****The Effect of Monochromatic Infrared Energy on Transcutaneous Oxygen Measurements and Protective Sensation: Results of a C

Author(s): 
Holly Franzen-Korzendorfer, PT, PhD, FACCWS; Mary Blackinton, PT, MS, EdD; Shari Rone-Adams, PT, DBA; and Joseph McCulloch, PT, PhD, FAPTA, FACCWS

The study group consisted of 18 participants (12 men and 6 women) with a mean age of 65 ± 13 years (range 39 to 86 years). Three were current smokers and the mean self-reported length of time since the onset/diagnosis of diabetes was 14.6 ± 11years (see Table 1). As per the study design, each treatment group (active and sham) consisted of nine right and nine left feet. The mean number of 30-minute treatments received during the 3 to 4 week study was 11.7

Paired t-tests showed no statistically significant difference in the pain or sensation pretest scores between the active or sham treatment groups. However, a statistically significant difference (P = 0.04) was noted in the TcPO2 pretest values between the sham and active group (see Table 2). The average mean values varied 3.6 mm Hg (clinically insignificant) from 48.9 mm Hg (sham group) to 45.3 mm Hg (active group). No statistically significant difference was found in the amount of change in TcPO2 scores between the active and sham treatment groups (P = 0.07). The mean change (± SD) in TcPO2 scores was 1.5 ± 9.6 mm Hg for the active feet and -1.3 ± 7.7 mm Hg for the sham feet. No statistically significant differences were noted between the active and sham groups for changes in sensation (P = 0.4) or pain (P = 0.4) (see Table 3).

No significant correlation was found between changes in TcPO2 and sensation (r = 0.1, P >0.05) or between actual TcPO2 and sensation scores (r = 0.3, P >0.05). Additionally, no significant differences were noted when pre- and posttest data for TcPO2 or pain were compared. However, a statistically significant change in sensation was noted for both the active (P = 0.002) and sham (P = 0.01) treatment groups between pre- and posttest.

During the seventh treatment session, one participant reported discomfort on one foot, now known to have been receiving active treatment. The research assistant immediately inspected the foot and noted a linear scabbed wound located at the distal lateral edge of the diode pad placed on the dorsum of the foot. The wound was not consistent with a burn. It was not possible to determine if the wound was an incidental scratch or caused by the edge of the diode pad. The wound was covered with a transparent film dressing and closed within 7 days. The participant did not wish to withdraw from the study and completed the protocol with no other adverse events.

None of the four participants who consumed caffeine or nicotine before a testing session had a significant change in TcPO2 scores that would skew results.

During the course of the study, four participants had medication changes. One decreased the dose of furosemide and started linezolid; one started taking insulin, gabapentin, and lisinopril during the course of the study; one started taking a beta-blocker; and one started azithromycin and had a cortisone shot in the left knee earlier in the posttest evaluation day.

Discussion

References: 

