Successful Aspects and Impacts of Diabetic Foot Exercise Among Indonesian Type 2 Diabetes Mellitus Patients: A Literature Review
Abstract
Backgrounds: Prevalence of diabetic foot among patient remains high worldwide, including in Indonesia. Foot exercise becomes one solution to prevent this health issue. However, the procedure seems simple but many factors influence the successful of this intervention. Numerous studies had been published related to the successful aspects and the outcomes of diabetic foot exercise but those are still dispersed. So that, the comprehensive information of diabetic foot exercise is still puzzled and do not utilize maximally by clinicians. Purposes: This study aims to review and synthesis previous information related to successful aspects and impacts of diabetic foot exercise among Indonesian Type 2 Diabetes Mellitus patients. The present comprehensive review compile and synthesize the information on diabetic foot exercise, which can serve as a source for future studies or be utilized for clinical practices. Methods: A literature review had been chosen in this study with PRISMA approach to sort the articles from EBSCOHost, Google Scholar, Science Direct, Wiley Online and ProQuest. We used a Mixed Method Appraisal Tool to determine the eligibility of articles that included to this study. Results: We harvested 1,481 articles and synthesized 20 selected articles. Our findings revealed intrinsic and extrinsic aspects of diabetic foot exercise were the key to improve the intervention’s outcome. Most outcomes of diabetic foot exercise were related to physical benefits. Although, mental benefits also captured in this study. Interestingly, our review found a unique finding, which in the Indonesia context, the spiritual outcome was also mentioned by diabetic patients after received diabetic foot exercise. Conclusion: By deliberate our findings, clinicians may scale up and aware the supporting aspects of diabetic foot exercise when providing this therapy to diabetes
Keywords:
Diabetic foot exercise, Successful aspects, Type 2 Diabetes Mellitus
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References
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Francia, P., Anichini, R., De Bellis, A., Seghieri, G., Lazzeri, R., Paternostro, F., & Gulisano, M. (2015). Diabetic foot prevention: the role of exercise therapy in the treatment of limited joint mobility, muscle weakness and reduced gait speed. Ital.ian journal. of anatomy and embryology, 120(1), 21-32. https://doi.org/10.13128/IJAE-16470
Francia, P., Gulisano, M., Anichini, R., & Seghieri, G. (2014). Diabetic foot and exercise therapy: step by step the role of rigid posture and biomechanics treatment. Current diabetes reviews, 10(2), 86-99. https://doi.org/10.2174/1573399810666140507112536
Gagliardino, J. J., Chantelot, J. M., Domenger, C., Ramachandran, A., Kaddaha, G., Mbanya, J. C., ... & IDMPS Steering Committee. (2019). Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS). Diabetes research and clinical. practice, 147, 29-36. https://doi.org/10.1016/j.diabres.2018.09.008
Gamboa-Antiñolo, F. M. (2023). Diabetic foot ulcers: a growing global health emergency in the COVID-19 era. Internal. and Emergency Medicine, 18(5), 1259-1261. https://doi.org/10.1007/s11739-023-03217-8
Graciella, V., & Prabawati, D. (2020, November). The effectiveness of diabetic foot exercise to peripheral neuropathy symptoms and fasting blood glucose in type 2 diabetes patients. In International. Conference of Heal.th Development. Covid-19 and the Role of Heal.thcare Workers in the Industrial. Era (ICHD 2020) (pp. 45-49). Atlantis Press. https://doi.org/10.2991/ahsr.k.201125.008
Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Heal.th information & libraries journal., 26(2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
Handayani, O. W., Nugroho, E., & Hermawati, B. (2020). Determinant of diabetes mellitus focusing on differences of Indonesian culture: Case studies in the Java and outer java region in Indonesia. The Open Public Heal.th Journal., 13(1), 323-340. https://doi.org/10.2174/1874944502013010323
Hong, Q. N. (2021). Questions on the MMAT version 2018.
Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., ... & Pluye, P. (2018a). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for information, 34(4), 285-291. https://doi.org/10.3233/EFI-180221
Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., ... & VEDEL, I. (2020b). Mixed methods appraisal tool (MMAT) version française 2018. Education for Information. http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf%0Ahttp://mixedmethodsappraisaltoolpublic.pbworks.com/
Isworo, A., Sari, Y., Sumeru, A., & Nuriya, N. (2021). Barriers in Diabetes Self-management: A Qualitative Study from the Perspective of Nurses in Primary Health Centers, Indonesia. Open Access Macedonian Journal. of Medical. Sciences, 9(E), 1345-1352. https://doi.org/10.3889/oamjms.2021.7451
Kamillah, S., Panduragan, S. L., Poddar, S., & Bhaumik, A. (2023). Improving Diabetes Condition Through Health Literacy: A Case Study From Cianjur, West Java, Indonesia. Malaysian Journal of Medicine & Health Sciences, 19(Supp9): 221-229. https://doi.org/10.47836/mjmhs.19.s9.31
Kristianto, H. (2023). Analysis of risk factors responsible for neuropathy in patients with type 2 diabetes mellitus with diabetic foot during the COVID-19 pandemic. Iranian Journal. of Nursing and Midwifery Research, 28(1), 85-91. https://doi.org/10.4103/ijnmr.ijnmr_180_21
Ligita, T., Wicking, K., Francis, K., Harvey, N., & Nurjannah, I. (2019). How people living with diabetes in Indonesia learn about their disease: A grounded theory study. PloS one, 14(2), e0212019. https://doi.org/10.1371/journal.pone.0212019
Marwati, T. A., Kusmayanti, N. A., & Rosyidah, R. (2022). Quality of Life Among Diabetes Mellitus Patients in Indonesian Chronic Disease Management Program (Prolanis). Epidemiology and Society Health Review (ESHR), 4(2), 76-86. https://doi.org/10.26555/eshr.v4i2.5341
Matos, M., Mendes, R., Silva, A. B., & Sousa, N. (2018). Physical activity and exercise on diabetic foot related outcomes: a systematic review. Diabetes Research and Clinical Practice, 139, 81-90. https://doi.org/10.1016/j.diabres.2018.02.020
Monteiro, R. L., Ferreira, J. S., Silva, É. Q., Cruvinel-Júnior, R. H., Veríssimo, J. L., Bus, S. A., & Sacco, I. C. (2022). Foot–ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: A randomized controlled trial. Scientific reports, 12(1), 1-12. https://doi.org/10.1038/s41598-022-11745-0
Nasir, W. A., Palutturi, S., Arifin, A., Daud, A., & Mallongi, A. (2023). Analysis of Policy Implementation of Minimum Service Standards for Hypertension in Marusu Health Center Maros District. Pharmacognosy Journal, 15(5). https://doi.org/10.5530/pj.2023.15.165
Nurhayati, N. (2022). The Effect of Foot Exercise on Daily Activities and Blood Sugar Levels of Elderly in South Bangka, Indonesia. Journal of Drug Delivery and Therapeutics, 12(2-S), 58-62. https://doi.org/10.22270/jddt.v12i2-S.5421
Nursalam, H. (2020). Penulisan Literature Review dan Systematic Review Pada Pendidikan Kesehatan (Contoh). Surabaya: Fakultas Keperawatan Universitas Airlangga.
Oktavianti, D. S., & Hernawati, Y. (2022). Edukasi Senam Kaki Diabetik Sebagai Upaya Pencegahan Diabetic Foot Pada Pasien Diabetes Melitus. Journal Community Service of Health Science, 1(1), 26-29. https://doi.org/10.58730/jcshs.v1i1.36
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj, 372. https://doi.org/10.1136/bmj.n71
Parellangi, P., Wahyuni, E. P., Mustofa, K., Seda, B., & Tini, T. (2022). Endurance diabetes foot exercise based on family centered care (EDFE-BFCC) to reduce blood sugar levels patients diabetes mellitus type 2. Health Notions, 6(2), 51-54. https://doi.org/10.33846/hn60201
Pasaribu, D. A., & Sebayang, S. M. (2020). Pengaruh senam kaki terhadap penyembuhan luka diabetik pada pasien diabetes mellitus di ruang rawat inap ra1 dan ra2 penyakit dalam rsup. H. Adam malik medan. Indonesian Trust Health Journal, 3(1), 265-271. https://doi.org/10.37104/ithj.v3i1.45
Puwaningsih, E., Ludiana, L., & Immawati, I. (2023). Penerapan senam kaki diabetes untuk meningkatkan sensitivitas kaki pasien diabetes mellitus tipe ii di puskesmas metro. Jurnal Cendikia Muda, 3(2), 235-244.
Sanjaya, P. B., Yanti, N. L. P. E., & Puspita, L. M. (2019). Pengaruh senam kaki diabetik terhadap sensitivitas kaki pada pasien dm tipe 2. Community of Publishing in Nursing (COPING), 7(2), 97-102.
