the vascular patient and outpatient vascular clinic at the Eldmerdash Surgical Hospital which is affiliated with Ain Shams University Hospitals.
b- Subjects:
A Purposive sample of (84) patients diagnosed with lower limb ischemia will be selected to conduct the study, the sample size was determined by statistical analysis (power analysis) where it represents the total number of patients who are diagnosed with chronic lower limb ischemia in general surgery department- ward 7 and outpatient vascular clinic of the Eldmerdash Surgical Hospital at year 2011 were 280 patients.
Inclusion criteria:
• Adult patients from both genders
• Diagnosed with chronic lower limb ischemia
• Free from leg ulcer
• Able to perform self care
• Excluded from mental problems
• No foot or leg amputations
• Able to comprehend instructions and who agree to participate in the study
• The patient not participated in a previous educational program related to chronic lower limb ischemia care.
c- Data collection tools:
Four different tools were used in data collection, according to the following:
1-Patients knowledge assessment interview questioner sheet: the tool content is:
• Bio-social demographic data; It covers (age, gender, marital status, level of education, employment, place of residence and financial support).
• Medical characteristics data; It was used to cover (past, present medical history and family history).
• Patient’s knowledge sheet; used to assess levels of patient’s knowledge as regards: chronic lower limb ischemia, which includes; (chronic lower limb ischemia knowledge, health habits, exercise, smoking cessation, pain management, foot care and lifestyle).
II- Patient leg assessment sheet; it will be covered (pain, skin color – temperature and turgor, foot deformities- nails- orthotics and appropriate footwear, sensory, autonomic, motor, circulation and edema).
III- Observational checklist for foot care; to observe patient practice related to foot care as regards (prepare equipments, daily inspection, daily hygiene, care of the toenail and proper footwear).
IV- Patients’ compliance assessment questioner sheet; It used to assess patients’ compliance regarding (pain management, nutrition, smoking cessation, exercise, lower limb care, pharmacotherapy, risk factor modification and follow up).
(II): Operational design:
The operational design includes; preparatory phase, content validity, reliability, ethical consideration, pilot study and field work
(III): Administrative design
An official permission was obtained from the directors and chief person of each department of the settings to conduct this study. Patients’ consent was obtained for data collection after explaining the purpose of the study.
(IV): Statistical analysis
Data analysis was done thorough using percentage, mean, standard deviation, Freidman test and correlation to compare between results pre, immediate post program implementation, after 3 month follow up and after 6 months to evaluate outcome of the program and patient compliance.
Results:
The most age of the studied patients was <45 yrs (79.8%); more than half of them were female and doing usual daily works (54.8% & 53.6%) respectively. Also, around two fifth of the study sample were illiterate. The most of patients in the present study with duration of disease occurrence more than 6 months and didn’t complain from complications. More than two third of them were diabetic (67.9%).
The study showed marked improvement in patient’s level of knowledge, practice of foot care and level of patient compliance after program implementation; immediate post program, 3 month and 6 month follow up than pre program implementation phase at level (P<0.001*); so patient education consider important basic line of chronic lower limb ischemia management to prevent its complication as an open wound, ulceration or amputation.
The study also clarifies that, presence significant relation between importance of exercise and pain at P-value
0.039*. Also the study showed a statistically significant positive (direct) correlation between educational level and daily inspection at P-value 0.030*.
The study concluded that the educational program was affected positively regarding compliance of patients with chronic lower limb ischemia which indicates justification of the study hypothesis. This study recommended that an educational program should be developed for patients at every time with continuous update education