1. Kochman AB, Carnegie DH, Burke TJ. Symptomatic reversal of peripheral neuropathy in patients with diabetes. J Am Podiatr Med Assoc. 2002;92(3):125–130.
2. Leonard DR, Farooqi HM, Myers S. Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy. Diabetes Care. 2004;27:168–172.
3. Prendergast JJ, Miranda G, Sanchez M. Improvement of sensory impairment in patients with peripheral neuropathy. Endocr Prac. 2004;10:24–30.
4. Cavanagh PR, Ulbrecht JS, Caputo GM. The biomechanics of the foot in diabetes mellitus. In: Bowker JH, Pfeifer MA, eds. Levin and O’Neal’s The Diabetic Foot. St. Louis, Mo: Mosby, Inc.;2001:181.
5. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2002. Available at: at www.diabetes.org. Accessed March 12, 2004.
6. Kochman AB. Monochromatic infrared photo energy and physical therapy for peripheral neuropathy: influence on sensation, balance, and falls. J Geriatr Phys Ther. 2004;27:16–19.
7. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Available at: www.diabetes.org. Accessed March 14, 2006.
8. Centers for Medicare and Medicaid Services. CMS Decision Memo. Diabetic peripheral neuropathy with loss of protective sensation (LOPS) (CAG-00059N). Available at: www.cms.hhs.gov/mcd/search.asp?clickon=search. Accessed April 16, 2004.
9. Burke TJ. 5 Questions — and answers — about MIRE treatment. Adv Skin Wound Care. 2003;16:369–371.
10. Goldberg N. Monochromatic infrared photo energy and DPN. Diabetic Microvascular Complications Today. 2005;March/April:30–32.
11. Burke TJ. Nitric oxide: its role in diabetes, peripheral neuropathy, and wound healing. Vol. 2005: Diabetes In Control, 2004. Available at: www.diabetesincontrol.com/anodyne/burkeseries.shtml. Accessed January 14, 2005.
12. Horwitz LR, Burke TJ, Carnegie D. Augmentation of wound healing using monochromatic infrared energy. Adv Skin Wound Care. 1999;12:35–40.
13. Rich K. Transcutaneous oxygen measurements: implications for nursing. J Vasc Nurs. 2001;19:55–61.
14. Sheffield PJ, Buckley CJ. Transcutaneous oximetry: a sophisticated tool for assessing tissue oxygenation and potential for wound healing. In: Sheffield PJ, Fife CE, Smith APS, eds. Wound Care Practice. Flagstaff, Ariz: Best Publishing Co.;2004:117–136.
15. Clarke D. Transcutaneous monitoring of pO2 in hyperbaric medicine. Patient Focus Circle™, Vol. DK-2700. Denmark: Radiometer Medical A/S;1997:1–20.
16. Nicasio M, Larson-Lohr V, Kimbrell P. Transcutaneous oxygen measurements. In: Larson-Lohr V, Norvell HC, eds. Hyperbaric Nursing. Flagstaff, Ariz: Best Publishing Co.;2002:304–314.
17. Anodyne® Therapy System Professional Unit 480 JCAHO policy and procedure manual. Vol. 2004: Anodyne® Therapy, 2004.
18. Clifft J, Kasser RJ, Newton TS, Bush AJ. The effect of monochromatic infrared energy on sensation in patients with diabetic peripheral neuropathy. Diabetes Care. 2005;28:2896–2900.
19. Wimberley P, Burnett R, Covington A, et al. Guidelines for transcutaneous po2 and pco2 measurement. Clinica Chimica Acta. 1990;190:S41–S50.
20. Lukkari-Rautiainen E, Lepantalo M, Pietila J. Reproducibility of skin blood flow, perfusion pressure and oxygen tension measurements in advanced lower limb ischaemia. Eur J Vasc Surg. 1989;3:345–350.
21. National Institute of Diabetes and Digestive and Kidney Disease. Feet Can Last a Lifetime: a health care provider’s guide to preventing diabetes foot problems. National Diabetes Education Program;2004.
22. Jörneskog G. Measurements of transcutaneous oxygen tension in patients with diabetic foot complications. Denmark: Radiometer Medical;AS 132; 2001;May 1:1–3.
23. Volkert W, Hassan A, Smock VL, et al. Effectiveness of monochromatic infrared photo energy and physical therapy for peripheral neuropathy: changes in sensation, pain, and balance — a preliminary, multi-center study. Phys Occupational Ther Geriatr. 2005;24:1–17.
24. Dowd G, Linge K, Bentley G. Measurement of transcutaneous oxygen pressure in normal and ischaemic skin. J Bone Joint Surg. 1983;65(suppl B):79–83.
25. Dowd G, Linge K, Bentley G. The effect of age and sex of normal volunteers upon the transcutaneous oxygen tension in the lower limb. Clin Phys Physiol Meas. 1983;4:65–68.
26. Olerud JE, Pecoraro RE, Burgess EM, et al. Reliability of transcutaneous oxygen tension (TcPo2) measurements in elderly normal subjects. Scand J Clin Lab Invest. 1987;47:535–541.
27. de Graaff JC, Ubbink DT, Legemate DA, de Haan RJ, Jacobs J. Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease. J Vasc Surg. 2001;33:1033–1040.
28. DeLellis SL, Carnegie DH, Burke TJ. Improved sensitivity in patients with peripheral neuropathy: effects of monochromatic infrared photo energy. J Am Podiatr Med Assoc. 2005;95:143–147.
29. Harkless L, DeLellis SL, Carnegie DH, Burke TJ. Improved foot sensitivity and pain reduction in patients with peripheral neuropathy after treatment with monochromatic infrared photo energy — MIRE. J Diabetes Complic. 2006;20:81–87.



bendjaminsays: November 27.2009 at 05:34 am

Very interesting article. Thanks. I used it in my student work.

Ben Stokson
---
my hobby: electric infrared heaters

Reply to this comment »

Post new comment

  • Lines and paragraphs break automatically.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Use to create page breaks.

More information about formatting options

Image CAPTCHA
Enter the characters shown in the image.