en Nursing Original Article <div style="text-align: justify;"><span style="font-size:12px;"><span style="font-family:Times New Roman;"><b>Background:</b> Given the anxiety experienced by patients awaiting diabetic foot ulcer surgery, evidence supporting the efficacy of preoperative art therapy can be clinically valuable. However, evidence on the effectiveness of digital coloring, a modern and accessible form of art therapy, remains limited. This study aimed to investigate the effects of digital coloring on state-trait anxiety levels and pulse rate in elderly patients scheduled for diabetic foot ulcer surgery.<br> <b>Methods:</b> This quasi-experimental study employed a pre-test&ndash;post-test design with intervention and control groups. The study was conducted from January 2023 to July 2024 at a referral teaching hospital in Amol, Iran. The participants were selectively assigned to either an intervention group (n=30) or a control group (n=30) via purposive sampling. Both groups received standard preoperative care, but one hour before the scheduled surgery, the intervention group received a one-session digital coloring. Data were collected using a demographic questionnaire and the State-Trait Anxiety Inventory (STAI Form Y-1). The variables were assessed at baseline and immediately after the coloring session in both study groups. An analysis of covariance (ANCOVA) was conducted to compare post-intervention state anxiety between the intervention and control groups, while controlling for pre-intervention anxiety levels. Data analysis in SPSS v25 employed &chi;&sup2;, Fisher&rsquo;s exact, paired, and independent t-tests, with significance set at <i>p</i> <0.05.<br> <b>Results:</b> Both study groups were homogeneous in terms of gender, age, and education level.&nbsp; Baseline anxiety (<i>p</i>=0.43) and pulse rate (<i>p</i>=0.12) were similar between groups. Post-intervention results revealed a clinically meaningful reduction in the intervention group (43.20&plusmn;3.70) versus controls (50.33&plusmn;6.18), with a significant between-group difference (<i>p</i><0.001, d=1.42). The between-group difference in pulse rate was also significant (<i>p</i>=0.002), with a large effect size (Cohen&rsquo;s d=0.87).<br> <b>Conclusion</b>: Our findings suggest that the digital coloring intervention may be associated with reductions in state anxiety and pulse rate among elderly patients awaiting diabetic foot ulcer surgery. Given that this intervention is simple, inexpensive, and easily accessible, we recommend its use to alleviate state anxiety in clinical settings that typically provoke anxiety, such as during diagnostic procedures.</span></span></div> Anxiety, Diabetic foot, Aged, Art therapy, Surgical procedures 40 45 http://nmj.goums.ac.ir/browse.php?a_code=A-10-2125-1&slc_lang=en&sid=1 Fatemeh Aramideh fatemeharamideh10@gmail.com 100319475328460016410 100319475328460016410 No Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Sepideh Mohammadi sepidmohamadi@gmail.com 100319475328460016411 100319475328460016411 Yes Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Abbas Shamsalinia abbasshamsalinia@yahoo.com 100319475328460016412 100319475328460016412 No Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Omolhoda Kaveh kaveh.hoda@yahoo.com 100319475328460016413 100319475328460016413 No School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran