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Romeyke T, Stummer H. Multimodal Approaches in the Treatment of Chronic Peripheral Neuropathy-Evidence from Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:66. [PMID: 38248531 PMCID: PMC10815843 DOI: 10.3390/ijerph21010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
Patients with chronic peripheral neuropathy suffer greatly and their quality of life is often restricted. Drug therapy can be accompanied by undesirable side effects and intolerances, or the hoped-for effect does not materialize. Therefore, in addition to drug therapy, attempts are also made to treat the physical symptoms with complementary procedures. In the case of severe forms, the search for a suitable form of therapy is difficult. Complex treatments can be an innovative way to treat peripheral neuropathy. At the same time, several different therapy methods are carried out at high frequency by a specialized treatment team. This study aimed to provide an overview of possible complementary forms of therapy. The focus was on a comparison of two interdisciplinary complex therapies that are used in severe cases in an acute inpatient care setting in Germany. The six dimensions (energy, sleep, pain, physicality, emotional response and social isolation) of the Nottingham Health Profile (NHP) were used to assess quality of life. Both complex treatments (naturopathic complex therapy/multimodal pain therapy) showed a significant reduction in impairment in all dimensions of the NHP. In addition, a multivariate analysis was carried out to take into account several influencing variables at the same time. At the time of admission to the hospital, the degree of chronicity was recorded for each patient. This allowed statements to be made about the effect of the respective therapy depending on the chronification stage of the patient. It has been shown that patients with acutely exacerbated pain with the highest degree of chronicity also benefit from both complex treatments. The naturopathic complex treatment gives the treatment team more options. Aspects such as nutrition, methods from phytotherapy and traditional Chinese medicine can be integrated into inpatient care. Thus, a patient-centered, holistic therapy can take place. However, an interdisciplinary holistic therapy requires more time for both the practitioner and the patient. This should be taken into account in the health systems in the context of the diagnosis related groups.
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Affiliation(s)
- Tobias Romeyke
- Institute for Management and Economics in Health Care, UMIT—University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
- Waldhausklinik, Acute Hospital for Internal Medicine, Pain Therapy, Complementary and Individualized Patient Centred Medicine, 86391 Deuringen, Germany
| | - Harald Stummer
- Institute for Management and Economics in Health Care, UMIT—University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
- University Seeburg Castle, 5201 Seekirchen am Wallersee, Austria
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Rao VP, Kim YK, Ghazi A, Park JY, Munir KM. Efficacy of recurrent transcutaneous magnetic stimulation in the treatment of diabetic peripheral neuropathy: Multicenter randomized trial. Pain Pract 2023; 23:914-921. [PMID: 37395169 PMCID: PMC10761591 DOI: 10.1111/papr.13269] [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: 03/02/2023] [Revised: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
AIMS Transcutaneous magnetic stimulation (TCMS) is successful in decreasing pain in several neurologic conditions. This multicenter parallel double-blind phase II clinical trial is a follow-up to a pilot study that demonstrated pain relief in patients with diabetic peripheral neuropathy (DPN) treated with TCMS. METHODS Thirty-four participants with confirmed DPN and baseline pain score ≥ 5 were randomized to treatment at two sites. Participants were treated with either TCMS (n = 18) or sham (n = 16) applied to each foot once a week for four weeks. Pain scores using the Numeric Pain Rating Scale after 10 steps on a hard floor surface and answers to Patient-Reported Outcomes Measurement Information System pain questions were recorded by participants daily for 28 days. RESULTS Thirty-one participants completed the study and were analyzed. Average pain scores decreased from baseline in both the groups. The difference in pain scores between TCMS and sham treatments was -0.55 for morning, -0.13 for evening, and -0.34 overall, below the pre-determined clinically relevant difference of -2. Moderate adverse events that resolved spontaneously were experienced in both treatment arms. CONCLUSION In this two-arm trial, TCMS failed to demonstrate a significant benefit over sham in patient reported pain suggesting a substantial placebo effect in our previous pilot study. TRIAL REGISTRATION TCMS for the Treatment of Foot Pain Caused By Diabetic Neuropathy, https://clinicaltrials.gov/ct2/show/NCT03596203, ID-NCT03596203.
