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Nie XY, Dong XX, Lu H, Li DL, Zhao CH, Huang Y, Pan CW. Multimorbidity patterns and the risk of falls among older adults: a community-based study in China. BMC Geriatr 2024; 24:660. [PMID: 39112944 PMCID: PMC11304791 DOI: 10.1186/s12877-024-05245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Due to the high prevalence of multimorbidity and realistic health service demands for fall prevention, there is growing interest in the association between multimorbidity and falls. Our study aimed to identify multimorbidity patterns among Chinese older adults and explore the association between multimorbidity patterns and falls. METHODS Data from 4,579 Chinese community-dwelling older adults was included in this analysis. Information regarding falls and 10 chronic conditions was collected. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of individual chronic disease or multimorbidity patterns with falls. RESULTS Among 4,579 participants, 368 (8.0%) were defined as fallers, including 92 (2.0%) frequent fallers, and multimorbidity affected 2,503 (54.7%) participants. Older adults with multimorbidity were more likely to be fallers [odds ratio (OR) = 1.3, P = 0.02] and frequent fallers (OR = 1.7, P = 0.04). Three multimorbidity patterns were identified (i.e., cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases), and the associations between psycho-cognitive diseases/organic diseases and prevalent falls or frequent falls were found to be significant. CONCLUSIONS The psycho-cognitive disease pattern and organic disease pattern are significantly associated with falls. Therefore, more attention should be paid to patients with psycho-cognitive diseases and timely, targeted diagnostic and treatment services should be provided in fall prevention.
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Affiliation(s)
- Xin-Yi Nie
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xing-Xuan Dong
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Heng Lu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Chun-Hua Zhao
- Department of General Medicine, Medical Big Data Center, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Yueqing Huang
- Department of General Medicine, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China.
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
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Alsayed Hassan DA, Chivese T, Syed MA, Alhussaini NWZ. Prevalence and factors associated with falls in older adults in a Middle Eastern population: a retrospective cross-sectional study. Public Health 2024; 233:54-59. [PMID: 38848620 DOI: 10.1016/j.puhe.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/24/2024] [Accepted: 04/05/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE The main objective was to determine the prevalence of falls and associated factors in older adults living in Qatar. STUDY DESIGN Cross-sectional study. METHODS This is a cross-sectional study of older adults aged ≥60 years with at least one encounter with primary health care corporation (PHCC) in Qatar during the period 2017-2022. Data on documented falls, demographic variables, and medical comorbidities were extracted from all PHCCs in Qatar. Descriptive and inferential statistics were used to address the aim of the study. RESULTS A total of 68,194 older adults had at least one encounter with PHCC. The median age was 65.0 years, 58.9% were males, and 32.6% were Qatari nationality. A higher percentage of falls was found in individuals with hypertension (80%), diabetes (74.2%), and dyslipidemia (48.9%), which were also the most prevalent comorbidities. The prevalence of falls was 6.7% (95% CI 6.6-6.9). Compared to individuals aged 60-69 years, individuals aged 70-79, 80-89, and 90-99 had increased odds of falls by 1.6 (95% CI 1.5, 1.8), 2.5 (95% CI 2.2, 2.8), and 2.6 (95% CI 2.0, 3.3), respectively. Females and individuals of Qatari nationality had increased odds of fall by 1.5 (95% CI 1.4, 1.6) and 1.2 (95% CI 1.1, 1.3), respectively. Orthostatic hypotension, syncope, Parkinson's disease, and hip arthritis showed the strongest associations with falls. CONCLUSIONS Given the growing population of older adults in the Middle East and North African region, falls is a public health concern. The risk factors identified in this study suggest the need for proactive healthcare strategies tailored to the unique needs of older adult populations.
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Affiliation(s)
| | - T Chivese
- College of Medicine, Qatar University, QU Health, Doha, Qatar
| | - M A Syed
- Primary Health Care Corporation, Doha, Qatar
| | - N W Z Alhussaini
- College of Health Sciences, Qatar University, QU Health, Doha, Qatar
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Varghese NM, Varghese JS. Sex differences in association of joint glycemic, blood pressure and lipid control and two-year risk of falls among older adults with diabetes. J Diabetes Complications 2024; 38:108815. [PMID: 39024755 DOI: 10.1016/j.jdiacomp.2024.108815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/05/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
AIMS To characterize the risk of falls among males and females by joint glycemic, blood pressure (BP) and cholesterol control among older adults (≥65 years) with diagnosed diabetes in USA. METHODS Using longitudinal data from the Health and Retirement Study (2006-2019), we studied the association of joint glycemic (HbA1c < 7.5 %), BP (systolic <140 and diastolic <90 mmHg) and cholesterol (total < 200 mg/dL) control with two-year risk of falls. We estimated risk ratios (RR) to describe the associations for joint ABC control and independent biomarker control by sex, using modified Poisson regressions after adjusting for known individual and household risk factors. RESULTS The analytic sample consisted of 4509 observations from 2829 older adults (54.7 % female) with a mean age of 72.2 (SD: 6.6) years and duration of diabetes of 9.9 years. Joint ABC control was not associated with risk of falls among females but was associated with lower risk among males (0.91 [95%CI: 0.81-1.02]). Furthermore, achievement of glycemic control (0.85 [95%CI: 0.73-0.98]) and BP control (0.89 [95%CI: 0.79-1.01]) were associated with lower risk but cholesterol control (1.15 [95%CI: 0.99, 1.34]) was associated with higher risk of falls among males. CONCLUSIONS Joint achievement of glycemic, BP and cholesterol targets may prevent falls among older males. Future studies among people with diabetes should consider biomarker control as a preventive factor for falls.
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Affiliation(s)
| | - Jithin Sam Varghese
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
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Irigoyen-Camacho ME, Velazquez-Alva MC, Zepeda-Zepeda MA, Lazarevich I, Castano-Seiquer A, Flores-Fraile J. Physical Performance, Body Composition, and Oral Health in Community-Residing Older Adults: A Cross-Sectional Study. Geriatrics (Basel) 2024; 9:89. [PMID: 39051253 PMCID: PMC11270300 DOI: 10.3390/geriatrics9040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Physical activity is essential for healthy aging. This study aimed to identify an association between physical performance, body fat percentage (%BF), and the perception of oral health-related quality of life (OHRQoL) in independent older adults. METHOD A group of active older adults was selected from a government-sponsored reunion center in Mexico City. OHRQoL was assessed using the General Oral Health Index (GOHAI), and nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool. A short physical performance battery (SPPB) was applied, and, for body composition, DXA (dual X-ray absorptiometry) was conducted. Data were analyzed using logistic regression models, and marginal probabilities were obtained. RESULTS This study involved 366 participants; their mean age was 73.9 (±6.2) years, and 24.9% had type 2 diabetes mellitus (T2DM). OHRQoL information revealed that pain or discomfort in the oral cavity was perceived by 63.9% of the older adults during the previous three months. The SPPB score was low in 159 (43.44%) participants. The logistic regression model revealed that age (OR = 1.13, p < 0.001), T2DM (OR = 2.10, p = 0.009), the risk of malnutrition/malnutrition (OR = 1.76, p = 0.047), high %BF (OR = 1.09, <0.001), and poor OHRQoL (OR = 1.96, p = 0.009) were associated with deteriorated physical performance. CONCLUSION OHRQoL self-perception, excess body fat, and nutritional status impacted physical performance. Aging well requires a comprehensive approach.
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Affiliation(s)
- Maria Esther Irigoyen-Camacho
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | - Maria Consuelo Velazquez-Alva
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | - Marco Antonio Zepeda-Zepeda
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | - Irina Lazarevich
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | | | - Javier Flores-Fraile
- Department of Surgery, Faculty of Medicine, University of Salamanca, C. Alfonso X el Sabio, s.n., 37008 Salamanca, Spain;
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Corral-Pérez J, Mier A, Vázquez-Sánchez MÁ, Naranjo-Márquez M, Ponce-Gonzalez JG, Casals C. Multidimensional associations of physical performance, balance, wellness and daily activities with frailty in older adults with coexisting frailty and diabetes. J Clin Nurs 2024. [PMID: 38932443 DOI: 10.1111/jocn.17336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The coexistence of frailty and type 2 diabetes mellitus in the older population heightens the risk of adverse events. However, research on functional and wellness factors associated with frailty in this population is limited. PURPOSE To investigate the associations of physical performance, functional dependency, physical activity, nutritional status, sleep, self-perceived health and depression with frailty in community-dwelling older adults with coexisting frailty and type 2 diabetes mellitus. DESIGN Cross-sectional. METHODS The study included 123 community-dwelling older adults (73.7 ± 6.0 years) with pre-frailty/frailty and type 2 diabetes mellitus. Physical performance (Short Physical Performance Battery), functional dependency (Barthel Index and Lawton & Brody), physical activity and inactivity (GeneActiv wrist-worn accelerometer), malnutrition risk (Mini Nutritional Assessment), sleep (Pittsburgh Sleep Quality Index), self-perceived health (EuroQoL 5-Dimension 3-Level) and depression (Yesavage 15-item-Geriatric-Depression-Scale) were evaluated through personal interviews. Principal component analysis (PCA) was performed to categorize the variables into components, and logistic regressions were used to propose the best-fitted model for each component. RESULTS The PCA identified four components: (i) physical performance, with gait speed and leg mean velocity as the main variables associated with frailty; (ii) balance, showing significant associations with monopodal balance; (iii) daily activities, with moderate to vigorous physical activity and the Lawton and Brody score as the main variables associated with frailty within this component; and (iv) wellness factors, with nutritional status, self-perceived health and depression score as the primary variables associated with frailty. CONCLUSIONS This research underscores the significance of physical function and daily activities as protective factors against frailty in community-dwelling older adults with coexisting frailty and type 2 diabetes mellitus. The health dimension contributes both protective and risk factors, emphasizing the need for comprehensive assessments in managing frailty in this population. REPORTING METHOD The study adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Juan Corral-Pérez
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Alba Mier
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - María Ángeles Vázquez-Sánchez
- Department of Nursing, Faculty of Health Sciences, PASOS Research Group, UMA REDIAS Network of Law and Artificial Intelligence Applied to Health and Biotechnology, University of Malaga, Málaga, Spain
| | | | - Jesus Gustavo Ponce-Gonzalez
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Cristina Casals
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
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Hao J, Chen Z, Yao Z, Remis A, Huang B, Li Y. Effects of virtual reality on balance in people with diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord 2024; 23:417-425. [PMID: 38932876 PMCID: PMC11196464 DOI: 10.1007/s40200-024-01413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 06/28/2024]
Abstract
Purpose This systematic review aims to identify, critically appraise, and synthesize the effects of virtual reality on balance in people with diabetes. Methods Five biomedical databases were searched from inception to December 15, 2023. Clinical trials investigating the effects of virtual reality on performance-based or patient-reported outcome measures related to balance function among people with diabetes were included. Two independent reviewers conducted study selection, data extraction, and quality assessment. Cochrane risk-of-bias tool-2 were used to assess included studies. Meta-analysis was performed to examine the effects of the intervention. Results Six studies with a total of 257 participants were identified. Two studies had high risk of bias, and four studies had some concerns regarding risk of bias. No adverse events related to virtual reality were reported. Meta-analysis revealed significant improvements in the Berg Balance Scale (SMD = 1.56, 95% CI 0.71 to 2.40, p < 0.001), Timed Up and Go test (SMD = -0.74, 95% CI -1.21 to -0.28, p = 0.002), and falls efficacy (SMD = 0.99, 95% CI 0.43 to 1.54, p < 0.001) following virtual reality intervention. No significant differences were found for postural sway and single leg stance measures. Conclusion Virtual reality-based rehabilitation demonstrates promising effects for improving balance in people with diabetes. Further studies with high methodological quality and large sample sizes are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01413-7.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, 68198 Omaha, NE USA
- Department of Physical Therapy, Southeast Colorado Hospital, 81073 Springfield, CO USA
- University of Nebraska Medical Center , 68198 Omaha, NE USA
| | - Ziyan Chen
- School of Basic Medical Sciences, Capital Medical University, 100069 Beijing, P.R. China
| | - Zixuan Yao
- Department of Rehabilitation Medicine, Beijing Hospital, National Center of Gerontology, Institution of Geriatric Medicine, Chinese Academy of Medical Science, 100051 Beijing, P.R. China
| | - Andréas Remis
- Health Research Association of Keck Medicine, University of Southern California, 90033 Los Angeles, CA USA
| | - Biying Huang
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, 68198 Omaha, NE USA
| | - Yanfei Li
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, 68198 Omaha, NE USA
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Freire LB, Brasil-Neto JP, da Silva ML, Miranda MGC, de Mattos Cruz L, Martins WR, da Silva Paz LP. Risk factors for falls in older adults with diabetes mellitus: systematic review and meta-analysis. BMC Geriatr 2024; 24:201. [PMID: 38413865 PMCID: PMC10900672 DOI: 10.1186/s12877-024-04668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/04/2024] [Indexed: 02/29/2024] Open
Abstract
AIM To identify risk factors for falls in older adults with Type 2 Diabetes Mellitus (T2DM). METHODS The eligible studies identified factors associated with the risk of falls in older adults with T2DM. We searched PubMed, Cinahl, Web of Science, Scopus, and the Cochrane Library databases. The review has been updated and the last review date was November 30, 2023 (CRD42020193461). RESULTS Twelve studies met the inclusion criteria, and eight studies were included in the meta-analysis. These studies included a total of 40,778 older adults with T2DM, aged 60 to 101 years. The risk of developing the outcome falls in older adults with T2DM is 63% higher compared to the risk in older adults without T2DM (HR 1.63; 95% CI [1.30 - 2.05]). The overall chance of falling in older adults with T2DM is 59% higher than that of non-diabetic older adults (OR 1.59; 95% CI [1.36 -1.87]), and in older adults with T2DM who take insulin the chance of falling is 162% higher (OR 2.62; 95% CI [1.87 - 3.65]). No results on diabetic polyneuropathy were found in the studies. CONCLUSION Older adults with T2DM present a higher risk of falls compared to non-diabetics. Among the included older adults with T2DM, the most important factor associated with a higher risk of falls was insulin use. TRIAL REGISTRATION Registered in the International Prospective Register of Systematic Reviews (CRD42020193461).
