Relax to heal? Perspectives of patients with diabetic foot ulcers and health professionals on relaxation sessions for wound healing

OBJECTIVE: To explore patients’ and healthcare professionals’ (HPs’) perspectives on the suitability/acceptability of a relaxation intervention, its effects on patients’ well-being and diabetic foot ulcer (DFU) healing, and its incorporation into the multidisciplinary management of patients with diabetic foot.
METHODS: This qualitative study was nested within a three-arm pilot randomized controlled trial. Patients with a chronic DFU received four relaxation sessions. Investigators then interviewed patients, physicians, and nurses involved with diabetic foot consultations. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis.
RESULTS: Five themes emerged from patient’s interviews about the suitability/acceptability of the relaxation intervention: perceptions regarding the psychological intervention, distress, the relaxation technique, changes in the patient’s life, and changes in DFU/contribution to healing. Three themes emerged from interviews with HPs: perceptions regarding relaxation, changes in the patient, and changes in DFU/healing. Regarding the feasibility of the relaxation intervention, three themes emerged for both patients and HPs: suggested modifications, stressors/difficulties, and impact of COVID-19 pandemic. The utility theme emerged only in HP interviews, with subthemes of patients’ distress, psychological interventions, relaxation intervention, and integration of the psychologist in the team.
CONCLUSIONS: These findings provide evidence for the suitability/acceptability, feasibility, and utility of a relaxation intervention in diabetic foot consultations.
The authors thank all of the patients and health professionals who participated in this study, as well as the teams from the Multidisciplinary
Diabetic Foot Outpatient Clinics and, particularly, M. Jesus Dantas, MD, from Centro Hospitalar de Tâmega e Sousa; Rui Carvalho, MD, from Centro Hospitalar e Universitário do Porto; Olinda Marques, MD,
Catarina Machado, MD, and the 2CA-Braga staff from Hospital de Braga for their support and availability in conducting this study. The authors also thank André Louro, Ângela Dias, Diana Costa, and
Margarida Vilaça, Marcelo Costa, MD, Susana Neto, MD, and Marta Martins, MD, for their collaboration in data collection. This study was supported by the Foundation for Science and Technology
through the Portuguese State Budget (UIDB/01662/2020) by a PhD fellowship (SFRH/BD/131780/2017) and a Foundation for Science and Technology grant (PTDC/PSI-GER/28163/2017) assigned to Dr
Pereira. The authors have disclosed no other financial relationships related to this article. Submitted May 27, 2022; accepted in revised form August 9, 2022.