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Affiliation(s)
- Vishnu P. Rao
- University of Maryland, School of Medicine, 800 Linden Avenue, altimore, MD, 21201, 443-682-6800
| | - Yoon Kook Kim
- University of Maryland, School of Medicine, 800 Linden Avenue, Baltimore, MD 21201, 443-682-6800
| | - Anahita Ghazi
- Rosalind Franklin University of Medicine and Science Medical Sciences, 3333 Green Bay Road, North Chicago, IL 60064, 847-578-3000
| | - Jean Y. Park
- MedStar Medical Group, 5601 Loch Raven Blvd., Floor 3, Baltimore, MD, 21239, 443-444-5663
| | - Kashif M. Munir
- Division of Endocrinology, Diabetes and Nutrition, Address: 800 Linden Avenue, 8 floor, Division of Endocrinology, Baltimore, Maryland, 21201
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Walz ID, Waibel S, Lippi V, Kammermeier S, Gollhofer A, Maurer C. "PNP slows down" - linearly-reduced whole body joint velocities and altered gait patterns in polyneuropathy. Front Hum Neurosci 2023; 17:1229440. [PMID: 37780958 PMCID: PMC10534044 DOI: 10.3389/fnhum.2023.1229440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Gait disturbances are a common consequence of polyneuropathy (PNP) and a major factor in patients' reduced quality of life. Less is known about the underlying mechanisms of PNP-related altered motor behavior and its distribution across the body. We aimed to capture whole body movements in PNP during a clinically relevant mobility test, i.e., the Timed Up and Go (TUG). We hypothesize that joint velocity profiles across the entire body would enable a deeper understanding of PNP-related movement alterations. This may yield insights into motor control mechanisms responsible for altered gait in PNP. Methods 20 PNP patients (61 ± 14 years) and a matched healthy control group (CG, 60 ± 15 years) performed TUG at (i) preferred and (ii) fast movement speed, and (iii) while counting backward (dual-task). We recorded TUG duration (s) and extracted gait-related parameters [step time (s), step length (cm), and width (cm)] during the walking sequences of TUG and calculated center of mass (COM) velocity [represents gait speed (cm/s)] and joint velocities (cm/s) (ankles, knees, hips, shoulders, elbows, wrists) with respect to body coordinates during walking; we then derived mean joint velocities and ratios between groups. Results Across all TUG conditions, PNP patients moved significantly slower (TUG time, gait speed) with prolonged step time and shorter steps compared to CG. Velocity profiles depend significantly on group designation, TUG condition, and joint. Correlation analysis revealed that joint velocities and gait speed are closely interrelated in individual subjects, with a 0.87 mean velocity ratio between groups. Discussion We confirmed a PNP-related slowed gait pattern. Interestingly, joint velocities in the rest of the body measured in body coordinates were in a linear relationship to each other and to COM velocity in space coordinates, despite PNP. Across the whole body, PNP patients reduce, on average, their joint velocities with a factor of 0.87 compared to CG and thus maintain movement patterns in terms of velocity distributions across joints similarly to healthy individuals. This down-scaling of mean absolute joint velocities may be the main source for the altered motor behavior of PNP patients during gait and is due to the poorer quality of their somatosensory information. Clinical Trial Registration https://drks.de/search/de, identifier DRKS00016999.