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Affiliation(s)
- Larissa Barros Freire
- Postgraduate course in Health Sciences and Technologies, University of Brasília (UnB) - Campus Ceilândia, Brasília, DF, Brazil
| | | | | | | | - Lorrane de Mattos Cruz
- Graduate program of Physical Therapy, University of Brasilia - Campus Ceilândia, Brasília, Brazil
| | - Wagner Rodrigues Martins
- University of Brasilia, Faculty of Ceilândia, Rehabilitation Sciences and Physical Education Postgraduate Program, Brasília, DF, Brazil
| | - Leonardo Petrus da Silva Paz
- Postgraduate course in Health Sciences and Technologies, University of Brasília (UnB) - Campus Ceilândia, Brasília, DF, Brazil.
- University of Brasilia, Campus Ceilandia - Faculty of Ceilandia, Brasília, 72220-275, Brazil.
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Mahalingasivam AA, Jespersen AK, Ejskjaer N, Hougaard DD, Vestergaard P, Rasmussen NHH, Røikjer J. The co-existence of peripheral and vestibular neuropathy in diabetes: a cross-sectional study. Eur Arch Otorhinolaryngol 2024; 281:663-672. [PMID: 37515636 PMCID: PMC10796646 DOI: 10.1007/s00405-023-08130-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Diabetic neuropathy can lead to decreased peripheral sensation and motor neuron dysfunction associated with impaired postural control and risk of falling. However, the relationship between decreased peripheral sensation and impaired vestibular function in diabetes mellitus is poorly investigated. Therefore, the aim of this study was to investigate the relationship between peripheral and autonomic measurements of diabetic neuropathy and measurements of vestibular function. METHODS A total of 114 participants with type 1 diabetes (n = 52), type 2 diabetes (n = 51) and controls (n = 11) were included. Vestibular function was evaluated by video head impulse testing. Peripheral neuropathy was assessed by quantitative sensory testing and nerve conduction. Autonomic neuropathy using the COMPASS 31 questionnaire. Data were analyzed according to data type and distribution. RESULTS Measurements of vestibular function did not differ between participants with type 1 diabetes, type 2 diabetes or controls (all p-values above 0.05). Subgrouping of participants according to the involvement of large-, small- or autonomic nerves did not change this outcome. Correlation analyses showed a significant difference between COMPASS 31 and right lateral gain value (ρ = 0.23, p = 0.02,), while no other significant correlations were found. CONCLUSION Diabetic neuropathy does not appear to impair vestibular function in diabetes, by means of the VOR. CLINICAL TRIALS NCT05389566, May 25th, 2022.
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Affiliation(s)
| | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Balance & Dizziness Centre, Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Nicklas Højgaard-Hessellund Rasmussen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Integrative Neuroscience, Aalborg University, Søndre Skovvej 3E, 9000, Aalborg, Denmark.
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DiLiberto FE, Kamath HER, Olson ML, Cherchi M, Helminski JO, Schubert MC. When, where, and why should we look for vestibular dysfunction in people with diabetes mellitus? FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1306010. [PMID: 38273862 PMCID: PMC10808374 DOI: 10.3389/fresc.2023.1306010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
The biochemistry of diabetes mellitus results in multi-system tissue compromise that reduces functional mobility and interferes with disease management. Sensory system compromise, such as peripheral neuropathy and retinopathy, are specific examples of tissue compromise detrimental to functional mobility. There is lack of clarity regarding if, when, and where parallel changes in the peripheral vestibular system, an additional essential sensory system for functional mobility, occur as a result of diabetes. Given the systemic nature of diabetes and the plasticity of the vestibular system, there is even less clarity regarding if potential vestibular system changes impact functional mobility in a meaningful fashion. This commentary will provide insight as to when we should employ diagnostic vestibular function tests in people with diabetes, where in the periphery we should look, and why testing may or may not matter. The commentary concludes with recommendations for future research and clinical care.
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Affiliation(s)
- Frank E. DiLiberto
- Department of Audiology and Speech Pathology, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, United States
- Department of Physical Therapy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Heather E. R. Kamath
- Department of Audiology and Speech Pathology, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, United States
| | - Maxine L. Olson
- Department of Audiology and Speech Pathology, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, United States
- Department of Physical Therapy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Marcello Cherchi
- Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Janet O. Helminski
- Department of Physical Therapy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
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Amput P, Wongphon S, Phrompao P. Evaluating the Balancing Ability of Older Adults with Diabetes Mellitus Using the Multi-directional Reach Test. Curr Aging Sci 2024; 17:113-117. [PMID: 38904153 DOI: 10.2174/0118746098253144231024052312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 06/22/2024]
Abstract
BACKGROUND The incidence of elderly people experiencing falls is currently increasing, which results in serious medical issues, such as fear of falling, limited physical activity, disability, and bone fractures, especially hip fractures. This study aimed to investigate balancing ability using a multi-directional reach test (MDRT) in older adults with and without diabetes mellitus. METHODS 72 older adults with and without diabetes mellitus were recruited, and divided into two groups, including older adults without diabetes mellitus (n = 36) and older adults with diabetes mellitus (n = 36). All subjects completed all directions of the MDRT. RESULTS There were no significant differences in MDRT scores in all directions between the two groups (p>0.05). Both groups achieved the highest MDRT scores in the forward direction. In contrast, the two groups had the lowest scores of MDRT in a backward direction. Furthermore, older adults with diabetes mellitus had lower MDRT scores in all directions than older adults without diabetes mellitus. CONCLUSION The current study indicated that MDRT could be used to investigate the ability of balance in individuals with diabetes mellitus.
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Affiliation(s)
- Patchareeya Amput
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitation, University of Phayao, Phayao, Thailand
| | - Sirima Wongphon
- Department of Traditional Chinese Medicine, School of Public Health, University of Phayao, Phayao, Thailand
| | - Patcharin Phrompao
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
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Pedro ACM, Campelo BLD, Souza WC, da Silva Sousa FM, da Rocha RB, Cardoso VS. Therapeutic Interventions to Improve Static Balance in Type 2 DiabetesMellitus: A Systematic Review and Meta-Analysis. Curr Diabetes Rev 2024; 20:e060224226109. [PMID: 38310484 DOI: 10.2174/0115733998272338231213070602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 10/10/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a metabolic disorder characterized by an abnormal increase in blood glucose levels resulting from insulin secretion and/or dysfunctional activity that can lead to several serious complications in addition to decreased postural balance. OBJECTIVE This study aimed to identify and analyze the main interventions used to improve static balance in patients with DM. METHODS For the selection of articles, a bibliographic search was performed using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only clinical trials that investigated the effect of training on static balance in adults with type 2 DM were selected, and 34 studies were included. RESULTS The search resulted in the identification of 2681 articles, and of these, 31 were eligible for the study. The identified interventions were proprioceptive, aerobic, resistance training on platforms, in virtual reality, and Tai Chi. The main results obtained were an increase in time in the one-leg stance, Romberg test, and tandem position, a significant increase in the Berg Balance Scale score and balance index, and a reduction in the variables of postural sway. CONCLUSION There are a variety of effective training methods for improving static balance, and the choice of intervention to be applied goes beyond proven effectiveness, depending on reproducibility and/or financial cost.
