Exploring the Impact of Mindfulness-Based Meditation on the Quality of Life, Symptoms of Depression and Anxiety,

and Wound Healing for Individuals with Diabetic Foot Ulcers: A Pilot Study
Cecilia Wan MScOT, OT Reg. (Ont.), Ann-Marie McLaren DCh, MCIScWH, Suzanne Lu DCh, MScCH

BACKGROUND Demographic Characteristics of the Participants Participants’ Anecdotal Feedback

Protocol
• An estimated 15% of individuals with diabetes will develop a • Participants were randomized into Group 1 or Group 2 by the Characteristics
diabetic foot ulcer (DFU) during their lifetime.1 study coordinator, for the purpose of having equal sized groups. Age (mean, range) (years) 56.6, 34-69 It is a journey
• Individuals with an active DFU have a lower quality of life (QoL), • Group 1 consisted of 9 participants, receiving MBM training towards mindful
Duration of diabetes (range) (years) 10 to 33 behaviour.
and are more depressed than those with no diabetic foot ulcers.2,3 between May and June, 2016.
• Group 2 consisted of 8 participants, receiving MBM training Gender
What is Mindfulness? Male: Female 5:1
between July and August 2016.
• Mindfulness is “the awareness that arises when we pay attention, I am enjoying
• During the 8-week MBM training, participants met once a week Education (n)
the course.
non-judgmentally, to what is happening in the present moment”.4 for 2 hours and 15 minutes. High School 1
• Mindfulness meditation has been used in a variety of treatments • A demographic questionnaire was collected at baseline. Some College 2
(i.e. diabetes, heart disease, cancer, depression and anxiety). • Two self administrated tools were used. The info was collected at Completed College/University 2 I am calmer
baseline, immediately following MBM training, and at two month and I am
What is Mindfulness-Based Meditation (MBM) Program? Post Graduate Studies 1
less
follow-up:
• We used an adaptation of a program from the 13-week Meditation Experience Before stressed.
• Diabetic Foot Scale – short form (DFS-SF) is a QoL
Mindfulness-Based Chronic Pain Management (MBCPMTM) measure with 6 subscales. It has a maximum score of 100, Yes: No (n) 3:3
curriculum developed by Dr. Jackie Gardner-Nix, a chronic pain and a higher score indicates higher QoL. CONCLUSION
consultant physician. • Hospital Anxiety and Depression Scale (HADs) measures Mean Scores for pre-MBM, post-MBM, & 2 month follow-up
• The course covers various types of meditations and meditation signs of depression and anxiety. The higher the score, the • Individuals with DFUs expressed a high interest in learning
topics i.e., judging, beginner’s mind, mind-body connection. Pre- MBM Post- MBM 2-month follow- about Mindfulness-Based Meditation.
more depressed or more anxious one feels. (n=6) (n=6) up (n=4)
• Participants were supplied with meditation CDs and a textbook at • Wound healing was assessed using photographs and the • There is a positive impact in the QoL and reduction in
no cost. Photographic Wound Assessment Tool (PWAT). symptoms of anxiety for the MBM group with DFUs.
• It was facilitated by an Occupational Therapist trained in • PWAT has 6 subscales. A healed ulcer receives a score of DFS-SF 52.85 60.58 78.45
MBCPMTM. 0. HADS 7.33 5.67 5.5 CONSIDERATIONS FOR FUTURE RESEARCH
OBJECTIVE • Photos were taken by the research assistant in a particular Anxiety
manner and was assigned a number. The co-investigator HADS 4.17 5.5 4.75 • Design a study with a larger sample size and flexible MBM
• This pilot study is the first of its kind to explore the feasibility of completed PWAT using the anonymized photographs. program to enhance participation.
Depression
running an 8-week session MBM program for people with DFUs. • Data was collected on an excel spread sheet from the Diabetic • Financial resources to support a larger trial and cover the
This study will also provide some preliminary outcomes related to Foot Scale – short form (DFS-SF), Hospital of Depression and PWAT 1.67 2.17 1.6 cost of MBM program.
the impact of MBM training on QoL, symptoms of depression and Anxiety Scale (HADS), and Photographic Wound Assessment • Propose MBM training to include individuals at high risk
anxiety, and wound healing in individuals with DFUs. Percentage of Improvement Compared to Baseline and/or with closed wounds as a self care tool.
Tool (PWAT).
Post- 2-month follow-
METHODS MBM (%) up (%) REFERENCES
• Research ethics board approval was obtained. RESULTS
Improvement in Quality of Life 14.60 48.44 1. Singh, N., Armstrong D, G., & Lipsky B, A. (2005). Preventing foot ulcers in patients with

Participants
• Chiropodists in two outpatient clinics at St. Michael’s Hospital
recruited 39 potential participants with 1 or more DFUs between
March and May 2016.
• A total of 18 participants consented to enroll. One participant was
withdrawn from the study prior to the intervention as the wound
etiology was related to trauma rather than a DFU, resulting in 17
participants.
• Greater than 40% of potential candidates were enrolled in this pilot
study.
• A total of 6 participants (3 in each Group) completed the program.
• Reasons for participant withdrawal include: personal illness (1),
family related illness (1), employment (3), loss of interest (4), did
not provide a reason (2).
• 2 participants were lost to follow-up due to unavailability.
Reduction in symptoms of anxiety 22.65 24.97
• Symptoms of depression and wound healing did not
decrease post- MBM.
• The 2-month follow-up survey revealed that participants
continued to meditate for about 10-15 minutes four times
per week.
diabetes. Journal of American Medical Association, 293, 217-228.
2. Meijer, J. W., Trip, J., Jaegers, S. M., & Eisma, W. H. (2001). Quality of life in patients with
diabetic foot ulcers. Disability and Rehabilitation, 23, 336-340.
3. Ribu, L., Hanestad, B. R., Moum, T., Birkeland, K., & Rustoen, T. (2007). A comparison of the
health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a
non diabetes group from the general population. Quality of Life Research, 16, 179-189.
4. Gardner-Nix, J., & Costin-Hall, L. (2009). The mindfulness solution to pain: Step-by-step
techniques for chronic pain management. Oakland, CA: New Harbinger Publications.
ACKNOWLEDGEMENTS
Thank You to Dr. Jackie Gardner-Nix, Ryan Khan,
Jason Liu, Karen Polansky, & Sreenath Rave