Aims: To identify risk factors for falls in older people with diabetes mellitus (DM) and to develop a low-cost fall risk screening tool.Methods: Older adults with DM (n=103; age=61.6+6.0years) were recruited from diabetic clinics. Demographic, DM specific factors, lower limb strength and sensation, cognition, fear of falling, hand reaction time, balance, mobility and gait parameters were assessed using validated methods. Falls were prospectively recorded over six months.Results: Past falls and female gender were identified as significant predictors of falls: history of falls and female gender increased fall rates by 4.62 (95% CI = 2.31 to 9.27) and 2.40 (95% CI = 1.04 to 5.54) respectively. Fall rates were significantly associated with Diabetic Neuropathy scores, HbA1c level, contrast sensitivity, quadriceps strength, postural sway, tandem balance, stride length and Timed Up and Go Test times. A multi-variable fall risk tool derived using five measures, revealed that absolute risk for multiple falls increased from 0% in participants with zero or one factor to 83% in participants with all five risk factors. Conclusions:Simple screening items for fall risk in people with DM were identified, with parsimonious explanatory risk factors. These findings help guide tailored interventions for preventing falls in DM.

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Background: The COVID-19 pandemic is currently a severe challenge for healthcare workers, with significant implications for their mental health. Physiotherapy is one of the healthcare professions on the frontline managing this pandemic and is directly exposed to the virus. The aim of the study was to determine the impact of this pandemic on the psychological health of physiotherapists in Sri Lanka.Methods: A descriptive cross-sectional study was conducted among physiotherapists who were recruited from government and private hospitals via purposive sampling.  Depression-anxiety-stress scale-21 was used to assess psychological health and was distributed online.Results: The sample comprised 48 participants (males=33.3%; females=66.7%; age=30.2±3.8 years). The rates with extremely severe, severe, moderate and mild stress were 4.8%, 33.3%, 35.7% and 16.7% respectively and 9.5% of them had no stress perceived. No physiotherapists were found in normal or mild anxiety and depression categories. Moderate, severe and extremely severe anxiety levels were found in 9.5%, 28.6% and 61.9% of physiotherapists respectively. There were 28.6% physiotherapists with extremely severe depression, 19.0% with severe depression and 52.4% with moderate depression. There was a positive correlation and a significant association of stress with depression (r=0.876, p<0.001), stress with anxiety (r=0.780, p<0.001) and anxiety with depression (r=0.752, p<0.001).  Stress, anxiety and depression had no significant associations with age and gender (p>0.05). Fear of infecting family members was found as the main cause of stress (81%).Conclusions: Physiotherapists had elevated levels of anxiety, depression, and stress, highlighting the significance of systematically monitoring physiotherapists’ mental health and implementing supportive measures to improve their well-being during the crisis.

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Introduction Diabetes mellitus (DM), aging and falls have been recognized as a growing and a challenging triad. Despite many tools to assess risk of falls, they may not be applicable for fall risk assessment in DM patients. The aim of the study was to develop a low- cost tool to predict the faller status of DM people. Methods People with DM (n=103) were recruited from diabetic clinics in Sri Lanka. Demographic, neuropathy status, contrast sensitivity (Melbourne Edge test) lower limb (LL) sensation, cognitive functions, fear of falling (Icon-FES), LL strength (maximal isometric quadriceps strength), hand reaction time, balance abilities (postural sway, maximal balance range, coordinated stability, unipedal stand time (UST) and tandem and near tandem standing ability), mobility (Timed up and go test-TUG) and gait parameters were assessed. Falls were prospectively recorded over six months. Data were analyzed using SPSS and STATA with negative binominal regression. Results Fall rates were significantly associated with DM symptoms (p=0.001) and examination scores (p=0.026), HbA1c (p=0.012), contrast sensitivity (p=0.033), TUG (p=0.006), quadriceps strength (p=0.015), sway path on floor eyes closed (p=0.002), sway on foam eyes opened (p=0.009), near tandem (p=0.006) and tandem (p=0.008) balance, UST (p=0.027), stride length (p=0.009), TUG times with cognitive task (p=0.007), dual task backward walking (p=0.005). A multivariate negative binomial regression model comprised two significant and independent variables influencing falls: quadriceps strength and tandem balance ability (likelihood ratio Chi square=12.43, p=0.002). For 1kg increase in quadriceps strength fall rates decreased by 0.94% and the presence of poor tandem balance increased fall rates by a factor of 2.48. Discussion and Conclusion We identified multiple factors that elucidate why people with DM fall. A simple, easy to use tool comprising two independent risk factors: tests of quadriceps strength and tandem balance ability are suggested as a simple screen for fall risk in this population. Such patients may then warrant further detailed assessment and a tailored intervention.