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Affiliation(s)
- Ana Cristina Marques Pedro
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | | | - Wellington Costa Souza
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Fernanda Mello da Silva Sousa
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
- Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Rebeca Barbosa da Rocha
- Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
- Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Vinicius Saura Cardoso
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
- Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
- Diabetic Foot Clinic, Center of Medical Specialties, Parnaíba, Piauí, Brazil
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12
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Pouwer F, Mizokami-Stout K, Reeves ND, Pop-Busui R, Tesfaye S, Boulton AJM, Vileikyte L. Psychosocial Care for People With Diabetic Neuropathy: Time for Action. Diabetes Care 2024; 47:17-25. [PMID: 38117989 DOI: 10.2337/dci23-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 12/22/2023]
Abstract
Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
- Lieutenant Colonel Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester, U.K
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Andrew J M Boulton
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
| | - Loretta Vileikyte
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
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13
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Sharma S, Kalia V. Effect of tibial nerve mobilization on balance & gait functions in subjects with subclinical diabetic neuropathy: A randomized clinical trial. J Diabetes Metab Disord 2023; 22:1283-1290. [PMID: 37975109 PMCID: PMC10638326 DOI: 10.1007/s40200-023-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/04/2023] [Indexed: 11/19/2023]
Abstract
Introduction With advancing age, balance control diminishes as a result of cognitive impairment, decreased muscle strength, and impairment in visual, vestibular, and somatosensory systems. Besides aforesaid factors, the addition of diabetes to all these leads to balance and gait-related issues such as falls and fall-related injuries. Impaired balance and gait performance in diabetics are primarily attributed to the diminished sensory function of the foot and ankle region owing to diabetic neuropathy. The purpose of this study was to explicitly examine the impact of neural mobilization on the balance & gait functions of subjects having subclinical diabetic neuropathy. Methods 40 individuals with subclinical diabetic neuropathy, ranging in age from 50 to 75 years, were assigned to two groups at random: Group 1 received the concurrent application of Tibial nerve mobilization and Balance-Gait training whereas Group 2 received only Balance-Gait training. The therapy was administered five times each week, for four weeks. On the first and last day of treatment, measurements of VPT, BBS, TUG, and DGI were taken from each subject. Results The results of the study found that post neural mobilization and Balance-Gait training, scores of VPT, BBS, DGI, and TUG showed improvement but it was not significant. As it is evident that diabetic neuropathy is progressive in nature, even small changes can be helpful. Conclusion Neural mobilization integrated with balance-gait training of subclinical diabetic neuropathic individuals resulted in improved sensory functions along with enhanced balance-gait functions. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01246-w.
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Affiliation(s)
- Shanika Sharma
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001 India
| | - Varun Kalia
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001 India
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14
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Shahrjerdi S, Bahrpeyma F, Bagherian SA. Acute short term effects of endurance and resistance training on balance control in patients with diabetic peripheral neuropathy. Int J Neurosci 2023; 133:1017-1023. [PMID: 35109765 DOI: 10.1080/00207454.2022.2033739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/08/2020] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Exercise training have numerous beneficial effects on the complications of diabetic peripheral neuropathy. Exercise training may cause immediate effects on balance control in DPN patients. This study aims to assess the Acute Short Term effects of endurance and resistance exercise training on balance control in DPN patients. METHODS In this study, 11 patients with DPN and 11 healthy subjects participated. Patients and healthy subjects did endurance and resistance training in two separate exercise sessions. Dynamic balance and functional balance test were assessed before and after the interventions. Independent t-test was used to compare balance indices before and after training, the intervention effects were examined using ANOVA repeated measure test. The statistical significance level was set at p < 0.05. RESULTS The results showed that dynamic and functional balance in DPN patients were significantly lower than in healthy subjects. Anterior-posterior stability and total stability indices and functional balance test deteriorated significantly after training. CONCLUSION Endurance or resistance training may lead to acute disturbance of dynamic and functional balance in DPN patients. Hence, immediately after exercise, patients with diabetes are at an increased risk of falling, therefore, preventive considerations are necessary.
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Affiliation(s)
- Samira Shahrjerdi
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Ahmad Bagherian
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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15
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Gulley Cox LI, Dias N, Zhang C, Zhang Y, Gorniak SL. Effects of Type II Diabetes on Proprioception during a Reach to Pinch Task. J Mot Behav 2023; 56:263-274. [PMID: 37997260 PMCID: PMC10957313 DOI: 10.1080/00222895.2023.2285888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Older adults with type II diabetes (T2D) are at risk of developing nerve disorders that result in functional impairment. Most work in proprioceptive dysfunction in older adults with T2D has focused on functional deficits of the lower limb. The purpose of this study was to examine proprioceptive effects of T2D on the upper limb in older adults. Kinematic performance of a reach-to-pinch action toward a virtual target was assessed in a T2D group (60+ years old with T2D) and a healthy age- and sex-matched control group. Tactile and vibratory thresholds did not differ between T2D and controls. Task accuracy via mean pinch location was significantly worse for persons with T2D (pwT2D) with differences in wrist extension/flexion (ex/fl), wrist abduction/adduction (ab/ad), 1st carpometacarpal (CMC) ab/ad, 2nd metacarpophalangeal (MCP2) ex/fl, MCP2 ab/ad, and digit 1 and hand transport trajectories. Group differences persisted with consideration of body mass index; sex differences in task accuracy emerged. Findings indicate that proprioception of the upper extremity is altered in pwT2D such that they exhibit a unique aperture position and aiming strategy during a reach-to-pinch action. These findings characterize functional sensorimotor impairment of the upper limb in pwT2D with respect to workspaces without visual or tactile feedback.
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Affiliation(s)
- Lauren I. Gulley Cox
- Department of Health and Human Performance, University of Houston, Houston, TX 77204
| | - Nicholas Dias
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Chuan Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Stacey L. Gorniak
- Department of Health and Human Performance, University of Houston, Houston, TX 77204
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16
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Jørgensen IEH, Devantier L, Tankisi H, Andersen H, Khan KS. The impact of vestibular dysfunction on falls and postural instability in individuals with type 2 diabetes with and without diabetic polyneuropathy. PeerJ 2023; 11:e16382. [PMID: 38025708 PMCID: PMC10652841 DOI: 10.7717/peerj.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Aim This study aimed to determine the association between vestibular dysfunction, falls, and postural instability in individuals with type 2 diabetes (T2D) compared to healthy control individuals and to examine the impact of diabetic polyneuropathy (DPN). Methods This cross-sectional study included individuals with T2D with DPN (n = 43), without DPN (n = 32), and healthy controls (n = 32). Cervical and ocular vestibular evoked myogenic potentials (VEMP) were recorded, and latencies and amplitudes were determined. DPN was diagnosed based on nerve conduction studies and clinical scores. Postural instability was examined using a static posturographic balance system and calculated as an instability index (ST). Falls were recorded retrospectively during the past year. Group comparisons were conducted by using univariate and bivariate statistics. Results Individuals with T2D experienced more falls than healthy controls (T2D with DPN n = 12[38%], T2D without DPN n = 15[35%], controls n = 5[16%], p = 0.04). Individuals with T2D had decreased postural stability, T2D with DPN, ST (median of 52[iqi = 33; 77]), T2D without DPN, ST (median of 31[iqi = 24; 39]), controls ST (median of 26[iqi = 19; 33], p = 0.01), when comparing all three groups. Individuals with T2D had a greater number of no-responses in oVEMP compared to controls (T2D with DPN, n = 15[46.9%] T2D without DPN n = 25[58.1%], controls n = 9[28.1%], p = 0.04). No difference was found in cVEMP and oVEMP amplitudes in any of the groups. Irrespectively of DPN, fallers with T2D had decreased oVEMP and cVEMP latencies on the right ears, when comparing to non-fallers, respectively, n10 (fallers [median of 16, iqi=15;19 ms.] vs. non-fallers [median of 25 iqi=16;35 ms]); p13 (fallers [median of 16, iqi=15;17 ms.] vs. non-fallers [median of 15, iqi=8;16 ms.], p < 0.05). Conclusion Falls and postural instability were more frequent in individuals with T2D compared to healthy controls. Fallers with T2D had vestibular end-organ impairments based on the oVEMP and cVEMP latencies on the right but not the left ears, irrespective of DPN. Individuals with T2D had more frequent no-response of the oVEMP, indicating impaired vestibular nerve function.
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Affiliation(s)
| | - Louise Devantier
- Department of Otorhinolaryngology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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17
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Rushan Z, Kumar S. Letter to editor: Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus. Acta Diabetol 2023; 60:1595-1596. [PMID: 37640798 DOI: 10.1007/s00592-023-02156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/03/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Zahira Rushan
- Shifa College of Medicine, H-8/4, Islamabad, Pakistan.
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi, Karachi, Pakistan
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18
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Seo H, Yoon J, Cho OH. Falls, fear of falling, and related factors in patients with diabetic foot disease. Appl Nurs Res 2023; 73:151715. [PMID: 37722783 DOI: 10.1016/j.apnr.2023.151715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Falls and fear of falling (FOF) are common in patients with diabetic foot disease (DFD). PURPOSE To understand the relationship between falls, FOF, and related factors in patients with DFD. METHOD We recruited 70 patients being treated for DFD at two hospitals in Korea. A structured questionnaire was used in investigating fall experience, FOF, and related factors. RESULTS Among the participants, 42.8 % fell in the past year, and FOF was reported in 57.1 %. Rates of "no caregiver," "DFD duration (>1 year)," and "burning pain" were higher in fallers than non-fallers. The rates of "older adults (≥65 years of age)," "unemployed," "not using assistive devices," "visual impairment," and "hearing impairment" were higher in patients with FOF than in those without FOF. However, the level of balance confidence was lower in patients with FOF. CONCLUSIONS The fall experience of patients with DFD was associated with the presence of their caregiver, disease-related factors, and foot pain symptoms, while FOF was related to age and fall-related factors.
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Affiliation(s)
- Hyerim Seo
- Department of Nursing, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
| | - Jeongeun Yoon
- Department of Nursing, Kunsan College of Nursing, Gunsan, Republic of Korea
| | - Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea.
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19
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Hu XX, Yang XG, Wang X, Ma X, Geng X. The influence of diabetes and age-related degeneration on body balance control during static standing: a study based on plantar center-of-pressure trajectories and principal component analysis. J Orthop Surg Res 2023; 18:740. [PMID: 37775789 PMCID: PMC10542244 DOI: 10.1186/s13018-023-04129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/23/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Aging and diabetes can impair the balance function of the elderly and diabetic patients and increase their fall risk. This study aimed to assess the shaking amplitude of the center-of-pressure (CoP) during static standing, to analyze the effects of aging and diabetes on the balance control. MATERIALS AND METHODS This cross-sectional observational study, compared the balance performance of 20 healthy younger adults (27.65 ± 5.60 years), 16 healthy older adults (58.88 ± 3.54 years) and 15 diabetic patients (58.33 ± 5.33 years) in four static standing conditions on a force plate: horizontal, anteroposterior (AP), left and right slope planes (5° angles on AP, left and right directions, respectively). The trajectory coordinates of the CoP over time were recorded and analyzed by principal components analysis to obtain the 95% confidence ellipse and its parameters: angle, major and minor axes lengths, and area. The balance indicators were compared among the three groups using one-way analysis of variance (ANOVA), Brown-Forsythe test or Kruskal-Wallis H test, depending on the normality and homogeneity of variance assumptions. RESULTS The diabetic group had a significantly larger confidence ellipse area than the healthy younger adults on the horizontal plane (P = 0.032) and than the healthy older adults on the horizontal (P = 0.036), AP slope (P = 0.023), and right ML slope (P = 0.037) planes. There were no significant differences in the major axis length of the confidence ellipse among the three groups. The diabetic group had a significantly longer minor axis length than the healthy younger adults on the AP slope (P = 0.039), left ML slope (P = 0.045) and right ML slope (P = 0.016) planes and than the healthy older adults on the AP slope (P = 0.007), left ML slope (P = 0.035) and right ML slope (P = 0.012) planes. CONCLUSIONS The balance control of diabetic patients is decreased compared with healthy younger and older people, and the body swing amplitude increases mainly in the direction of minor axis of confidence ellipse during static standing, while the swing amplitude in the direction of the major axis has no significant change. Evaluating the balance function of diabetic patients can help clinicians identify people with fall risk early and intervene early, thereby reducing the occurrence of fall events in this population.
