Test-Retest Reliability of Kinematic Parameters of Timed Up and Go in People with Type 2 Diabetes

Implementing a contextually appropriate foot-ankle exercise programme in primary care for the prevention of modifiable risk factors for ulcers in people with diabetes: protocol for a hybrid type 2 study

INTRODUCTION

Diabetes is a highly prevalent disease that negatively impacts people's health and quality of life. It can result in diabetic peripheral neuropathy (DPN) and foot complications, which in turn lead to ulcers and amputations. The international guidelines on diabetic foot included specific foot-ankle exercises as preventive strategy capable of modifying the risk factors for ulcers. Our aim is to test the effectiveness and to implement a contextually appropriate preventive intervention-a foot-ankle exercises programme alongside educational strategies-in a primary care setting to improve range of motion (ROM), strength, functionality of foot-ankle, and quality of life in people with diabetes.

METHODS AND ANALYSIS

This is a hybrid type 2 implementation-effectiveness study organised in four phases, being undertaken in Limeira, São Paulo. Phase 1, preimplementation, aims to gather information about the contextual characteristics, barriers, and facilitators and to form the implementation team. In phase 2, the implementation team will structure the foot-ankle programme, adapting it to the context of primary healthcare, and develop the training for health professionals. In phase 3, effectiveness of the 12 week group-based intervention will be tested by a cluster randomised controlled trial. Primary care units (18 clusters) will be randomly allocated to a control or intervention group, with a total sample of 356 people. Primary outcomes will be DPN symptoms and ankle and first metatarsal phalangeal joint ROM. Reach, adoption, and implementation will be evaluated by Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. In phase 4, maintenance and expansion of the programme in the municipality will be assessed.

ETHICS AND DISSEMINATION

This protocol and the informed consent to be signed by the participants were approved by the Ethics Committee of the School of Medicine of the University of São Paulo (CAAE:63457822.0.0000.0068, 29 November 2022). The project will generate and share data in a public repository. Results will be disseminated through peer-reviewed journals, conference proceedings, and electronic communications for health professionals.

TRIAL REGISTRATION NUMBER

NCT05639478.

A Narrative Literature Review on the Role of Exercise Training in Managing Type 1 and Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia associated with impaired carbohydrate, lipid, and protein metabolism, with concomitant absence of insulin secretion or reduced sensitivity to its metabolic effects. Patients with diabetes mellitus have a 30% more risk of developing heart failure and cardiovascular disease compared to healthy people. Heart and cardiovascular problems are the first cause of death worldwide and the main complications which lead to high healthcare costs. Such complications can be delayed or avoided by taking prescribed medications in conjunction with a healthy lifestyle (i.e., diet and physical activity). The American College of Sports Medicine and the American Diabetes Association recommend that diabetic people reduce total sedentary time by incorporating physical activity into their weekly routine. This narrative literature review aims to summarize and present the main guidelines, pre-exercise cardiovascular screening recommendations, and considerations for patients with diabetes and comorbidities who are planning to participate in physical activity programs.

Kinematic evaluation and reliability assessment of the Nine Hole Peg Test for manual dexterity

BACKGROUND

The Nine Hole Peg Test (NHPT) is one of the most frequently used tools to assess manual dexterity. However, no kinematic parameters are provided to describe the quality of the motor performance, since time is the only score.

PURPOSE

To investigate test-retest and intra-rater reliability, correlation with clinical test score, and discriminant validity of kinematic indexes during NHPT.

STUDY DESIGN

A clinical measurement study.

METHODS

Twenty-five healthy right-handed volunteers performed the NHPT. An experienced physiotherapist administered two sessions at a 6-hour interval with two trials for dominant and non-dominant upper limbs. An optoelectronic system was used to detect NHPT performance, which was divided into nine consecutive peg-grasp, peg-transfer, peg-in-hole, hand-return phases, and one final removing phase. Outcome measures were total and single phases times, normalized jerk, mean, peak and time-to-peak of velocity, curvature index during peg-grasp and hand-return phases, and trunk 3D displacement. The statistical analysis included Intraclass Correlation Coefficients (ICCs) for test-retest and intra-rater reliability, Pearson's coefficients for correlation with the NHPT score, and paired t-tests for discriminant validity.

RESULTS

Test-retest reliability was excellent for trunk rotation (ICC: 0.91) and good to moderate for the other indexes (ICCs: 0.89-0.61). Intra-rater reliability was excellent for total and removing times (ICCs: 0.91 and 0.94) and good to moderate for the other indexes (ICCs: 0.84-0.66), except for trunk inclination (ICC: 0.37). NHPT phases, normalized jerk, mean velocity, peak of velocity, time-to-peak and curvature index correlated with total time (r-score: 0.8-0.3). NHPT phases and most kinematic indexes discriminated the dominant from non-dominant upper limb, with the greatest effect size for normalized jerk during hand-return (d = 1.16).

CONCLUSIONS

Kinematic indexes during NHPT can be considered for manual dexterity assessment. These indexes may allow for the detection of kinematic changes responsible for NHPT score variations in healthy subjects or patients with upper limb impairments.

