Buerger-Allen Exercise for Improving Lower Limb Tissue Perfusion among Diabetic Patients in a Selected Community in Bangalore
DOI:
https://doi.org/10.64428/rm/v6.i1.1Keywords:
Buerger-Allen Exercise, Diabetes Mellitus, Lower Limb Tissue Perfusion, Patient Education, Structured Teaching ProgramAbstract
Diabetes mellitus (DM) is a major epidemiological concern, with India heavily affected. Poor lower limb tissue perfusion is common in DM patients, increasing risks of foot ulcers, infections, and amputations. Buerger-Allen exercise (BAE) is a non-pharmacological intervention enhancing collateral circulation and perfusion. This study assessed effectiveness of structured teaching program (STP) on BAE knowledge for improving lower limb tissue perfusion in selected Bangalore community. The objectives of the research were to assess pre- and post-test knowledge levels, evaluate STP effectiveness, and examine associations with socio-demographic variables. A quasi-experimental pretest-posttest design was adopted. Sixty diabetic patients were selected using non-probability purposive sampling. Structured questionnaire with reliability r = 0.92 was used. The STP with audiovisual aids and demonstrations was delivered, followed by post-test after seven days. Data were analyzed using descriptive statistics, paired t-test, and chi-square test (p<0.05). Pre-test showed inadequate knowledge in 63.3%, moderate in 36.7%, and adequate in 0% (mean = 8.90 ± 1.87, 44.5%). Post-test showed 0% inadequate, 28.3% moderate, and 71.7% adequate (mean = 16.03 ± 1.21, 80.2%), with mean improvement of 7.13 (35.7%; t=31.34, p<0.001). Significant associations were found with gender (χ²=5.48, p=0.019), education (χ² = 6.54, p=0.038), weight (χ²=6.76, p=0.034), and BAE awareness (χ²=6.01, p=0.014). The STP enhanced knowledge, highlighting its role in DM patient education. Nurse-led STPs should be integrated into community diabetes care to improve self-care and reduce complications.
References
Abbass, H. M., Abd El-Azeem, A. A., & Abd El-Hafez, A. I. (2024). Effect of Buerger-Allen Exercise Versus Intraneural Facilitation on Lower Limb Perfusion in Diabetic Neuropathy Patients. Egyptian Journal of Health Care, 15(2), 123-135. https://doi.org/10.21608/ejhc.2024.355199
Abbass, H. M., Rehman, M., Emaan, I., Shaukat, U., Farooq, S. U. R., & Rehman, M. M. U. (2024). Comparative Effect of Buerger-Allen Exercise and Intraneural Facilitation on Lower Extremity Perfusion and Peripheral Neuropathy Symptoms among Patients with Type II Diabetes Mellitus. Journal of Health and Rehabilitation Research, 4(2), 1511–1517. https://doi.org/10.61919/jhrr.v4i2.1181
Ahn, J.-A., Kim, E.-M., Lee, J. E., & Kim, K.-A. (2024). Diabetes Education Program for Nursing Students: A Systematic Review and Meta-Analysis. Nursing Open, 11(12), E70105. https://doi.org/10.1002/nop2.70105
Anjana, R. M., Unnikrishnan, R., Deepa, M., Pradeepa, R., Tandon, N., Das, A. K., & Mohan, V. (2023). Metabolic Non-Communicable Disease Health Report of India: The ICMR-INDIAB National Cross-Sectional Study (ICMR-INDIAB-17). The Lancet Diabetes & Endocrinology, 11(7), 474-489. https://doi.org/10.1016/s2213-8587(23)00119-5
Athavale, A., Fukaya, E., & Leeper, N. J. (2024). Peripheral Artery Disease: Molecular Mechanisms and Novel Therapies. Arteriosclerosis, Thrombosis, and Vascular Biology, 44(6), 1165–1170. https://doi.org/10.1161/atvbaha.124.320195
Baty, M., Chimoriya, R., James, S., Kritharides, L., Behdasht, S., Suryawanshi, A., & Aitken, S. J. (2025). Diabetes in Peripheral Artery Disease: Prevalence, Complications, and Polypharmacy. Journal of Clinical Medicine, 14(4), Article 1383. https://doi.org/10.3390/jcm14041383
Carey, M., Khunti, K., & Davies, M. (2012). Structured Education in Diabetes: A Review of the Evidence. Diabetes & Primary Care, 14(3), 154–162.
