Background
Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling.
Methods
A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe.
Results
Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = −0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling.
Conclusions
Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.
The purposes of this study were to (1) describe errors in weightbearing at three target levels for patients with neuropathic feet and control subjects, (2) compare the absolute errors at the three target levels between groups, and (3) identify predictor variables of errors in weightbearing by the neuropathic group. The groups of 26 subjects were matched for age and height. Weightbearing was measured with digital scales while subjects attempted to adjust their weight through a designated lower extremity to each target level (25, 50, and 75% of body weight). Analysis of variance indicated no significant difference in the percentage weightbearing between groups at the three target levels. There was a significant difference in errors made in weightbearing by the groups at the three target levels. Mean errors ranged from 8.5 to 9.7% for the neuropathic group and from 2.4 to 6.6% for the control group. The findings cast doubt on the utility (in the absence of feedback) of requesting individuals, particularly those with neuropathic feet, to weightbear at specific target levels.
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