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Affiliation(s)
- Isabelle D. Walz
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Sarah Waibel
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Vittorio Lippi
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine Freiburg, Institute of Digitalization in Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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The Role of Physical Exercise and Rehabilitative Implications in the Process of Nerve Repair in Peripheral Neuropathies: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13030364. [PMID: 36766469 PMCID: PMC9914426 DOI: 10.3390/diagnostics13030364] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The various mechanisms involved in peripheral nerve regeneration, induced by exercise and electrical nerve stimulation, are still unclear. OBJECTIVE The aim of this review was to summarize the influence of physical exercise and/or electrical stimulation on peripheral nerve repair and regeneration and the variation of impact of intervention depending on timing, as well as kind and dosage of the intervention. A literature survey was conducted on PubMed, Scopus, and Web of Science, between February 2021 to July 2021, with an update in September 2022. METHODOLOGY The literature search identified 101,386 articles with the keywords: "peripheral nerve" OR "neuropathy" AND "sprouting" OR "neuroapraxia" OR "axonotmesis" OR "neurotmesis" OR "muscle denervation" OR "denervated muscle" AND "rehabilitation" OR "physical activity" OR "physical exercise" OR "activity" OR "electrical stimulation". A total of 60 publications were included. Eligible studies were focused on evaluating the process of nerve repair (biopsy, electromyographic parameters or biomarker outcomes) after electrical stimulation or physical exercise interventions on humans or animals with peripheral sensory or motor nerve injury. SYNTHESIS This study shows that the literature, especially regarding preclinical research, is mainly in agreement that an early physical program with active exercise and/or electrical stimulation promotes axonal regenerative responses and prevents maladaptive response. This was evaluated by means of changes in electrophysiological recordings of CMAPs for latency amplitude, and the sciatic functional index (SFI). Furthermore, this type of activity can cause an increase in weight and in muscle fiber diameter. Nevertheless, some detrimental effects of exercising and electrical stimulation too early after nerve repair were recorded. CONCLUSION In most preclinical studies, peripheral neuropathy function was associated with improvements after physical exercise and electrical stimulation. For humans, too little research has been conducted on this topic to reach a complete conclusion. This research supports the need for future studies to test the validity of a possible rehabilitation treatment in humans in cases of peripheral neuropathy to help nerve sprouting.
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Phyu SN, Wanpen S, Chatchawan U. Responsiveness of the Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy. J Multidiscip Healthc 2022; 15:3015-3028. [PMID: 36601428 PMCID: PMC9807068 DOI: 10.2147/jmdh.s392058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
Background Mini-BESTest is an instrument for assessing the balance impairment; however, the use of the Mini-BESTest in type 2 diabetic patients with peripheral neuropathy is not well documented in the literature. The aim of this study was to examine the responsiveness and the minimal important change (MIC) of the Mini-BESTest after four weeks of the balance exercises. Methods A prospective single group pretest-posttest design was applied, and forty-eight type 2 diabetic patients with peripheral neuropathy were participated (mean age of 59.04 ± 7.533 years; 3 males and 45 females). All participants were given an intervention program including foot care and balance exercises (50-minute sessions, three times a week for four weeks). The responsiveness of the Mini-BESTest was determined using two approaches: 1) the distribution-based method evaluating the change scores (pre- and post-intervention), the effect size (ES), the standard response mean (SRM), the standard error of measurement (SEM) and the minimum detectable change (MDC95) and 2) the anchor-based method evaluating the MIC using the Global Rating of Change scale (GRC) as an external criterion. Results After the balance exercises treatment, the Mini-BESTest scores significantly improved (p < 0.001) with an ES of 3.9 and SRM of 4.32. SEM was 0.73 and MDC95 was 2.03 points. The area under the receiver operating characteristic (ROC) curve corresponded to 81%. The cutoff point of the Mini-BESTest was ≥5 points corresponding to the GRC ≤3 versus >3 for the discrimination of the Mini-BESTest between improvement and no improvement after exercises. Conclusion The Mini-BESTest can be demonstrated as high responsiveness according to the determination of the distribution-based and the anchor-based methods. The MIC of the Mini-BESTest was taken as ≥5 points and could be used as an outcome measure for the discriminated evaluation of type 2 diabetic patients with peripheral neuropathy.