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Affiliation(s)
- Xing-Xi Hu
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiong-Gang Yang
- Department of Orthopaedics, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
- Yunnan Key Laboratory of Digital Orthopaedics, Kunming, 650032, China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Xiang Geng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
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20
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Çakici R, Saldiran TÇ, Kara İ, Açik H. Plantar fascia stiffness in patients with type 2 diabetes mellitus: Stiffness effect on fall risk and gait speed. Foot (Edinb) 2023; 56:102020. [PMID: 36990015 DOI: 10.1016/j.foot.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023]
Abstract
AIMS The primary objective was to compare patients with type 2 diabetes mellitus (T2DM) and healthy peers in terms of plantar fascia (PF) stiffness, fall risk, and gait speed. The second objective was to examine the relationship between stiffness of PF and fall risk, gait speed. METHODS Fifty patients diagnosed with T2DM (mean duration = 10.74 ± 7.07 years) were included. Myotonometer was used to evaluate the stiffness of PF. To assess the risk of falling, and gait speed, the International Fall Efficiency Scale (FES-I) and the 4-Meter Gait Speed Test (4mGST) were used, respectively. RESULTS Compared to healthy controls, PF stiffness (right foot mean difference = 148.99 N/m, left foot mean difference = 113.13 N/m p < .001) was higher in the T2DM group. The FES-I and 4mGST scores were worse in the group with T2DM (p < .05). 12.8 % of FES-I and 23.4 % of 4mGST variance were explained by stiffness of PF. CONCLUSIONS The results of the study showed that the stiffness of PF changed in patients with T2DM. There was a decrease in gait speed and an increase in the risk of falling as PF stiffness increased.
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Affiliation(s)
- Rumeysa Çakici
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Okan University, Istanbul, Turkey
| | - Tülay Çevik Saldiran
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey.
| | - İlke Kara
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey; Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Hasan Açik
- Department of Internal Medicine, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
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21
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Inacio M, Esser P, Li J, Xu L, Zeng H, He R, Dawes H, Liu F. Spectral parameters of gait differentiate diabetic patients from healthy individuals. Foot (Edinb) 2023; 56:102038. [PMID: 37201241 DOI: 10.1016/j.foot.2023.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a clinical condition that affects gait performance and control in millions of individuals worldwide. Contrary to basic spatiotemporal parameters, gait-based spectral analysis may provide useful insights into gait neuromotor control. Hence, this study was set to investigate the spectral content of gait at the preferred speed in patients with DM. METHODS Total 1117 individuals [658 DM and 649 healthy adults (HA)] performed a 10 m walk while wearing an inertial measurement unit over the fourth lumbar vertebra. Mann-Whitney-U test was used for between-group gait parameters comparisons. RESULTS DM group had a slower step time (1.2%, p < 0.05) and gait speed (2.4%, p < 0.05) than HA. Additionally, DM individuals showed reduced dominant frequency (DM:0.24 Hz vs HA:0.25 Hz on average, p < 0.05). Increased antero-posterior and vertical dominant frequency width (DM:1.73 Hz vs HA:1.76 Hz on average, p < 0.05) and medio-lateral relative power spectral density at the dominant frequency (DM:6.19% vs HA:5.96%, p < 0.05). CONCLUSIONS It was demonstrated for the first time that the gait spectral content, not only corroborates spatiotemporal characteristics, but also provides further insight into their neuromotor control deficits in diabetic patients. Ultimately, this type of analysis in the diabetic population can help guide the therapeutic interventions to prevent diabetic foot.
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Affiliation(s)
- Mario Inacio
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; University of Maia, Maia, Portugal; Research Center in Sport Science, Health Sciences and Human Development, Vila Real, Portugal.
| | - Patrick Esser
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Junxian Li
- Dept of Endocrinology and Metabolism of Shanghai General Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China; Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Lei Xu
- Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Hui Zeng
- Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Rui He
- Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Helen Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; College of Medicine and Health, University of Exeter, Exeter, UK; Department of Clinical Neurology, University of Oxford, Oxford UK; Oxford Health Biomedical Research Centre, UK
| | - Fang Liu
- Dept of Endocrinology and Metabolism of Shanghai General Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China; Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China.
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22
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Wu X, Guo J, Chen X, Han P, Huang L, Peng Y, Zhou X, Huang J, Wei C, Zheng Y, Zhang Z, Li M, Guo Q. Comparison of the relationship between cognitive function and future falls in Chinese community-dwelling older adults with and without diabetes mellitus. J Formos Med Assoc 2023; 122:603-611. [PMID: 36336606 DOI: 10.1016/j.jfma.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine whether cognitive function is associated with future falls in older patients with diabetes mellitus (DM) compared with those without DM. Cognitive function was divided into several domains to further analyze. METHODS A total of 678 individuals met the inclusion criteria and comprised the final study population. The mean age was 74.35 ± 5.35 years, and 58.9% of the participants were female (n = 400). At the baseline, cognitive function was measured by the Mini Mental State Examination (MMSE), and DM diagnoses were determined by medical records. The self-reported any falls data were obtained via face-to-face questioning at the 1-year follow-up. RESULTS At baseline, 15.6% of participants (n = 106) were diagnosed with DM. According to whether they had any falls during 1-year follow-up, there was a significant difference between the two group in fasting plasma glucose (p = 0.012) and DM (p = 0.036) at baseline. Among the older adults with DM, those who had experienced any falls had poorer cognitive function (p = 0.014). After adjusting for various covariates, we found that MMSE (95% CI 0.790-0.991, p = 0.034), orientation to place (95% CI 0.307-0.911, p = 0.022) and registration (95% CI 0.162-0.768, p = 0.009) were significantly associated with falls in the follow-up. CONCLUSION Our study found that in patients with DM, cognitive function is related to future falls. Not only overall cognitive function, but also orientation to place and registration were all associated with future falls in older adults with DM. When completing the fall risk assessment of elderly patients with DM, clinicians should give more attention to the testing of cognitive function.
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Affiliation(s)
- Xinze Wu
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China; Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Jinlong Guo
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Xinlong Chen
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Liqin Huang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Youran Peng
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Xin Zhou
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Jiasen Huang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Chengyao Wei
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | | | | | - Ming Li
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Pudong New District, Shanghai, China.
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Parveen S, Noohu MM. Association between P300 parameters and cognitive function in people with diabetic neuropathy. J Diabetes Metab Disord 2023; 22:347-354. [PMID: 37255838 PMCID: PMC10225418 DOI: 10.1007/s40200-022-01148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 06/01/2023]
Abstract
Purpose The purpose of this study was to investigate the association between event-related potential (ERP) P300 with cognitive function in people with diabetic peripheral neuropathy (DPN). Methods We performed a cross-sectional analysis of 19 type 2 diabetes mellitus (T2DM) patients, aged 18 and older with DPN. The participants were assessed for neuropathy, cognitive function, & dual-task performance. DPN was examined via the administration of diabetic neuropathy symptom score (DNSS) and vibration perception threshold (VPT). Cognitive dysfunction was evaluated using Mini-mental state examination (MMSE), trail making test-B (TMT-B), and ERP P300 wave latency & amplitude. For assessing dual-task performance, the dual-task cost (DTC) was calculated using the timed-up and go (TUG) test and TUG with dual task (TUG-DT). Results P300 latency was linearly related to TMT-B (R = 0.31, p = 0.01) and DTC (R = 0.22, p = 0.04). A similar trend was observed in TMT-B (R = 0.13, p = 0.04) & DTC (R =0 .67, p = 0.001) with respect to P300 amplitude. MMSE did not relate with P300 latency (R = 0.14, p = 0.58) & amplitude (R = 0.63, p = .44). Conclusion P300 latency and amplitude are associated with cognitive function and DTC of individuals with DPN.
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Affiliation(s)
- Sarah Parveen
- Centre for Physiotherapy & Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Majumi M. Noohu
- Centre for Physiotherapy & Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
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Mao W, Wang T, Sun M, Zhang F, Li L. Effects of Tai Chi on Postural Control in People with Peripheral Neuropathy: A Systematic Review with Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11111559. [PMID: 37297699 DOI: 10.3390/healthcare11111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Effects of Tai Chi on people with peripheral neuropathy (PN) are not yet apparent. This systematic review was conducted to evaluate the effects of Tai Chi on postural control in people with PN. METHODS Literature was screened in seven databases for relevant randomized controlled trials. The reports and methodological quality were evaluated. A meta-analysis was performed using RevMan5.4 software. RESULTS Ten reports were included, involving a total of 344 subjects. The meta-analysis found that Tai Chi therapy for people with PN resulted in a smaller sway area, in the double-leg stance with eyes closed test (SMD = -2.43, I2 = 0%), than that observed in the control group, greater distance covered in the six-minute walking test (SMD = -0.46, I2 = 49%) and faster performance in the timed-up-and-go test (SMD = 0.68, I2 = 50%), than the baseline. CONCLUSIONS Tai chi effectively enhanced dynamic postural control in people with PN. However, no better effects on postural control from Tai Chi than from other rehabilitation approaches were observed in this study. Further high-quality trials are needed to better understand Tai Chi's effects on individuals with PN.
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Affiliation(s)
- Wenhui Mao
- School of Sports Science, Nanjing Normal University, Nanjing 210023, China
| | - Ting Wang
- School of Sports Science, Nanjing Normal University, Nanjing 210023, China
| | - Mengzi Sun
- School of Sports Science, Nanjing Normal University, Nanjing 210023, China
| | - Fangtong Zhang
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Li Li
- Department of Health Sciences and Kinesiology, Georgia Southern University, P.O. Box 8076, Statesboro, GA 30460, USA
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Gialanella B, Comini L, Prometti P, Vanoglio F, Santoro R. Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls. Life (Basel) 2023; 13:life13041059. [PMID: 37109588 PMCID: PMC10144929 DOI: 10.3390/life13041059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.