Chauhan, S., Khatib, M. N., Ballal, S., Bansal, P., Bhopte, K., Gaidhane, A. M., & Pant, M. (2025). The Rising Burden of Diabetes and State-Wise Variations in India: Insights from the Global Burden of Disease Study 1990–2021 and Projections to 2031. Frontiers in Endocrinology, 16, 1505143. https://doi.org/10.3389/fendo.2025.1505143
Chowdhury, S. R., Alam, S. R., Chowdhury, R. H., & Barua, S. (2021). Review the Evidence for Structured Education in Diabetes Management. Diabetes and Endocrinology Research, 1(1), 1-4. DOI:10.52803/21221SI
Eleftheriadou, I., Samakidou, G., Tentolouris, A., Papanas, N., & Tentolouris, N. (2021). Nonpharmacological Management of Diabetic Foot Ulcers: An Update. The International Journal of Lower Extremity Wounds, 20(3), 188–197. https://doi.org/10.1177/1534734620963561
Ghimire, H. C., & Ojha, O. (2023). Diabetes Self-Management Practices among Diabetic Patients Attending Chitwan Medical College Teaching Hospital. Nepal Journal of Health Sciences, 3(1), 1-9. https://doi.org/10.3126/njhs.v3i1.63227
Gillett, M., Royle, P., Snaith, A., Scotland, G., Poobalan, A., Imamura, M., Black, C., Boroujerdi, M., Jick, S., Wyness, L., Mcnamee, P., Brennan, A., & Waugh, N. (2012). Non-Pharmacological Interventions to Reduce the Risk of Diabetes in People with Impaired Glucose Regulation: A Systematic Review and Economic Evaluation. Health Technology Assessment, 16(33), 1–236, Iii-Iv. https://doi.org/10.3310/hta16330
Gong, J., Sun, X., Fu, H., Zhang, Y., & Gao, T. (2025). Comparative Efficacy and Safety of Non-Pharmacological Nursing Interventions for Diabetic Foot Ulcers: A Systematic Review and Network Meta-Analysis. BMC Nursing, 24, Article 1445. https://doi.org/10.1186/s12912-025-04065-x
Hsieh, Y. S., Lo, C. L., & Lin, Y.Y. (2025). Effectiveness of A Structured 2-Year Diabetes Health Education Program of Patients with Type 2 Diabetes Mellitus in Disease-Related Serum Markers. Diabetes, Metabolic Syndrome and Obesity, 18, 1849–1858. https://doi.org/10.2147/dmso.s519747
International Diabetes Federation. (2024). IDF Diabetes Atlas (11th ed.). https://diabetesatlas.org
International Diabetes Federation. (2025). IDF Diabetes Atlas (11th ed.). https://diabetesatlas.org
Ismail, I. M., & Naik, P. R. (2024). Prevalence and Determinants of Uncontrolled Diabetes Mellitus: A Community-Based Study from Karnataka, India. National Journal of Community Medicine, 15(10), 842–849. https://doi.org/10.55489/njcm.151020244459
Jadon, R. S., Anis, H., Pandey, S., Ranjan, P., & Vikram, N. K. (2025). Prevalence of Obesity and Diabetes in a Rural Village of India. Journal of Family Medicine and Primary Care, 14(8), 3357-3362. doi: 10.4103/jfmpc.jfmpc_196_25
Janghu, E., Kumar, P., Dular, S. K., & Thakur, N. (2025). Enhancing Peripheral Circulation through Buerger Allen Exercise among Diabetic Patients. D Y Patil Journal of Health Sciences, 13(4), 251–257. https://doi.org/10.4103/dypj.dypj_53_25
Maiti, S., Akhtar, S., Upadhyay, A. K., & Mohanty, S. K. (2023). Socioeconomic Inequality in Awareness, Treatment and Control of Diabetes among Adults in India: Evidence from National Family Health Survey of India (NFHS), 2019–2021. Scientific reports, 13(1), 2971. https://doi.org/10.1038/s41598-023-29978-y
Maniyara, K., & Kodali, P. B. (2025). Assessing Type-2 Diabetes Risk Based on the Indian Diabetes Risk Score among Adults Aged 45 and Above in India. Scientific Reports, 15(1), 4495. https://doi.org/10.1038/s41598-025-88460-z
Meloni, M., & Vas, P. R. J. (2025). Peripheral Arterial Disease in Diabetic Foot: One Disease with Multiple Patterns. Journal of Clinical Medicine, 14(6), Article 1987. https://doi.org/10.3390/jcm14061987
Nugroho, A. D. S., & Rosyid, F. N. (2026). The Effect of Buerger Allen Exercise on Peripheral Tissue Perfusion in Patients with Type 2 Diabetes Mellitus: A Literature Review. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 12(1), 40–48. https://doi.org/10.33755/jkk.v12i1.945
Pendsey, S. (2010). Understanding Diabetic Foot. International Journal of Diabetes in Developing Countries, 30(2), 75-79. https://doi.org/10.4103/0973-3930.62596
Radhika, J., Poomalai, G., Nalini, S. J., & Revathi, R. (2020). Effectiveness of Buerger-Allen Exercise on Lower Extremity Perfusion and Peripheral Neuropathy Symptoms among Patients with Diabetes Mellitus. Iranian Journal of Nursing and Midwifery Research, 25(4), 291-295. https://doi.org/10.4103/ijnmr.ijnmr_63_19
Rai, S., Singh, R., Pandey, A., & Mishra, M. H. (2024). Prevalence of Diabetes Distress among Type 2 Diabetes Mellitus Patients in India: A Systematic Review and Meta-Analysis. Diabetes Management, 14(2), Article 2324091. https://doi.org/10.1080/21642850.2024.2324091
Raveendran, A. V., Misra, A., & Vikneswaran, G. (2018). Non-Pharmacological Treatment Options in the Management of Diabetes Mellitus. European Endocrinology, 14(2), 31–39. https://doi.org/10.17925/ee.2018.14.2.31
Ruemenapf, G., Morbach, S., & Sigl, M. (2022). Therapeutic Alternatives in Diabetic Foot Patients without an Option for Revascularization: A Narrative Review. Journal of Clinical Medicine, 11(8), Article 2155. https://doi.org/10.3390/jcm11082155
Yu, C., Zhang, Q., Yang, W., Tao, L., & Jiang, X. (2024). Health Economic Evaluation of Structured Education Programs for Patients with Diabetes: A Systematic Review. Frontiers in Public Health, 12, Article 1467178. https://doi.org/10.3389/fpubh.2024.1467178
Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global Epidemiology of Diabetic Foot Ulceration: A Systematic Review and Meta-Analysis. Annals of Medicine, 49(2), 106-116. https://doi.org/10.1080/07853890.2016.1231932
Zu, Y.-Z., & Tang, C. (2025). Analysis of Risk Factors and Predictive Value of a Nomogram for Peripheral Arterial Disease in Patients with Type 2 Diabetes. Frontiers in Endocrinology, 16, Article 1632637.https://doi.org/10.3389/fendo.2025.1632637
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Preksha Shah
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