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Affiliation(s)
- Sitt Nyein Phyu
- Human Movement Sciences, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medicine Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Sawitri Wanpen
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Uraiwan Chatchawan
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medicine Sciences, Khon Kaen University, Khon Kaen, Thailand,School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Uraiwan Chatchawan, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Muang, Khon Kaen, Thailand, Tel/Fax +6643202085, Email
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Reliability and Validity of Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116944. [PMID: 35682526 PMCID: PMC9180405 DOI: 10.3390/ijerph19116944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 01/27/2023]
Abstract
Type 2 diabetic peripheral neuropathy is known to cause balance limitations in static, dynamic, and functional activity. The Mini-BESTest, a shortened version of BESTest, was evolved to identify balance disorders within a short duration. No prior studies have yet been conducted to assess the usefulness of Mini-BESTest in the diagnosis of type 2 diabetic peripheral neuropathy. The current study aimed to examine the reliability and discriminant validity by comparing the Mini-BESTest scores between type 2 diabetic patients with peripheral neuropathy, divided into two 2 groups based on reporting scores of <4 and ≥4 in the MNSI questionnaire, respectively. Therefore, a cross-sectional study design was conducted including 44 type 2 diabetic patients (4 males and 40 females; aged 56.61 ± 7.7 years old). Diabetic peripheral neuropathy was diagnosed by physical assessment using the Michigan Neuropathy Screening Instrument (MNSI). Inter-rater (two physiotherapists) and Intra-rater (7−10 days) reliability of the Mini-BESTest were explored with intraclass correlation coefficients (ICC2,1) and (ICC3,1). The Mini-BESTest presented an excellent inter-rater reliability (ICC2,1= 0.95, 95% CI = 0.91−0.97, SEM = 0.61) and an excellent intra-rater reliability (ICC3,1 = 0.93, 95% CI = 0.87−0.96, SEM = 0.66), with confirmation by a good agreement presented by the Bland−Altman plots. The internal consistency measured with the overall Cronbach’s alpha showed an acceptable agreement (0.73). The MDC was 2.16. In addition, the Mini-BESTest scores in the type 2 diabetic neuropathy patients reporting MNSI questionnaire scores <4 was found to be significantly higher when compared with those reporting scores ≥4. The Mini-BESTest can be used as a highly reliable and valid clinical application in the population with type 2 diabetic peripheral neuropathy.
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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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Rao VP, Satyarengga M, Lamos EM, Munir KM. The Use of Transcutaneous Magnetic Stimulation to Treat Painful Diabetic Neuropathy. J Diabetes Sci Technol 2021; 15:1406-1407. [PMID: 34218718 PMCID: PMC8655299 DOI: 10.1177/19322968211026943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vishnu P. Rao
- Department of Medicine, Division of
Endocrinology, Diabetes and Nutrition, School of Medicine, University of Maryland,
Baltimore, MD, USA
| | - Medha Satyarengga
- Department of Medicine, Division of
Endocrinology, Diabetes and Nutrition, School of Medicine, University of Maryland,
Baltimore, MD, USA
| | - Elizabeth M. Lamos
- Department of Medicine, Division of
Endocrinology, Diabetes and Nutrition, School of Medicine, University of Maryland,
Baltimore, MD, USA
| | - Kashif M. Munir
- Department of Medicine, Division of
Endocrinology, Diabetes and Nutrition, School of Medicine, University of Maryland,
Baltimore, MD, USA
- Kashif M. Munir, MD, Department of Medicine,
Division of Endocrinology, Diabetes and Nutrition, School of Medicine, University of
Maryland, 827 Linden Avenue, 2nd floor, Baltimore, MD 21201, USA.
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Diabetic Peripheral Neuropathy Affects Pinch Strength and Hand Dexterity in Elderly Patients. Neural Plast 2021; 2021:9959103. [PMID: 34335735 PMCID: PMC8318756 DOI: 10.1155/2021/9959103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, leading to disability and decreased quality of life. In past research and clinical studies, the lower limb function of DPN patients was often the principal subject of research, with little attention given to the upper limb and hand. Our goal was to assess and compare hand function between elderly diabetic patients with DPN and without DPN. Methods A total of 52 diabetic patients were registered and underwent hand function assessments and electrodiagnostic tests. Dynamometer, pinch meter, Semmes Weinstein monofilaments, and the Purdue Pegboard Test (PPT) were used to assess the patients' grip strength, pinch strength, tactile sensory threshold, and hand dexterity. Results Compared with the non-DPN group, the elderly DPN group showed worse thumb-middle fingertip pinch strength and thumb-little fingertip pinch strength in the dominant hand (3.50 (2.50, 4.25) vs. 4.50 (3.00, 5.00), p = 0.019; 1.50 (1.00, 2.00) vs. 2.50 (2.00, 3.00), p < 0.001); the elderly DPN group displayed worse thumb-middle fingertip pinch strength, thumb-ring fingertip pinch strength, and thumb-little fingertip pinch strength in the nondominant hand (3.50 (2.00, 4.50) vs. 4.00 (3.00, 5.00), p = 0.013; 2.50 (1.25, 3.00) vs. 3.00 (2.50, 3.50), p = 0.033; 1.00 (0.75, 2.25) vs. 2.50 (2.00, 2.50), p < 0.001). The elderly DPN group scored lower than the non-DPN group on the PPT test of assembly (13.96 ± 5.18 vs. 16.96 ± 4.61, t = 2.212, p = 0.032). Conclusion Motor function limitation is the principal hand dysfunction in elderly patients with DPN, which is mainly manifested as a decline in fingertip pinch strength and a decrease in hand dexterity. This trial is registered with Clinical Trial Registry no. ChiCTR1900025358.