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Affiliation(s)
- Bernardo Gialanella
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, 25065 Lumezzane, Italy
| | | | - Fabio Vanoglio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy
| | - Raffaele Santoro
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy
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Vargas Matamala M, Tapia C, Salvador Sagüez F, Guerrero-Henriquez J. Postural performance assessment in aging people with diabetes and diabetic peripheral neuropathy using a Wii balance board. Disabil Rehabil 2023; 45:1202-1207. [PMID: 35369833 DOI: 10.1080/09638288.2022.2055168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the effect of sensory perturbations on static postural control in older people with type 2 diabetes mellitus by comparing postural outcomes of people with and without diabetic neuropathy using a Wii Balance Board (WBB). MATERIALS AND METHODS Static postural balance assessments were performed in 31 participants: nine with type 2 diabetes mellitus; 12 with diabetic neuropathy; and 10 non-diabetic controls. Participants stood on the WBB under sensory perturbations (visual and proprioceptive). Body balance was analysed using centre of pressure ellipse area, mean velocity, and sample entropy. The effects of within-participant factors, sensory perturbations and the between-participants factor 'group' on outcomes were analysed using a multivariate analysis of variance model. RESULTS Type 2 diabetes mellitus participants with and without neuropathy showed altered postural performance under sensory perturbations compared to non-diabetic participants. Moreover, participants with diabetic neuropathy showed impaired postural performance when one perceptual system was disturbed. Finally, participants with type 2 diabetes mellitus without neuropathy decreased their postural performance when both sensory disturbances were present. CONCLUSIONS The Wii Balance Board can be a useful alternative for balance impairment screening related to diabetic neuropathy and contribute as an affordable source of insight in early interventions in integral diabetes care.Implications to rehabilitationOlder people with diabetic peripheral neuropathy depend on visual and somatosensory cues to keep their static postural balance.Static balance assessment using the Wii Balance Board allows the identification of alterations in postural performance in participants with diabetes.This low-cost method used can be considered as a complement to integral diabetes care.
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Affiliation(s)
- Martin Vargas Matamala
- Department of Rehabilitation Sciences and Human Movement, University of Antofagasta, Antofagasta, Chile
| | - Claudio Tapia
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Juan Guerrero-Henriquez
- Department of Rehabilitation Sciences and Human Movement, University of Antofagasta, Antofagasta, Chile
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Gupta G, Maiya GA, Bhat SN, Hande HM, Mayya SS. Functional Fitness and Risk of Falling in Older Adults with Diabetic Neuropathy. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2023. [DOI: 10.1080/02703181.2023.2187104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Garima Gupta
- Centre for Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - G. Arun Maiya
- Centre for Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shyamasunder N. Bhat
- Department of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - H. Manjunatha Hande
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shreemathi S. Mayya
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Factors influencing the self-perceived mobility of active unilateral lower limb amputees assessed with the Prosthetic Mobility Questionnaire: a brief report. Int J Rehabil Res 2023; 46:108-111. [PMID: 36728884 DOI: 10.1097/mrr.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Prosthetic Mobility Questionnaire (PMQ 2.0) represents a reliable solution for evaluating amputees' self-perceived mobility. The study aimed to evaluate the perceived mobility of middle-aged users with a traumatic amputation using the PMQ 2.0 and to assess the influence of age, stump and phantom limb pain, amputation level, time since amputation, and prosthesis use on it. Fifty subjects were recruited. The median value of the score was higher than previously published reference values, reflecting the 'active' mobility status of the sample. The hours of prosthesis use per day explained about 21% of the variance of the questionnaire score and was a significant predictor of perceived mobility. Reference values for the recently developed PMQ 2.0 survey and relative to active, traumatic amputees were reported. As prosthesis use was a significant predictor of the amputees' perceived mobility, prolonged use of the artificial limb should be always encouraged in clinical practice.
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Vági OE, Svébis MM, Domján BA, Körei AE, Tesfaye S, Horváth VJ, Kempler P, Tabák ÁG. The association between distal symmetric polyneuropathy in diabetes with all-cause mortality - a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1079009. [PMID: 36875485 PMCID: PMC9978416 DOI: 10.3389/fendo.2023.1079009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Distal symmetric polyneuropathy (DSPN) is a common microvascular complication of both type 1 and 2 diabetes with substantial morbidity burden and reduced quality of life. Its association with mortality is equivocal. PURPOSE To describe the association between DSPN and all-cause mortality in people with diabetes and further stratify by the type of diabetes based on a meta-analysis of published observational studies. DATA SOURCES We searched Medline from inception to May 2021. STUDY SELECTION Original data were collected from case-control and cohort studies that reported on diabetes and DSPN status at baseline and all-cause mortality during follow-up. DATA EXTRACTION was completed by diabetes specialists with clinical experience in neuropathy assessment. DATA SYNTHESIS Data was synthesized using random-effects meta-analysis. The difference between type 1 and 2 diabetes was investigated using meta-regression. RESULTS A total of 31 cohorts (n=155,934 participants, median 27.4% with DSPN at baseline, all-cause mortality 12.3%) were included. Diabetes patients with DSPN had an almost twofold mortality (HR: 1.96, 95%CI: 1.68-2.27, I2 = 91.7%), I2 = 91.7%) compared to those without DSPN that was partly explained by baseline risk factors (adjusted HR: 1.60, 95%CI: 1.37-1.87, I2 = 78.86%). The association was stronger in type 1 compared to type 2 diabetes (HR: 2.22, 95%CI: 1.43-3.45). Findings were robust in sensitivity analyses without significant publication bias. LIMITATIONS Not all papers reported multiple adjusted estimates. The definition of DSPN was heterogeneous. CONCLUSIONS DSPN is associated with an almost twofold risk of death. If this association is causal, targeted therapy for DSPN could improve life expectancy of diabetic patients.
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Affiliation(s)
- Orsolya E. Vági
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- *Correspondence: Orsolya E. Vági, ; Ádám Gy. Tabák,
| | - Márk M. Svébis
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- School of PhD studies, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Beatrix A. Domján
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Anna E. Körei
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Viktor J. Horváth
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Ádám Gy. Tabák
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- *Correspondence: Orsolya E. Vági, ; Ádám Gy. Tabák,
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Villegas CM, Curinao JL, Aqueveque DC, Guerrero-Henríquez J, Matamala MV. Identifying neuropathies through time series analysis of postural tests. Gait Posture 2023; 99:24-34. [PMID: 36327535 DOI: 10.1016/j.gaitpost.2022.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In physical therapy, postural tests are frequently used to diagnose neuropathies, particularly in diabetic individuals. This study aims to develop a method based on the analysis of time series that allows discriminating between healthy and diabetic subjects with or without a neuropathic condition. RESEARCH QUESTION Do features obtained from time series corresponding to postural tests allow us to reliably discriminate between healthy, diabetic and neuropathic patients? METHODS In this study, 32 people participated in the healthy, diabetic, and neuropathic categories (11, 9, and 12, respectively). The data was collected by positioning each participant on a Wii Balanced Board platform, under 8 different conditions. The analyzed time series are sensed by devices that capture variations in the subject's center of pressure when subjected to a test on different conditions over a short period of time. The method proposed considers statistical techniques used for characterizing the time series combined with machine learning techniques to classify the individual's profile into one of the three categories mentioned. The classification is supported by an underlying probabilistic model, based on the characteristics of the time series, generating average curves for each class, which are then used by the classification methods. RESULTS The empirical results include classification models for each class, obtaining a performance (F-score) over 98%. In addition, other models considering the particular conditions to which the subject is exposed during the test are developed, revealing that the conditions of eyes open and eyes closed show the highest levels of discrimination to classify participants into one of the three class categories. SIGNIFICANCE These results suggest a test protocol simplification and, at the same time, that the proposed method based on the analysis of the time series associated with the test used is highly predictive and may reliably complement or substitute a questionnaire-based diagnosis.
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Affiliation(s)
- Claudio Meneses Villegas
- Department of Computing and Systems Engineering, Universidad Católica del Norte, Antofagasta, Chile.
| | | | - David Coo Aqueveque
- Department of Computing and Systems Engineering, Universidad Católica del Norte, Antofagasta, Chile.
| | - Juan Guerrero-Henríquez
- Department of Rehabilitation Sciences and Human Movement, Universidad de Antofagasta, Antofagasta, Chile.
| | - Martín Vargas Matamala
- Department of Rehabilitation Sciences and Human Movement, Universidad de Antofagasta, Antofagasta, Chile.
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Risk of fracture in adults with type 2 diabetes in Sweden: A national cohort study. PLoS Med 2023; 20:e1004172. [PMID: 36701363 PMCID: PMC9910793 DOI: 10.1371/journal.pmed.1004172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/09/2023] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is considered a risk factor for fracture but the evidence regarding the impact of T2DM on fracture risk is conflicting. The objective of the study was to determine if patients with T2DM have increased fracture risk and if T2DM-related risk factors could be identified. METHODS AND FINDINGS In this national cohort study in Sweden, we investigated the risk of fracture in 580,127 T2DM patients, identified through the national diabetes register including from both primary care and hospitals, and an equal number of population-based controls without diabetes matched for age, sex, and county from 2007 to 2017. The mean age at entry was 66.7 years and 43.6% were women. During a median follow-up time of 6.6 (interquartile range (IQR) 3.1 to 9.8) years, patients with T2DM had a marginally but significantly increased risk of major osteoporotic fracture (MOF) (hazard ratio (HR) 1.01 (95% confidence interval [CI] 1.00 to 1.03)) and hip fracture (HR 1.06 (95% CI 1.04 to 1.08)) compared to controls, associations that were only minimally affected (HR 1.05 (95% CI 1.03 to 1.06) and HR 1.11 (95% CI 1.09 to 1.14), respectively) by multivariable adjustment (age, sex, marital status, and an additional 20 variables related to general morbidity, cardiovascular status, risk of falls, and fracture). In a multivariable-adjusted Cox model, the proportion of the risk for all fracture outcomes (Heller's R2) explained by T2DM was below 0.1%. Among the T2DM patients, important risk factors for fracture were a low BMI (<25 kg/m2), long diabetes duration (≥15 years), insulin treatment, and low physical activity. In total, 55% of the T2DM patients had none of these risk factors and a significantly lower fracture risk than their respective controls. The relatively short mean duration of T2DM and lack of bone density data, constitute limitations of the analysis. CONCLUSION In this study, we observed only a marginally increased fracture risk in T2DM, a condition that explained less than 0.1% of the fracture risk. Consideration of the herein identified T2DM-related risk factors could be used to stratify T2DM patients according to fracture risk.
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Mohapatra S, Ramachandran M, Behera KK, Priyadarsini N, Nanda P, Devi S. Association of peripheral neuropathy with skeletal muscle mass and function in type two diabetes mellitus patients: A cross-sectional study. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Association of peripheral neuropathy with skeletal muscle mass and function in type two diabetes mellitus patients: A cross-sectional study. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2022; 69:591-599. [PMID: 36446485 DOI: 10.1016/j.endien.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND & OBJECTIVE Diabetic peripheral neuropathy (DPN) is considered to be a risk factor for development of sarcopenia. Therefore, our study aimed to detect the association between peripheral neuropathy with skeletal muscle mass and function in type two diabetes mellitus (T2DM) patients. METHODS A total of 176 participants, ≥45 years were included in the study. Out of 176, 60 were healthy volunteers, 60 had T2DM without neuropathy, 56 had T2DM with neuropathy. In all the participants peripheral nerve function was assessed by nerve conduction studies (Common peroneal and Sural nerve) and sarcopenia parameters were evaluated according to the Asian Working Group for Sarcopenia (AWGS) criteria. RESULTS The present study suggested that diabetic peripheral neuropathy (DPN) was associated with decline in muscle mass, which was found only in men. Our study showed a positive correlation between appendicular skeletal muscle index (ASMI) and common peroneal nerve amplitude and sural nerve amplitude with r=0.527, p<0.05; r=0.847, p<0.001 respectively. Furthermore, in multiple linear regression analyses, we found a positive relationship between ASMI and sural nerve amplitude after adjustment for confounders like age, duration of diabetes, and HbA1C (B=0.739; p<0.001). CONCLUSION As DPN patients are more prone to developing sarcopenia, and periodic assessment of skeletal muscle mass and function is warranted to initiate early lifestyle interventions in these patients, which will improve their quality of life.
