الفهرس 
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Abstract
Summary
Peripheral vascular disease (PVD) and peripheral neuropathy (PN), both lower-extremity diseases, are the leading cause of non–injury-related amputations and disabilities, declines in physical functioning and loss of independence later in life are additional complications of these conditions (Kerr et al., 2019). The common denominator of PN and PVD is diabetes (DM) where PN may weaken the arterial walls, PAD makes them rough allowing plaque to accumulate (Megallaa et al., 2019).
The study was aimed to evaluate the effect of Buerger Allen exercise on lower limb perfusion and peripheral neuropathy among patients with peripheral vascular diseases through the following:
1- Assess lower limb perfusion and neuropathy among patients with peripheral vascular diseases.
2- Apply Buerger Allen exercise for patients with peripheral vascular diseases.
3- Evaluate the effect of Buerger Allen exercise on lower limb perfusion and peripheral neuropathy among patients with peripheral vascular diseases.
Research hypothesis
The current study hypothesized that the implementation of Buerger Allen exercise affected positively on lower limb perfusion and peripheral neuropathy among patients with peripheral vascular diseases.
Study Design:
A quasi-experimental design was utilized to conduct this study.
Setting of the study:
The study was conduct at cardiovascular and endocrinology departments affiliated to Ain Shams University Hospitals, affiliated to Ain Shams University, Cairo, Egypt.
Sampling:
Sample type: Purposive sample of 62 patients with DM receiving care at the previously mentioned setting at the time of data collection.
Tools for data collection:
Three tools were used for data collection:
Tool I: Patients’ interviewing questionnaire.
This tool was developed by the researcher based on review of relevant literatures. It included three parts to assess patients’ demographic characteristics anthropometric measurements, and clinical data as the following:
Part (1): Patients’ demographic characteristics assessment:
This part was used to assess demographic characteristics of patients under study. It consisted of seven questions regarding age, gender, marital status, level of education, type of work, diet pattern and number of meals per day.
Part (2): Patients’ anthropometric measurements
This part was used to assess weight, height, and body mass index for patients under study.
Part (3): Patients clinical data assessment:
This part concerned with assessment of patients’ clinical data. It included: Present history, Past history, and Family history.
Tool (II): Assessment of lower limb perfusion through the following:
Part (1) Ankle Brachial Index (ABI) scale.
This scale adopted from (Baby, 2015) to calculate the perfusion of lower limbs right and left. The manual Ankle-Brachial Index (ABI) was performed by a researcher using a standard manual sphygmomanometer for the measurement of lower extremity pressure.
Part (2) Assessment checklist for selected clinical features of peripheral vascular disease.
This checklist was used to assess the symptoms level of peripheral vascular disease (PVD). It was adopted by Priya, (2016). It includes six (6) parameters (Peripheral pulse, Capillary refill, Edema, Temperature, Pain, Skin color).
(III): Michigan Neuropathy Screening Instrument (MNSI)
This scale adopted from (Herman, 2022). it was used for the evaluation of distal symmetrical peripheral neuropathy in DM.
The main findings of the present study can be summarized as follows:
showed that, 54.8% of the studied patients their age ranged between 51-65 years old, the mean ± SD of age was 57.16 ± 7.56 years; males were 69.4% of the studied patients. Also, 72.6% of them were married. Moreover, 38.7% of the studied patients were employed, as 54.2% of them had moderate work. Furthermore, 27.4% of the studied patients had a high fat diet and 54.8% of them take three meals per day. Also, 62.9% of the studied patients their weight was > 80, the mean ± SD of weight was 83.23 ± 14.8. Also, 43.5% of the studied patients their height ranged between 165-<175, with mean ± SD of height was 168.7 ± 8.13. Moreover, 43.5% of studied patients were obese.
According to Ankle Brachial index, there was an improvement in lower limb perfusion among the studied patients post implementation of BAE compared to pre-intervention phase with a highly statistically significant difference (P < 0.01).
Concerning clinical features of PVD, there was an improvement in clinical features of PVD among the studied patients post implementation of BAE compared to pre-intervention phase with a highly statistically significant difference (P < 0.01).
According to total peripheral neuropathy history, there was an improvement according to peripheral neuropathy history among the studied patients post implementation of BAE compared to pre-intervention phase with a highly statistically significant difference (P < 0.01).
There was an improvement according to peripheral neuropathy symptoms among the studied patients post implementation of BAE compared to pre-intervention phase with a statistically highly significant difference (P < 0.01).
There was highly statistically significant relation between total mean score of ABI, clinical features of PVD among the studied patients at pre-intervention phase and their age and educational level at (P= < 0.01).
There was a there was highly significant statistical negative correlation between patients’ ABI and total clinical features of PVD, total PN history and Total PNS at pre and post intervention at p < 0.01. While there was highly significant statistical positive correlation between total patients’ clinical features of PVD and total PN history, total PNS at pre and post intervention at p < 0.0.
Conclusion
Based on the current study hypotheses, the implementation of Buerger Allen exercise affected positively on lower limb perfusion and peripheral neuropathy among patients with peripheral vascular diseases through the following:
There was an improvement in ankle brachial index score, and reduction of clinical features of peripheral vascular disease after Implementation of Buerger Allen exercise, which enhanced the perfusion of lower extremities, Also, there was an improvement in peripheral neuropathy symptoms after Implementation of Buerger Allen exercise.
Recommendation
In the light of the findings of the current study, the researcher recommended the following:
Patients must attend health education sessions based on evidence guidelines regarding Buerger Allen exercise for improvement of lower peripheral circulation.
Share patients with diabetes, Family members in planning the care and encourage them to manage and reduce the complication of diabetes.
Training course for nursing about proper implementation of Buerger Allen exercise.
The study can be repeated by using a large sample to generalize the findings.