Diabetes mellitus is a global health problem that affects more than 387 million individuals which leads to multiple comorbidities and estimates a loss of $245 billion in medical cost and loss of wage (Tchanque-Fossuo, et al. , 2016). One of the most common and serious complication of diabetes mellitus is diabetic foot ulcer. Approximately 15% percent of diabetic patients will develop a foot ulcer in their lifetime and 6-40% of diabetic patients must receive a limb amputation (Kajagar, Godhi, Pandit, & Khatri, 2012).
Currently, diabetic foot ulcer accounts for more than 60% percent of non-traumatic lower limb amputation (Tchanque-Fossuo, et al. , 2016). Diabetic foot ulcer is very difficult to treat and manage due to impaired wound healing related to the disease process and the increased risk of infection (Tchanque-Fossuo, et al. , 2016). These ulcers may also contribute to decreased mobility and a diminished quality of life.
With non-healing diabetic foot ulcers becoming more problematic, many adjuvant therapies to stimulate healing have been researched such as; electrical stimulation, hyperbaric oxygen, and vacuum-assisted closure (Kajagar, Godhi, Pandit, & Khatri, 2012). Studies in the use of low-level light therapy has seemed most promising in the treatment of diabetic foot ulcers. However, it is often looked over as part of the treatment plan for diabetic foot ulcers and other complicated wounds.
Low-level light therapy (LLLT) uses either low-level, low-power lasers, or light emitting diodes (LED), to alter the cellular function and molecular pathways to promote healing (Tchanque-Fossuo, et al. , 2016). On a study conducted treating wounds on diabetic and non-diabetic rats with LLLT, the researchers observed an increase amount of collagen in scar tissue, a significant increase in proliferation of fibroblasts and number of developed capillaries (Da Silva, et al. , 2013).
The current proposed theory per Tchanque-Fossuo (2016) states, “absorption of light by photoacceptors or chromophores at the molecular, cellular, and tissue levels, that results in cellular changes including synthesis of collagen and extracellular matrix, recruitment of cytokines and growth factors, migration, proliferation, and differentiation of cells” (p. 419). This research will propose that LLLT can be safely utilized along with conventional therapy to stimulate healing, thus, decreasing the healing times of diabetic foot ulcers.
Through various literature, patients who receive LLLT experience faster recovery of wounds compared to those who do not. Thus, can be implemented in the clinical practice of the treatment of diabetic foot ulcers and possibly other type of wounds. If low-level light therapy is integrated into the treatment plan, it will also save valuable money, time, and resources, as well as improve the quality of life in patients. PICOT The proposed population of this evidence based practice will conducted on patients with type-II diabetes with a current diabetic foot ulcer with staging of I or II.
The intervention to be introduced is to expose the wound bed and margins of the diabetic ulcer to low-level light from a low-level laser or LED device for 20 minutes every day of the trial. LLLT is safe to use and has gained clearance by the United States Food and Drug Administration (Kajagar, Godhi, Pandit, & Khatri, 2012). The intervention group will also receive conventional treatment of the ulcer as well. The comparison group will only receive the conventional treatment offered for diabetic foot ulcers. The expected outcome is a decrease in size or staging of the ulcer compared to patients that received conventional treatment.
The time frame of this study will be 14 days as this will allow sufficient time for the healing to occur and to compare the results. The results will be used to discuss if registered nurses should use LLLT as part of the traditional treatment for diabetic foot ulcers and other complicated wounds. Literature Review In a study that used low-level laser therapy, its seven participants achieved recovery from their foot ulcers and had no sign of relapse after six months (Kazemi-Khoo, 2006). This was a level III one-group quasi-experimental design that studied if low-level laser therapy improved the healing of diabetic foot ulcers.
The sample used was seven type-II diabetes with grade 2 or 3 foot ulcers. The data collected was measurements of the ulcer surface area, ulcer height, duration, and A1C. The Braden Scale was used to determine the ulcer risk of the participants. The data was collected before the study and after the study concluded along with a six-month follow-up. All wounds were completed recovered after nineteen sessions and was concluded the low-level laser therapy, improved healing of diabetic foot ulcers (Kazemi-Khoo, 2006).
The limitation of this experiment disclosed by the researcher was the small sample size and a greater sample would be needed to test efficacy. In an experimental randomized controlled trial, a sample of sixty-eight patients with type-II diabetes with grade I foot ulcers of a duration of at least four weeks were used to test the efficacy of LLLT. The participants were separated into two groups randomly by a computer. The control group only received standard treatment while the intervention group received LLLT daily. The data was collected before the study started and at the conclusion.
The researchers created imprints of the wound before and after, along with measurements of size, staging, duration, and fasting blood sugar. The results concluded the group who received LLLT had a significant reduction in wound size and area and can be used as an adjunct to traditional treatment (Kajagar, Godhi, Pandit, & Khatri, 2012). In another experimental randomized control trial, researchers used diabetic rats to determine if LLLT helped restore balance to matrix metalloproteinase and collagen types, factors involved in wound healing.
The sample used were 120 rats randomly chosen into four groups; diabetic rats who receive LLLT, diabetic rats who do not receive LLLT, non-diabetic rats receives LLT, and non-diabetic rats who do not receive LLLT. All groups received a wound surgically and the selected groups received LLLT using a Diode laser. The data was collected by taking tissue samples from the both groups of rats for histological analysis. The results concluded the rats that received the LLLT had altered their expression of matrix metalloproteinase and increase the production of collagen, translating to accelerated tissue healing.
Also, there was no statistical difference in these factors with diabetic and non-diabetic rats which received LLT (Da Silva, et al. , 2013). In yet another one group quasi-experimental study conducted in nursing homes, researchers wanted to assess the effectiveness of LLLT on wound healing. The sample was sixteen nursing home residents with one or more pressure ulcers or diabetic foot ulcers. They received LLLT daily for the first week, along with standard dressing changes. Then, the participants received LLLT only three times a week with standard dressing changes. The data was collected before and after the study.
The data gathered was PUSH scores, based on the wound impression and EZ graph measurements. After the nine-week study concluded, 61. 8% of the participants’ wounds gained more than 50% wound closure and nine participants had 100% wound closure. The researchers determined that LLLT may be a viable option for the treatment of acute and chronic wounds (Saltmarche, 2008). Finally, in a level I systematic review of randomized controlled trials, researchers examined literature to determine if the clinical use of LLT would be an effective and beneficial treatment for diabetic foot ulcers compared to current standard treatment.
After searching multiple databases, the researchers selected four randomized controlled trials on LLT on diabetic foot ulcers to further examine. Upon their critique, they recommend more studies with comparable laser/light parameters, screen periods to exclude rapid healers, larger sample sizes, and additional follow-ups. Nevertheless, the review discussed that LLT has potential to become the convenient, cost-effective, low risk and minimally invasive treatment with no for diabetic foot ulcers in the clinical setting (Tchanque-Fossuo, et al. , 2016).
Synthesis and Answer Based upon the literature above, the evidence demonstrates LLLT hastens the recovery of diabetic foot ulcers compared to those who receive standard treatment. These results prove valuable as diabetic patients have impaired tissue healing, which can result to further complications. The reasoning for this phenomenon is explained by the LLLT stimulating biological and physiological factors to promote healing. With results showing the benefits and limited adverse effects, LLLT can be further studied and easily implemented into the clinical setting.