Association between TUG and Anthropometric Values, Vibration Perception Threshold, FHSQ and 15-D in Type 2 Diabetes Mellitus Patients

Background: Diabetes Mellitus (DM) is a chronic disease and it is characterized by reduced insulin sensitivity and/or impaired insulin production. It affects approximately 415 million people worldwide and involves a variety of complications. DM has a number of complications, including diabetic neuropathy. All of these complications can have effects on body composition, vibration perception threshold (VPT), foot health and health-related quality of life (HRQoL). Objective: The aim of this study is to determine the correlation between the Timed Up and Go (TUG), VPT, Foot Health Status Questionnaire and 15-D Questionnaire in type 2 diabetes mellitus (T2DM) patients. Methodology: A total of 90 T2DM patients (56 men and 34 women) were evaluated on their body composition, VPT, the foot health status through the FHSQ, the HRQoL was evaluated through the 15-D Questionnaire and the TUG test was performed. Results: Statistically significant associations were found between TUG and lean and fat mass, VPT, the sections "General Foot Health" and "Physical Activity" in the FHSQ questionnaire, and the 15D total score and its sections "Mobility" and "Depression". Conclusions: There is a moderate direct correlation between the Timed Up and Go and the fat mass percentage and the vibration perception threshold. Moreover, there is a moderate inverse correlation between Timed Up and Go and fat-free mass, foot health and health-related quality of life in T2DM patients. Therefore, Timed Up and Go can be a tool to assist clinicians in monitoring and managing T2DM patients.

Editorial “Biomechanical Spectrum of Human Sport Performance”

Several parameters can influence our health capital today and can have a negative impact on our performance, whether physiological or mechanical. Indeed, our health and wellbeing are influenced by a range of social, cultural, economic, psychological, and environmental factors across our lives. These change as we progress through the key transition points in life—from infancy and childhood through our teenage years to adulthood, working life, retirement and the end of life. Sport can be a vector that links many of these factors. Whether it is high-performance sport or sedentary practice, sport is very important for the improvement of psychological wellbeing and physical health. Our overarching aim was to increase quality of life. Sedentary practice can increase mobility and reduce the risk of disease, so changing adults’ behavior through sedentary practice could reduce illness and decrease costs to society concerning health problems. Furthermore, a higher frequency of practice can lead to improvements in technique and optimized performance. Our objective is to summarize the latest research in sport science and to quantify the most important parameters influencing human performance related to the health sciences for all age groups, throughout their lives.

Test-Retest Reliability of Vibration Perception Threshold Test in People with Type 2 Diabetes Mellitus

BACKGROUND

Diabetes mellitus is a chronic disease characterized by fasting hyperglycemia. It affects approximately 415 million people worldwide and involves a variety of complications. One of them is the loss of sensitivity to peripheral vibration.

OBJECTIVE

Our study aims to discover the test-retest reliability of a procedure for assessing vibration sensitivity in people with type 2 diabetes mellitus.

METHODOLOGY

90 people with type 2 diabetes mellitus (56 men and 34 women) performed the vibration perception threshold (VPT) test using the Vibratron II device. A re-test was completed seven days after the first reading.

RESULTS

The relative reliability of the VPT test result is excellent (intraclass correlation coefficient = 0.96). The same applies to gender and obesity subgroups. Regarding absolute reliability, the standard error of measurement is 8.99%, and the small real difference is 24.94%.

CONCLUSIONS

The relative and absolute reliability results of the vibration perception threshold in people with type 2 diabetes mellitus offer excellent results.

Effects of 8-Week Whole-Body Vibration Training on the HbA1c, Quality of Life, Physical Fitness, Body Composition and Foot Health Status in People with T2DM: A Double-Blinded Randomized Controlled Trial

The aim of this study was to analyze the effects of an 8-week whole-body vibration (WBV) on the quality of life, physical fitness, body composition, glycosylate hemoglobin (HbA1c), lipid profile, and foot health status in people with type II diabetes mellitus (T2DM). It was performed as a double-blinded randomized controlled trial of 90 people with T2DM. Primary care facilities were used. The 8-week WBV training consisted of maintaining a knee flexion at 45° during five to nine series of 30-60 s in a vibration frequency that oscillated between 12.5-18.5 and 30 s of recovery between series. The placebo group had to perform the same protocol but without vibration. Participants performed the protocol three times per week. The WBV training significantly reduced the fat mass (%) of people with T2DM. However, significant effects of WBV training were not found in the quality of life, physical fitness, foot health status, lipid profile, blood pressure, fasting blood glucose, or HbA1c. Nevertheless, within groups enhances were found in HbA1c, blood pressure, fasting blood glucose, foot health status, health-related quality of life, timed-up and go test, and chair-stand test in both WBV and placebo groups. WBV was shown to be beneficial for reducing the fat mass and lipid profile of people with T2DM. The improvements of the placebo group could be due to both the social benefits of enrolling in an intervention and the physical fitness benefits of isometric contractions. Further studies are needed to clarify the effects of WBV and to establish a dose-response relationship in people with T2DM.