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Bao YW, Shea YF, Chiu PKC, Kwan JSK, Chan FHW, Chow WS, Chan KH, Mak HKF. The fractional amplitude of low-frequency fluctuations signals related to amyloid uptake in high-risk populations—A pilot fMRI study. Front Aging Neurosci 2022; 14:956222. [PMID: 35966783 PMCID: PMC9372772 DOI: 10.3389/fnagi.2022.956222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with type 2 diabetes mellitus (T2DM) and subjective cognitive decline (SCD) have a higher risk to develop Alzheimer's Disease (AD). Resting-state-functional magnetic resonance imaging (rs-fMRI) was used to document neurological involvement in the two groups from the aspect of brain dysfunction. Accumulation of amyloid-β (Aβ) starts decades ago before the onset of clinical symptoms and may already have been associated with brain function in high-risk populations. However, this study aims to compare the patterns of fractional amplitude of low-frequency fluctuations (fALFF) maps between cognitively normal high-risk groups (SCD and T2DM) and healthy elderly and evaluate the association between regional amyloid deposition and local fALFF signals in certain cortical regions.Materials and methodsA total of 18 T2DM, 11 SCD, and 18 healthy elderlies were included in this study. The differences in the fALFF maps were compared between HC and high-risk groups. Regional amyloid deposition and local fALFF signals were obtained and further correlated in two high-risk groups.ResultsCompared to HC, the altered fALFF signals of regions were shown in SCD such as the left posterior cerebellum, left putamen, and cingulate gyrus. The T2DM group illustrated altered neural activity in the superior temporal gyrus, supplementary motor area, and precentral gyrus. The correlation between fALFF signals and amyloid deposition was negative in the left anterior cingulate cortex for both groups. In the T2DM group, a positive correlation was shown in the right occipital lobe and left mesial temporal lobe.ConclusionThe altered fALFF signals were demonstrated in high-risk groups compared to HC. Very early amyloid deposition in SCD and T2DM groups was observed to affect the neural activity mainly involved in the default mode network (DMN).
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Affiliation(s)
- Yi-Wen Bao
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yat-Fung Shea
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | | | - Joseph S. K. Kwan
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Felix Hon-Wai Chan
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Wing-Sun Chow
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Koon-Ho Chan
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Henry Ka-Fung Mak
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Gupta G, Maiya GA, Bhat N S, Hande HM, Dillon L, Keay L. Fear of falling and functional mobility in Elders with Diabetic Peripheral Neuropathy in Coastal Karnataka, India: A Hospital-Based Study. Curr Aging Sci 2022; 15:252-258. [PMID: 35331103 DOI: 10.2174/1874609815666220324153104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aging with diabetic neuropathy is likely to predispose people to falls. Despite being a high-risk population, estimates of falls and their associated factors are poorly documented in elderly diabetic neuropathy patients living in coastal Karnataka, India. OBJECTIVE To investigate fear of falling and functional mobility, as an approximate measure of clinical fall risk, and explore the associated risk factors in elderly diabetic neuropathy patients living in coastal Karnataka, India. METHOD A hospital-based cross-sectional study on 316 elders aged 60 to 80 with diabetic neuropathy was conducted. A detailed diabetic foot evaluation was done. Self-reported fear of fall and functional mobility was measured using the Falls Efficacy Scale- International and Timed Up and Go test, respectively with published cut-points. Additionally, a recall of 12 months of fall history was recorded. RESULTS Descriptive analysis showed that self-reported fear of fall and below-average functional mobility was present in 39% and 49% of the elders with diabetic neuropathy, respectively. Spearman's correlational analysis revealed that self-reported fall concerns and functional mobility are significantly interdependent. Regression analysis suggested female gender, the severity of neuropathy, and previous falls as significant modifiers for fear of fall and poor functional mobility. CONCLUSION Half of the elders (49%) with diabetic neuropathy have poor functional mobility and 39% have a fear of falling. Improving physical function and addressing fall concerns of elders with diabetic neuropathy can result in greater confidence to participate in everyday activities and contribute to their better health. Hence, early fall risk identification is recommended for providing better health care in these individuals.
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Affiliation(s)
- Garima Gupta
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shyamasunder Bhat N
- Department of Orthopaedics, Kasturba Hospital Manipal, Manipal Academy of Higher Education, Manipal, India
| | - H Manjunatha Hande
- Department of Medicine, Kasturba Hospital Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Lisa Dillon
- School of optometry and vision science, UNSW, Sydney
| | - Lisa Keay
- School of optometry and vision science, UNSW, Sydney
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Liu X, Zhou H, Wang Z, Liu X, Li X, Nie C, Li Y. Fully Convolutional Neural Network Deep Learning Model Fully in Patients with Type 2 Diabetes Complicated with Peripheral Neuropathy by High-Frequency Ultrasound Image. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5466173. [PMID: 35371289 PMCID: PMC8970954 DOI: 10.1155/2022/5466173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
This study was aimed at exploring the diagnostic value of high-frequency ultrasound imaging based on a fully convolutional neural network (FCN) for peripheral neuropathy in patients with type 2 diabetes (T2D). A total of 70 patients with T2D mellitus were selected and divided into a lesion group (n = 31) and a nonlesion group (n = 39) according to the type of peripheral neuropathy. In addition, 30 healthy people were used as controls. Hypervoxel-based and FCN-based high-frequency ultrasound images were used to examine the three groups of patients to evaluate their diagnostic performance and to compare the changes of peripheral nerves and ultrasound characteristics. The results showed that the Dice coefficient (92.7) and mean intersection over union (mIOU) (82.6) of the proposed algorithm after image segmentation were the largest, and the Hausdorff distance (7.6) and absolute volume difference (AVD) (8.9) were the smallest. The high-frequency ultrasound based on the segmentation algorithm showed higher diagnostic accuracy (94.0% vs. 86.0%), sensitivity (87.1% vs. 67.7%), specificity (97.1% vs. 94.2%), positive predictive value (93.1% vs. 86.7%), and negative predictive value (94.4% vs. 84.0%) (P < 0.05). There were significant differences in the detection values of the three major nerve segments of the upper limbs in the control group, the lesion group, and the nonlesion group (P < 0.05). Compared with the nonlesion group, the patients in the lesion group were more likely to have reduced nerve bundle echo, blurred reticular structure, thickened epineurium, and unclear borders of adjacent tissues (P < 0.05). In summary, the high-frequency ultrasound processed by the algorithm proposed in this study showed a high diagnostic value for peripheral neuropathy in T2D patients, and high-frequency ultrasound can be used to evaluate the morphological changes of peripheral nerves in T2D patients.
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Affiliation(s)
- Xiaoqiang Liu
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
| | - Hongyan Zhou
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
| | - Zhaoyun Wang
- Department of Wound Repair, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
| | - Xiaoli Liu
- Department of Respiratory, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
| | - Chen Nie
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
| | - Yang Li
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027 Liaoning Province, China
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Abdelaal AA, El-Shamy SM. Effect of lower body positive pressure aerobic training on fall risk in patients with diabetic polyneuropathy: randomized controlled trial. Eur J Phys Rehabil Med 2022; 58:33-42. [PMID: 34636527 PMCID: PMC9980519 DOI: 10.23736/s1973-9087.21.06847-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Retarded task-oriented gait, balance performance and increased fall risk are among the most debilitating problems in patients with diabetic polyneuropathy (DPN). The lower body positive pressure (LBPP) training was recently introduced in the field of rehabilitation, but evaluating the effects of the LBPP on gait, balance and fall risk in patients with DPN has not been thoroughly investigated. AIM The aim of this study was to evaluate the effect of LBPP treadmill training program on task-oriented gait, balance performance and fall risk in patients with DPN. DESIGN Single-blinded, randomized-controlled trial. SETTING Rehabilitative outpatient unit. POPULATION Sixty-two patients with DPN were randomly assigned into 5-groups; group-A (100% weight-bearing; N.=12), group-B (75% weight-bearing; N.=13), group-C (50% weight-bearing; N.=13), group-D (25% weight-bearing; N.=12) and group-E (control group; N.=12). METHODS The intervention groups (A, B, C, D) received moderate intensity aerobic exercise training (AET) program (30-45 minutes, 50-70% heart rate reserve) on the AlterG (AlterG, Inc., Fremont, CA, USA) treadmill for 12-weeks. Task-oriented gait, balance performance and the fall risk were evaluated at baseline (evaluation-1), after 12-weeks (evaluation-2) and 12-weeks poststudy cessation (evaluation-3; follow-up) for all groups using the Tinetti balance assessment tool. RESULTS At evaluation-2, there were significant "within-groups" increases in the balance, gait and fall risk scores. There were significant "between-groups" differences in the same evaluated variables, with the highest increases were in group-B (P<0.05). At evaluation-3, there was a decline in the mean values of the evaluated variables, but still significant increases in the mean values of balance, gait and fall risk compared to the baseline mean values. There were significant "between-groups" differences in all variables, with the highest increases were in group-B (P<0.05). CONCLUSIONS Moderate intensity LBPP treadmill training program can effectively improve task-oriented gait, balance performance, and fall risk scores in patients with DPN. The 25% off-loading weight percentage during the LBPP treadmill training program yielded the most favorable short and long-term improvements compared to the other weight off-loading percentages in patients with DPN. CLINICAL REHABILITATION IMPACT The LBPP aerobic training program is an effective rehabilitation procedure in patients with DPN especially when utilizing the 25% off-loading weight percentage during the LBPP treadmill training program.