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Wu B, Niu Z, Hu F. Study on Risk Factors of Peripheral Neuropathy in Type 2 Diabetes Mellitus and Establishment of Prediction Model. Diabetes Metab J 2021; 45:526-538. [PMID: 34352988 PMCID: PMC8369209 DOI: 10.4093/dmj.2020.0100] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most serious complications of type 2 diabetes mellitus (T2DM). DPN increases the risk of ulcers, foot infections, and noninvasive amputations, ultimately leading to long-term disability. METHODS Seven hundred patients with T2DM were investigated from 2013 to 2017 in the Sanlin community by obtaining basic data from the electronic medical record system (EMRS). From September 2018 to July 2019, 681 patients (19 missing) were investigated using a questionnaire, physical examination, biochemical index test, and follow-up Toronto clinical scoring system (TCSS) test. Patients with a TCSS score ≥6 points were diagnosed with DPN. After removing missing values, 612 patients were divided into groups in a 3:1 ratio for external validation. Using different Lasso analyses (misclassification error, mean squared error, -2log-likelihood, and area under curve) and a logistic regression analysis of the training set, models A, B, C, and D were established. The receiver operating characteristic (ROC) curve, calibration plot, dynamic component analysis (DCA) measurements, net classification improvement (NRI) and integrated discrimination improvement (IDI) were used to validate discrimination and clinical practicality of the model. RESULTS Through data analysis, model A (containing four factors), model B (containing five factors), model C (containing seven factors), and model D (containing seven factors) were built. After calibration, ROC curve, DCA, NRI and IDI, models C and D exhibited better accuracy and greater predictive power. CONCLUSION Four prediction models were established to assist with the early screening of DPN in patients with T2DM. The influencing factors in model C and D are more important factors for patients with T2DM diagnosed with DPN.
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Affiliation(s)
- Birong Wu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zheyun Niu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Corresponding author: Fan Hu https://orcid.org/0000-0002-7929-6953 School of Public Health, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China E-mail:
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Malik RA, Andag‐Silva A, Dejthevaporn C, Hakim M, Koh JS, Pinzon R, Sukor N, Wong KS. Diagnosing peripheral neuropathy in South-East Asia: A focus on diabetic neuropathy. J Diabetes Investig 2020; 11:1097-1103. [PMID: 32268012 PMCID: PMC7477502 DOI: 10.1111/jdi.13269] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10-g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South-East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug-induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B1 , B6 , B12 , D) should be actively excluded.