Sari, C. W. M., Witdiawati, W., Purnama, D., Kurniawan, T., & Santoso, M. B. (2022a). Effect of Integrated Care Programs on Self-Efficacy and Self-Management Behaviors among Diabetic in a Primary Health Care in Indonesia. Malaysian Journal of Medicine and Health Sciences, 18(Supp3): 157–161.
Sari, Y., Yusuf, S., Haryano, Sumeru, A., & Saryono. (2022b). The barriers and facilitators of foot care practices in diabetic patients in Indonesia: A qualitative study. Nursing Open, 9(6), 2867–2877. https://doi.org/10.1002/nop2.993
Simamora, F. A., Antoni, A., & Ritonga, S. H. (2023). Effectiveness of Diabetic Foot Exercise on Foot Pain Level in Diabetic Patients. In Proceedings of the Tapanuli International Health Conference 2022 (TIHC 2022). Atlantis Press International BV, 1 54-59 https://doi.org/10.2991/978-94-6463-032-9
Simbolon, S. M. (2020). Faktor-Faktor Yang Memengaruhi Senam Kaki Terhadap Sirkulasi Darah Kaki Pada Pasien Diabetes Mellitus Di Ruang Penyakit Dalam RSUD Dr Pirngadi Medan 2018. Dinamika Kesehatan: Jurnal Kebidanan Dan Keperawatan, 11(1), 310-318. https://doi.org/10.33859/dksm.v11i1.570
Sukartini, T., Panji Asmoro, C., & Nandani Alifah, P. (2019). The Influence of Diabetic Foot Exercise in Sensory Peripheral Neuropathy with Monofilament Test on Diabetes Mellitus Clients. Jurnal Ners, 14(3), 340–344. https://doi.org/10.20473/jn.v14i3.17263
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., ... & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
Syaipuddin, S., Haskas, Y., & Nurbaya, S. (2023). The effect of diabetic foot exercise on the effectiveness of blood sugar levels in type 2 diabetes mellitus patients at The Tamalanrea Jaya Health Center Makassar City. Science Midwifery, 10(6), 4581-4587. https://doi.org/10.35335/midwifery.v10i6.1180
WHO. (2023). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes
Widyaningsih, D. S., Prasetyowati, A. T., Harwanto, A., & Goenka, S. (2022). Newspaper Leg Exercise to Reduce the Type 2 Diabetes Mellitus Physical Symptoms. Journal of Health Sciences and Medical Development, 1(02), 83-91. https://doi.org/10.56741/hesmed.v1i02.141
Yusnita, E., Asra, A., Sulesmi, S., & Lusiani, M. (2020). Influnce of Health Education Using Audiovisual Foot Exercises of Knowledge and Specialization in Patients with Diabetes Mellitus at Rsud Dr. Dradjat Prawiranegara Serang. Journal of Industrial Engineering & Management Research, 1(4), 36-45. https://doi.org/10.7777/jiemar.v1i4.100
Fadlilah, S., Sucipto, A., & Rahil, N. H. (2019). Effectiveness of Diabetic Foot Exercises Using Sponges and Newspapers on Foot Sensitivity in Patients with Diabetes Mellitus. Belitung Nursing Journal., 5(6), 234-238. https://doi.org/10.33546/bnj.822
Francia, P., Anichini, R., De Bellis, A., Seghieri, G., Lazzeri, R., Paternostro, F., & Gulisano, M. (2015). Diabetic foot prevention: the role of exercise therapy in the treatment of limited joint mobility, muscle weakness and reduced gait speed. Ital.ian journal. of anatomy and embryology, 120(1), 21-32. https://doi.org/10.13128/IJAE-16470
Francia, P., Gulisano, M., Anichini, R., & Seghieri, G. (2014). Diabetic foot and exercise therapy: step by step the role of rigid posture and biomechanics treatment. Current diabetes reviews, 10(2), 86-99. https://doi.org/10.2174/1573399810666140507112536
Gagliardino, J. J., Chantelot, J. M., Domenger, C., Ramachandran, A., Kaddaha, G., Mbanya, J. C., ... & IDMPS Steering Committee. (2019). Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS). Diabetes research and clinical. practice, 147, 29-36. https://doi.org/10.1016/j.diabres.2018.09.008
Gamboa-Antiñolo, F. M. (2023). Diabetic foot ulcers: a growing global health emergency in the COVID-19 era. Internal. and Emergency Medicine, 18(5), 1259-1261. https://doi.org/10.1007/s11739-023-03217-8
Graciella, V., & Prabawati, D. (2020, November). The effectiveness of diabetic foot exercise to peripheral neuropathy symptoms and fasting blood glucose in type 2 diabetes patients. In International. Conference of Heal.th Development. Covid-19 and the Role of Heal.thcare Workers in the Industrial. Era (ICHD 2020) (pp. 45-49). Atlantis Press. https://doi.org/10.2991/ahsr.k.201125.008
Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Heal.th information & libraries journal., 26(2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
Handayani, O. W., Nugroho, E., & Hermawati, B. (2020). Determinant of diabetes mellitus focusing on differences of Indonesian culture: Case studies in the Java and outer java region in Indonesia. The Open Public Heal.th Journal., 13(1), 323-340. https://doi.org/10.2174/1874944502013010323
Hong, Q. N. (2021). Questions on the MMAT version 2018.
Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., ... & Pluye, P. (2018a). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for information, 34(4), 285-291. https://doi.org/10.3233/EFI-180221
Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., ... & VEDEL, I. (2020b). Mixed methods appraisal tool (MMAT) version française 2018. Education for Information. http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf%0Ahttp://mixedmethodsappraisaltoolpublic.pbworks.com/
Isworo, A., Sari, Y., Sumeru, A., & Nuriya, N. (2021). Barriers in Diabetes Self-management: A Qualitative Study from the Perspective of Nurses in Primary Health Centers, Indonesia. Open Access Macedonian Journal. of Medical. Sciences, 9(E), 1345-1352. https://doi.org/10.3889/oamjms.2021.7451
Kamillah, S., Panduragan, S. L., Poddar, S., & Bhaumik, A. (2023). Improving Diabetes Condition Through Health Literacy: A Case Study From Cianjur, West Java, Indonesia. Malaysian Journal of Medicine & Health Sciences, 19(Supp9): 221-229. https://doi.org/10.47836/mjmhs.19.s9.31
Kristianto, H. (2023). Analysis of risk factors responsible for neuropathy in patients with type 2 diabetes mellitus with diabetic foot during the COVID-19 pandemic. Iranian Journal. of Nursing and Midwifery Research, 28(1), 85-91. https://doi.org/10.4103/ijnmr.ijnmr_180_21
Ligita, T., Wicking, K., Francis, K., Harvey, N., & Nurjannah, I. (2019). How people living with diabetes in Indonesia learn about their disease: A grounded theory study. PloS one, 14(2), e0212019. https://doi.org/10.1371/journal.pone.0212019
Marwati, T. A., Kusmayanti, N. A., & Rosyidah, R. (2022). Quality of Life Among Diabetes Mellitus Patients in Indonesian Chronic Disease Management Program (Prolanis). Epidemiology and Society Health Review (ESHR), 4(2), 76-86. https://doi.org/10.26555/eshr.v4i2.5341
Matos, M., Mendes, R., Silva, A. B., & Sousa, N. (2018). Physical activity and exercise on diabetic foot related outcomes: a systematic review. Diabetes Research and Clinical Practice, 139, 81-90. https://doi.org/10.1016/j.diabres.2018.02.020
Monteiro, R. L., Ferreira, J. S., Silva, É. Q., Cruvinel-Júnior, R. H., Veríssimo, J. L., Bus, S. A., & Sacco, I. C. (2022). Foot–ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: A randomized controlled trial. Scientific reports, 12(1), 1-12. https://doi.org/10.1038/s41598-022-11745-0
Nasir, W. A., Palutturi, S., Arifin, A., Daud, A., & Mallongi, A. (2023). Analysis of Policy Implementation of Minimum Service Standards for Hypertension in Marusu Health Center Maros District. Pharmacognosy Journal, 15(5). https://doi.org/10.5530/pj.2023.15.165
Nurhayati, N. (2022). The Effect of Foot Exercise on Daily Activities and Blood Sugar Levels of Elderly in South Bangka, Indonesia. Journal of Drug Delivery and Therapeutics, 12(2-S), 58-62. https://doi.org/10.22270/jddt.v12i2-S.5421
Nursalam, H. (2020). Penulisan Literature Review dan Systematic Review Pada Pendidikan Kesehatan (Contoh). Surabaya: Fakultas Keperawatan Universitas Airlangga.
Oktavianti, D. S., & Hernawati, Y. (2022). Edukasi Senam Kaki Diabetik Sebagai Upaya Pencegahan Diabetic Foot Pada Pasien Diabetes Melitus. Journal Community Service of Health Science, 1(1), 26-29. https://doi.org/10.58730/jcshs.v1i1.36
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj, 372. https://doi.org/10.1136/bmj.n71
Parellangi, P., Wahyuni, E. P., Mustofa, K., Seda, B., & Tini, T. (2022). Endurance diabetes foot exercise based on family centered care (EDFE-BFCC) to reduce blood sugar levels patients diabetes mellitus type 2. Health Notions, 6(2), 51-54. https://doi.org/10.33846/hn60201
Pasaribu, D. A., & Sebayang, S. M. (2020). Pengaruh senam kaki terhadap penyembuhan luka diabetik pada pasien diabetes mellitus di ruang rawat inap ra1 dan ra2 penyakit dalam rsup. H. Adam malik medan. Indonesian Trust Health Journal, 3(1), 265-271. https://doi.org/10.37104/ithj.v3i1.45
Puwaningsih, E., Ludiana, L., & Immawati, I. (2023). Penerapan senam kaki diabetes untuk meningkatkan sensitivitas kaki pasien diabetes mellitus tipe ii di puskesmas metro. Jurnal Cendikia Muda, 3(2), 235-244.
Sanjaya, P. B., Yanti, N. L. P. E., & Puspita, L. M. (2019). Pengaruh senam kaki diabetik terhadap sensitivitas kaki pada pasien dm tipe 2. Community of Publishing in Nursing (COPING), 7(2), 97-102.
Sari, C. W. M., Witdiawati, W., Purnama, D., Kurniawan, T., & Santoso, M. B. (2022a). Effect of Integrated Care Programs on Self-Efficacy and Self-Management Behaviors among Diabetic in a Primary Health Care in Indonesia. Malaysian Journal of Medicine and Health Sciences, 18(Supp3): 157–161.
Sari, Y., Yusuf, S., Haryano, Sumeru, A., & Saryono. (2022b). The barriers and facilitators of foot care practices in diabetic patients in Indonesia: A qualitative study. Nursing Open, 9(6), 2867–2877. https://doi.org/10.1002/nop2.993
Simamora, F. A., Antoni, A., & Ritonga, S. H. (2023). Effectiveness of Diabetic Foot Exercise on Foot Pain Level in Diabetic Patients. In Proceedings of the Tapanuli International Health Conference 2022 (TIHC 2022). Atlantis Press International BV, 1 54-59 https://doi.org/10.2991/978-94-6463-032-9
Simbolon, S. M. (2020). Faktor-Faktor Yang Memengaruhi Senam Kaki Terhadap Sirkulasi Darah Kaki Pada Pasien Diabetes Mellitus Di Ruang Penyakit Dalam RSUD Dr Pirngadi Medan 2018. Dinamika Kesehatan: Jurnal Kebidanan Dan Keperawatan, 11(1), 310-318. https://doi.org/10.33859/dksm.v11i1.570
Sukartini, T., Panji Asmoro, C., & Nandani Alifah, P. (2019). The Influence of Diabetic Foot Exercise in Sensory Peripheral Neuropathy with Monofilament Test on Diabetes Mellitus Clients. Jurnal Ners, 14(3), 340–344. https://doi.org/10.20473/jn.v14i3.17263
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., ... & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
Syaipuddin, S., Haskas, Y., & Nurbaya, S. (2023). The effect of diabetic foot exercise on the effectiveness of blood sugar levels in type 2 diabetes mellitus patients at The Tamalanrea Jaya Health Center Makassar City. Science Midwifery, 10(6), 4581-4587. https://doi.org/10.35335/midwifery.v10i6.1180
WHO. (2023). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes
Widyaningsih, D. S., Prasetyowati, A. T., Harwanto, A., & Goenka, S. (2022). Newspaper Leg Exercise to Reduce the Type 2 Diabetes Mellitus Physical Symptoms. Journal of Health Sciences and Medical Development, 1(02), 83-91. https://doi.org/10.56741/hesmed.v1i02.141
Yusnita, E., Asra, A., Sulesmi, S., & Lusiani, M. (2020). Influnce of Health Education Using Audiovisual Foot Exercises of Knowledge and Specialization in Patients with Diabetes Mellitus at Rsud Dr. Dradjat Prawiranegara Serang. Journal of Industrial Engineering & Management Research, 1(4), 36-45. https://doi.org/10.7777/jiemar.v1i4.100
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Sirait, H., Said, F., & Mohamad, N. (2024). Successful Aspects and Impacts of Diabetic Foot Exercise Among Indonesian Type 2 Diabetes Mellitus Patients: A Literature Review. International Journal of Advancement in Life Sciences Research, 7(2), 9-16. https://doi.org/https://doi.org/10.31632/ijalsr.2024.v07i02.002
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