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Affiliation(s)
- Ashraf A Abdelaal
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia -
| | - Shamekh M El-Shamy
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
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The onset of falls and its effects on perceived social exclusion and loneliness. Evidence from a nationally representative longitudinal study. Arch Gerontol Geriatr 2022; 100:104622. [DOI: 10.1016/j.archger.2022.104622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/19/2021] [Accepted: 01/15/2022] [Indexed: 12/11/2022]
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Zhang L, Liu S, Wang W, Sun M, Tian H, Wei L, Wu Y. Dynapenic abdominal obesity and the effect on long-term gait speed and falls in older adults. Clin Nutr 2021; 41:91-96. [PMID: 34864458 DOI: 10.1016/j.clnu.2021.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/23/2021] [Accepted: 11/10/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although both dynapenia and abdominal obesity have negative impact on physical function and health, few prospective studies evaluate the association of dynapenic abdominal obesity (D/AO) with gait speed and falls. Our aim was to examine the combined effect of low muscle strength and abdominal obesity on long-term gait speed and falls in older adults. METHODS We used longitudinal data from the English Longitudinal Study of Ageing (ELSA), including 4987 individuals aged 60 years and over. Grip strength and waist circumference were measured at baseline. Gait speed and fall events (falls, recurrent falls, and fall-related injury) were evaluated during a 14-year follow-up. The study population were divided into nondynapenic nonabdominal obesity (ND/NAO), nondynapenic abdominal obesity (ND/AO), dynapenic nonabdominal obesity (D/NAO), and D/AO, according to the sex-specific grip strength (<16 kg for women and <26 kg for men) and waist circumference (>88 cm for women and >102 cm for men). We used generalized estimating equation (GEE) model with gait speed as the outcome and cox proportional hazards models with fall events as the outcome. RESULTS GEE model showed that gait speed decreased during the 14-year follow-up in all groups (all Ptime < 0.001). Participants with ND/AO, D/NAO, and D/AO at baseline exhibited a worse gait speed than those with ND/NAO (all Pgroup < 0.001). No significant difference in the rate of gait speed decline between four groups was found (Pgroup×time = 0.062). Cox regression analysis showed that D/NAO and D/AO highly predicted falls, and the hazard ratio (HR) was 1.181 (95% CI: 1.002, 1.392) for D/NAO and 1.195 (95% CI: 1.006, 1.421) for D/AO. D/AO was the unique condition associated with recurrent falls and fall-related injury, and the HRs were 1.276 (95% CI: 1.018, 1.599) and 1.348 (95% CI: 1.066, 1.704), respectively. CONCLUSION Dynapenia abdominal obesity, determined by low grip strength and high waist circumference, exhibits worse gait speed and increases the risk of fall events in older adults. Effort to maintain the mobility should focus on improving muscle strength and reducing excess body fat.
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Affiliation(s)
- Li Zhang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China
| | - Shuqin Liu
- Department of Emergency, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China
| | - Mengjie Sun
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China
| | - Huimin Tian
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China
| | - Lili Wei
- Department of Nursing, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yili Wu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China.
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Rosenblatt NJ, Young J, Andersen R, Wu. SC, Crews RT. Diabetes and Reactive Balance: Quantifying Stepping Thresholds With a Simple Spring Scale to Measure Fall-Risk in Ambulatory Older Adults. J Diabetes Sci Technol 2021; 15:1352-1360. [PMID: 33354995 PMCID: PMC8655272 DOI: 10.1177/1932296820979970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fall-risk assessments for patients with diabetes fail to consider reactive responses to balance loss. The purpose of this study was to assess the feasibility of using a simple clinical tool to evaluate the impact of diabetes and fall history on reactive balance in older adults. METHODS We recruited 72 older adults with and without diabetes. Postural perturbations were applied by a waist-mounted spring scale. Stepping thresholds (STs) in the anterior and posterior directions were defined as the lowest spring-loads that induced a step. Balance was assessed via the National Institutes of Health Toolbox Standing Balance Test, and lower extremity sensation was assessed using vibratory perception threshold and Semmes-Weinstein monofilaments. Fall history over the past year was self-reported. Cox regressions and analysis of variance were used to compare hazard rates for stepping and observed STs between groups. RESULTS Anterior STs were elicited in 42 subjects and posterior STs in 65 subjects. Hazard rates for posterior ST were significantly affected by diabetes, with greater hazards for fallers with diabetes versus control fallers and nonfallers, after accounting for balance and sensory loss. For those who stepped, ST was lower in the posterior direction for the diabetes group. Additionally, anterior but not posterior ST was lower in all fallers vs all nonfallers. CONCLUSIONS The waist-mounted spring scale is a clinically implementable device that can assess ST in older adults with diabetes. Using the device, we demonstrated that ST was affected by diabetes and could potentially serve as a fall-risk factor independent of balance or sensory loss.
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Affiliation(s)
- Noah J. Rosenblatt
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Noah Rosenblatt, Dr. William M. Scholl
College of Podiatric Medicine’s Center for Lower Extremity Ambulatory Research
(CLEAR) at Rosalind Franklin University of Medicine and Science, 3333 Green Bay
Road, North Chicago, IL 60064, USA.
| | - Jennifer Young
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ryley Andersen
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Stephanie C. Wu.
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ryan T. Crews
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Wearable Sensor for Assessing Gait and Postural Alterations in Patients with Diabetes: A Scoping Review. Medicina (B Aires) 2021; 57:medicina57111145. [PMID: 34833363 PMCID: PMC8621058 DOI: 10.3390/medicina57111145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Diabetes mellitus is considered a serious public health problem due to its high prevalence and related complications, including gait and posture impairments due to neuropathy and vascular alterations and the subsequent increased risk of falls. The gait of patients with diabetes is characterized by alterations of the main spatiotemporal gait parameters such as gait velocity, cadence, stride time and length, which are also known to worsen with disease course. Wearable sensor systems can be used for gait analysis by providing spatiotemporal parameters and postural control (evaluated from the perspective of body sway), useful for investigating the disease progression. Thanks to their small size and low cost of their components, inertial measurement units (IMUs) are easy to wear and are cheap tools for movement analysis. Materials and Methods: The aim of this study is to review articles published in the last 21 years (from 2000 to 2021) concerning the application of wearable sensors to assess spatiotemporal parameters of gait and body postural alterations in patients with diabetes mellitus. Relevant articles were searched in the Medline database using PubMed, Ovid and Cochrane libraries. Results: One hundred and four articles were initially identified while searching the scientific literature on this topic. Thirteen were selected and analysed in this review. Wearable motion sensors are useful, noninvasive, low-cost, and objective tools for performing gait and posture analysis in diabetic patients. The IMUs can be worn at the lumber levels, tibias or feet, and different spatiotemporal parameters of movement and static posture can be assessed. Conclusions: Future research should focus on standardizing the measurement setup and selecting the most informative spatiotemporal parameters for gait and posture analysis.
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Abstract
Diabetes is one of the most common disease states in older adults and there are significant risks to the use of antidiabetic medications. The older adult population varies greatly in functional ability, independence, and cognition. These factors, along with increased risk of hypoglycemia, falls, and other comorbidities, add to the complexity of creating medication regimens to treat diabetes in older adults. In the current review, a person-centered approach to diabetes care in older adults is described to aid clinician decision making. By keeping the patient and their individual factors in the center of the decision, risks of over- or under-treating diabetes can be minimized. The review will discuss person-centered goal setting, practical approaches to diabetes medication management, and specific considerations for choosing medication classes based on patient characteristics. [Journal of Gerontological Nursing, 47(10), 7-13.].
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Heisser RH, Aubin CA, Peretz O, Kincaid N, An HS, Fisher EM, Sobhani S, Pepiot P, Gat AD, Shepherd RF. Valveless microliter combustion for densely packed arrays of powerful soft actuators. Proc Natl Acad Sci U S A 2021; 118:e2106553118. [PMID: 34556574 PMCID: PMC8488685 DOI: 10.1073/pnas.2106553118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 01/19/2023] Open
Abstract
Existing tactile stimulation technologies powered by small actuators offer low-resolution stimuli compared to the enormous mechanoreceptor density of human skin. Arrays of soft pneumatic actuators initially show promise as small-resolution (1- to 3-mm diameter), highly conformable tactile display strategies yet ultimately fail because of their need for valves bulkier than the actuators themselves. In this paper, we demonstrate an array of individually addressable, soft fluidic actuators that operate without electromechanical valves. We achieve this by using microscale combustion and localized thermal flame quenching. Precisely, liquid metal electrodes produce sparks to ignite fuel lean methane-oxygen mixtures in a 5-mm diameter, 2-mm tall silicone cylinder. The exothermic reaction quickly pressurizes the cylinder, displacing a silicone membrane up to 6 mm in under 1 ms. This device has an estimated free-inflation instantaneous stroke power of 3 W. The maximum reported operational frequency of these cylinders is 1.2 kHz with average displacements of ∼100 µm. We demonstrate that, at these small scales, the wall-quenching flame behavior also allows operation of a 3 × 3 array of 3-mm diameter cylinders with 4-mm pitch. Though we primarily present our device as a tactile display technology, it is a platform microactuator technology with application beyond this one.
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Affiliation(s)
- Ronald H Heisser
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Cameron A Aubin
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Ofek Peretz
- Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nicholas Kincaid
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Hyeon Seok An
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Elizabeth M Fisher
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Sadaf Sobhani
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Perrine Pepiot
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Amir D Gat
- Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Robert F Shepherd
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853;
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Classification of Diabetic Walking for Senior Citizens and Personal Home Training System Using Single RGB Camera through Machine Learning. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11199029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Senior citizens have increased plasma glucose and a higher risk of diabetes-related complications than young people. However, it is difficult to diagnose and manage elderly diabetics because there is no clear symptom according to current diagnostic criteria. They also dislike the invasive blood sample test. This study aimed to classify a difference in gait and physical fitness characteristics between senior citizens with and without diabetes for a non-invasive method and propose a machine-learning-based personal home-training system for training abnormal gait motions by oneself. We used a dataset for classification with 200 over 65-year-old elders who walked a flat and straight 15 m route in 3 different walking speed conditions using an inertial measurement unit and physical fitness test. Then, questionnaires for participants were included to identify life patterns. Through results, it was found that there were abnormalities in gait and physical fitness characteristics related to balance ability and walking speed. Using a single RGB camera, the developed training system for improving abnormalities enabled us to correct the exercise posture and speed in real-time. It was discussed that there are risks and errors in the training system based on human pose estimation for future works.
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Khan KS, Pop-Busui R, Devantier L, Kristensen AG, Tankisi H, Dalgas U, Overgaard K, Andersen H. Falls in individuals with type 2 diabetes; a cross-sectional study on the impact of motor dysfunction, postural instability and diabetic polyneuropathy. Diabet Med 2021; 38:e14470. [PMID: 33259675 DOI: 10.1111/dme.14470] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/19/2023]
Abstract
AIM To estimate the incidence of falls in individuals with type 2 diabetes compared to healthy controls and to describe the characteristics of fallers with type 2 diabetes in relation to motor dysfunction, postural instability and diabetic polyneuropathy (DPN). METHODS This is a cross-sectional study of individuals with type 2 diabetes with DPN (n = 54), without DPN (n = 38) and healthy controls (n = 39). Falls were recorded within the preceding year. DPN was defined by clinical scores and nerve conduction studies. Motor function was assessed by a 6-min walk test (6 MWT), five-time sit-to-stand test (FTSST) and isokinetic dynamometry at the non-dominant ankle and knee. An instability index (ST) was measured using static posturography. Univariate and bivariate descriptive statistics were used for group comparisons. RESULTS Compared with healthy controls, individuals with diabetes had a higher incidence of falls 36%, (n = 33) versus 15%, (n = 6), p = 0.02. There were no differences in falls when comparing individuals with and without DPN. Fallers had an impaired 6 MWT versus non-fallers (450 ± 153 m vs. 523 ± 97 m respectively), a slower FTSST (11.9 ± 4.2 s vs. 10.3 ± 2.9 s respectively) and a higher ST (53 ± 29 vs. 41 ± 17 respectively), p < 0.02 for all. CONCLUSION Individuals with type 2 diabetes reported a higher number of falls within the preceding year compared to healthy controls, irrespective of the presence of DPN. The main factors associated with falls were increased postural instability, lower walking capacity and slower sit-to-stand movements. The 6 MWT, FTSST and posturography should be considered in future screening programs in identification of individuals at risk for falls.
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Affiliation(s)
- Karolina S Khan
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Louise Devantier
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Denmark
| | - Alexander G Kristensen
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
| | - Hatice Tankisi
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Sport Biological Research, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kristian Overgaard
- Sport Biological Research, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
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Cicek SC, Demir S, Yilmaz D, Yildiz S. Effect of reflexology on ankle brachial index, diabetic peripheral neuropathy, and glycemic control in older adults with diabetes: A randomized controlled trial. Complement Ther Clin Pract 2021; 44:101437. [PMID: 34237668 DOI: 10.1016/j.ctcp.2021.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/30/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of foot reflexology on ankle brachial index, diabetic peripheral neuropathy and glycemic control in older adults with diabetes. METHODS A randomized controlled, parallel-group trial study was conducted at the outpatient elderly health center in Bolu, Turkey. 48 adults aged 65 and over enrolled in the elderly health center were randomized into two groups in a ratio of 1:1 (experimental, n = 24; control, n = 24). Foot reflexology was performed for 12-week in the experimental group, whereas the control group continued their routine treatment and follow-up. The outcome measures included: (1) ankle brachial index, (2) diabetic peripheral neuropathy measured by a comprehensive foot exam, and (3) glycemic control by a glycated hemoglobin A blood test at baseline and after 12 weeks. RESULTS Post-test diabetic peripheral neuropathy scores (p < 0.001) and glycated hemoglobin A levels (p = 0.002) decreased in the experimental group and increased in the control group. There was no significant between-group difference regarding post-test ankle brachial index scores (p = 0.726). Foot reflexology had a medium effect size on diabetic peripheral neuropathy (95% confidence interval 0.003-2.24; d = 0.51; p < 0.001) and glycated hemoglobin A (95% confidence interval 0.72-1.22; d = 0.52; p = 0.002). CONCLUSIONS A foot reflexology practice can be a useful for improving the glycemic control and diabetic peripheral neuropathy in the older adults with diabetes. TRIAL REGISTRATION NUMBER NCT04416503.
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Affiliation(s)
- Saadet Can Cicek
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Nursing Department, Internal Medicine Nursing, Bolu, Turkey.
| | - Seyma Demir
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Nursing Department, Internal Medicine Nursing, Bolu, Turkey
| | - Dilek Yilmaz
- Bolu Abant Izzet Baysal University, Izzet Baysal Training and Research Hospital, Department of Neurology, Bolu, Turkey
| | - Sedat Yildiz
- Private Physical Therapy and Rehabilitation Clinic, Isparta, Turkey
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Wen Y, Liao J, Yin Y, Liu C, Gong R, Wu D. Risk of falls in 4 years of follow-up among Chinese adults with diabetes: findings from the China Health and Retirement Longitudinal Study. BMJ Open 2021; 11:e043349. [PMID: 34103310 PMCID: PMC8190046 DOI: 10.1136/bmjopen-2020-043349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study was to determine the incidence of falls and identify baseline factors increased risk for incident falls over time among people with diabetes. DESIGN This study was a secondary analysis using the baseline and 4 years of follow-up data from the China Health and Retirement Longitudinal Study (CHARLS). SETTING A nationally representative survey of 17 500 Chinese residents aged 45 years and older were recruited in the baseline national survey in 2011. These participants were followed up every 2 years. PARTICIPANTS A total of 1238 middle-aged and older adults with diabetes and no history of falls at baseline were included in the current study. PRIMARY AND SECONDARY OUTCOME MEASURES Information on incidence of falls and medical treatment resulting from falls were determined by self-report. RESULTS The findings showed that the incidence of falls was 29.4% during 4 years of follow-up. Participants with incident falls were younger, were more likely to be women, had lower education level and were less likely to be current drinkers. In addition, former drinkers were 2.22 times more likely to fall. Socially active individuals were 47% less likely to fall compared with those without social activities. Every 5 kg increase in grip strength was associated with a 13% lower risk of falls. A 10 mg/dL higher total cholesterol and 1 mg/dL higher blood urea nitrogen were associated with a 4% and 6% higher risk of falls. Finally, participants with depressive symptoms were 1.47 times more likely to fall compared with those without depressive symptoms. CONCLUSIONS These findings underscore the importance of developing a fall prevention programme for those with diabetes, and this programme should address potentially modifiable risk factors, including levels of total cholesterol, blood urea nitrogen, social activity, depressive symptoms and grip strength.
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Affiliation(s)
- Yue Wen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqiong Yin
- Gastrointestinal Department, West China Hospital, Sichuan University, Chengdu, China
| | - Chunjuan Liu
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, Chengdu, China
| | - Renrong Gong
- Department of Surgery, West China Hospital, Sichuan University/ Department of Surgery, West China School of Nursing, Sichuan University /Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Dongmei Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Department of Nursing, The Fourth People's Hospital of Chengdu & Chengdu Mental Health Center, Chengdu, China
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Jung J, Kim MG, Kang YJ, Min K, Han KA, Choi H. Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116046. [PMID: 34199765 PMCID: PMC8200021 DOI: 10.3390/ijerph18116046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance and other factors affecting balance impairment and fear of falling in patients with type 2 DM. Sixty-three patients with DM aged >50 years were categorized as having normal vibration sense (NVS; n = 34) or impaired vibration sense (IVS; n = 29) according to a VPT value of 8.9 μm. The following parameters were evaluated for all patients: postural steadiness through the fall index using posturography, functional balance through the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and fear of falling through the Falls Efficacy Scale-International (FES-I). The IVS group showed a significantly greater balance impairment in fall index, BBS, and TUG, as well as greater fear of falling on the FES-I than the NVS group. The linear regression analysis showed that the fall index was associated only with the VPT, whereas BBS, TUG, and FES-I were associated with the VPT, age, and/or lower extremity muscle strength. VPT, age, and/or muscle strength were identified as predictors of balance and fear of falling in patients with type 2 DM. Therefore, along with age and lower extremity strength, the VPT can be useful for balance assessment in patients with type 2 DM.
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Affiliation(s)
- Jisang Jung
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
| | - Min-Gyu Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
| | - Youn-Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
| | - Kyungwan Min
- Diabetes Center, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (K.M.); (K.-A.H.)
| | - Kyung-Ah Han
- Diabetes Center, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (K.M.); (K.-A.H.)
| | - Hyoseon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
- Correspondence: ; Tel.: +82-2-970-8315
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Vilaca T, Paggiosi M, Walsh JS, Selvarajah D, Eastell R. The Effects of Type 1 Diabetes and Diabetic Peripheral Neuropathy on the Musculoskeletal System: A Case-Control Study. J Bone Miner Res 2021; 36:1048-1059. [PMID: 33825260 DOI: 10.1002/jbmr.4271] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Fracture risk is increased in type 1 diabetes (T1D). Diabetic neuropathy might contribute to this increased risk directly through effects on bone turnover and indirectly through effects on balance, muscle strength, and gait. We compared patients with T1D with (T1DN+, n = 20) and without (T1DN-, n = 20) distal symmetric sensorimotor polyneuropathy and controls (n = 20). We assessed areal bone mineral density (aBMD) and appendicular muscle mass by dual-energy X-ray absorptiometry, microarchitecture by high-resolution peripheral quantitative tomography at the standard ultra-distal site and at an exploratory 14% bone length site at the tibia and radius, bone turnover markers, and muscle strength, gait, and balance by Short Physical Performance Battery (SPPB). At the standard ultra-distal site, tibial cortical porosity was 56% higher in T1DN+ compared with T1DN- (p = .009) and correlated positively with the severity of neuropathy (Toronto Clinical Neuropathy Score; r = 0.347, p = .028) and negatively with nerve conduction amplitude and velocity (r = -0.386, p = .015 and r = -0.358, p = .025, respectively). Similar negative correlations were also observed at the radius (r = -0.484, p = .006 and r = -0.446, p = .012, respectively). At the exploratory 14% offset site (less distal), we found higher trabecular volumetric BMD (tibia 25%, p = .024; radius 46%, p = .017), trabecular bone volume (tibia 25%, p = .023; radius 46%, p = .017), and trabecular number (tibia 22%, p = .014; radius 30%, p = .010) in T1DN- compared with controls. Both CTX and PINP were lower in participants with TD1 compared with controls. No difference was found in aBMD and appendicular muscle mass. T1DN+ had worse performance in the SPPB compared with T1DN- and control. In summary, neuropathy was associated with cortical porosity and worse performance in physical tests. Our findings suggest that bone structure does not fully explain the rate of fractures in T1D. We conclude that the increase in the risk of fractures in T1D is multifactorial with both skeletal and non-skeletal contributions. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Tatiane Vilaca
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
| | - Margaret Paggiosi
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
| | - Jennifer S Walsh
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
| | - Dinesh Selvarajah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Richard Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
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Kraiwong R, Vongsirinavarat M, Rueankam M, Sumalrot T. Effects of physical-cognitive training on physical and psychological functions among older adults with type 2 diabetes and balance impairment: a randomized controlled trial. J Exerc Rehabil 2021; 17:120-130. [PMID: 34012938 PMCID: PMC8103183 DOI: 10.12965/jer.2142106.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Risks of falls among older adults are multifactorial in nature. A combined training program might be beneficial on fall-related outcomes. This study aimed to explore the effects of group-based physical-cognitive trainings on physical and psychological outcomes among older adults with type 2 diabetes mellitus (T2DM) and balance impairment. Fall incidence were also determined. Thirty-seven older adults with T2DM and balance impairment were randomly assigned to control and intervention groups. The intervention program comprised of 24 training sessions of 45–60 min exercise for 8 weeks. The exercise consisted of warm-up, aerobic exercise by nine square stepping, resistance exercise combined with cognitive training and cool down. All participants were assessed at baseline, 4 and 8 weeks after intervention, and 1-year follow-up. Both groups reported similar rates of falls. Global cognition, depressive symptoms, and fear of falling did not differ between groups at any time. The Timed Up & Go (TUG) test, alternate stepping test (AST), knee extensors, ankle plantarflexors, and dorsiflexors strength differed at 4 weeks. TUG, AST, hip abductors, knee flexors, ankle plantarflexors, and dorsiflexors strength differed at 8 weeks. The activity of daily living (ADL), TUG test (P=0.002) and AST, hip extensors and abductors, knee extensors and flexors, ankle plantarflexors and dorsiflexors were different at 1-year follow-up. The group-based physical-cognitive training could benefit older adults with T2DM in terms of maintaining ADL. The intervention could reduce fall risk factors by improving balance and lower limb muscle strength among older adults with T2DM and balance impairment.
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Affiliation(s)
- Ratchanok Kraiwong
- Department of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Mantana Vongsirinavarat
- Department of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Maliwan Rueankam
- Department of Occupational Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Thanayot Sumalrot
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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