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Affiliation(s)
- Rayaz A Malik
- Weill Cornell Medicine‐QatarQatar FoundationDohaQatar
| | - Aimee Andag‐Silva
- College of MedicineDe La Salle Medical and Health Science InstituteDasmarinasthe Philippines
| | | | - Manfaluthy Hakim
- Department of NeurologyClinical Neurophysiology and Neuromuscular Disorder DivisionCipto Mangunkusumo National General HospitalUniversitas IndonesiaJakartaIndonesia
| | - Jasmine S Koh
- Department of NeurologyNational Neuroscience InstituteSingapore CitySingapore
| | - Rizaldy Pinzon
- Neurology DepartmentBethesda HospitalDuta Wacana Christian University YogyakartaYogyakartaIndonesia
| | - Norlela Sukor
- Department of MedicineThe National University of Malaysia (UKM) Medical CenterKuala LumpurMalaysia
| | - Ka Sing Wong
- Department of Medicine & TherapeuticsConvener of BRAINLui Che Woo Institute of Innovative MedicineSH Ho Center for Cardiovascular Disease & Stroke Faculty of MedicineThe Chinese University of Hong KongHong Kong
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Tseng CH, Chong CK, Sheu JJ. Prevalence and Risk Factors of Sensory Symptoms in Diabetes Patients in Taiwan. Front Endocrinol (Lausanne) 2020; 11:580426. [PMID: 33488515 PMCID: PMC7821276 DOI: 10.3389/fendo.2020.580426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic sensory neuropathy has rarely been studied in the Asian populations. This study investigated the prevalence and risk factors of sensory symptoms (SS) in the Taiwanese diabetes patients. METHODS A total of 1,400 diabetes patients received a health examination together with a structured questionnaire interview for three categories of abnormal sensation of numbness or tingling pain, electric shock, and skin thickness sensation on seven anatomical sites on upper limbs and six sites on lower limbs. Prevalence of SS was defined using nine different criteria, with the least stringent criterion of "any positive symptom on at least 1 site" and the most stringent criterion of "any positive symptom on at least bilateral and symmetrical 2 sites involving the lower limb." Logistic regression was used to estimate the odds ratios and their 95% confidence interval for SS by the different definitions. Fasting plasma glucose and hemoglobin A1c were entered in separate models to avoid hypercollinearity. RESULTS The prevalence of SS was 14.4 and 54.0% when using the most stringent and least stringent criterion, respectively. Women consistently had a significantly higher prevalence than men did. Among the three categories of symptoms, numbness or tingling pain was the most common, and fingers and toes were the most commonly involved anatomical sites. For any symptoms, 37.1% of the patients had any symptoms on the upper limbs and 41.7% had any symptoms on the lower limbs. Female sex, diabetes duration, hemoglobin A1c, and hypertension were associated with SS in all models. CONCLUSIONS Taiwanese diabetes patients may have a high prevalence of SS if a structured questionnaire is used for screening. Female sex, diabetes duration, hemoglobin A1c, and hypertension are associated with SS.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Zhunan, Taiwan
- *Correspondence: Chin-Hsiao Tseng,
| | - Choon-Khim Chong
- Chong’s Physical Medicine and Rehabilitation Center, Taipei, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
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Win MMTM, Fukai K, Nyunt HH, Linn KZ. Hand and foot exercises for diabetic peripheral neuropathy: A randomized controlled trial. Nurs Health Sci 2019; 22:416-426. [PMID: 31876991 DOI: 10.1111/nhs.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/08/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
Exercises for diabetic peripheral neuropathy remain controversial, especially with regard to recommended precautions and weightbearing exercises for individuals. We aimed to investigate the effect of 8 weeks of simple hand, finger, and foot exercises in patients with diabetic peripheral neuropathy. After randomization, exercise (n = 51) and control (n = 53) groups received usual care and diabetic foot care education; only the exercise group performed exercises. Primary outcomes, including activities of daily living (assessed using the Patient Neurotoxicity Questionnaire), neuropathy severity (monofilament and vibration test), and pain (behavioral rating scale and Visual Analog Scale), and secondary outcomes, including physical function of the hand and foot (grip, pinch, finger counting time, and Timed Up and Go tests), were assessed at baseline, after the 8-week intervention, and at the 16-week follow-up. The exercise group showed significantly stronger improvements in motor score and specific activities of daily living, such as climbing stairs and performing work or chores. Our exercises can be used to improve limb function in patients with diabetic neuropathy.
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Affiliation(s)
- Mi Mi Thet Mon Win
- Graduate School of Health Sciences, Okayama University, Okayama, Japan.,Department of Fundamental Nursing, University of Nursing, Yangon, Myanmar
| | - Kiyoko Fukai
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Htwe Htwe Nyunt
- Department of Fundamental Nursing, University of Nursing, Yangon, Myanmar
| | - Khaing Zaw Linn
- Department of Fundamental Nursing, University of Nursing, Yangon, Myanmar
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