Department of Neurosciences, Geneva University Hospital and University of Geneva, Geneva 1211, Switzerland.
Diabet Med. 2009 Oct;26(10):1003-9. doi: 10.1111/j.1464-5491.2009.02811.x.
To identify clinical factors associated with gait alterations in patients with Type 2 diabetes.
A sample of 76 diabetic patients underwent clinical examination and an outdoor gait assessment on tarred and cobblestoned terrains. We calculated respective differences in gait speed (performance measure) and gait variability (fall risk index) on changing terrains. Associations with clinical factors were investigated using correlation coefficients and linear regression analysis.
The mean walking speed on the tarred pathway was 4.5 +/- 0.6 km/h and 3.9 +/- 0.8 km/h on the cobblestone pathway (P < 0.001). The CVGCT increased from 2.6 +/- 0.9% on the tarred pathway to 5.1 +/- 2.8% on the cobblestone pathway (P < 0.001). Regression analysis showed that 36% of the decrease in gait speed was explained proportionally by the mean of maximal isometric lower limb strength (22.2%; P < or = 0.01), fear of falls (7.4%; P < or = 0.01) and participants' perceived vibration threshold (6.4%; P < or = 0.01). Moreover, mean maximal isometric strength explained 11.8% (P < or = 0.01) of the increase of the coefficient of variation of the gait cycle time when participants changed from tarred terrain to cobblestones.
This study indicated that both physiological (strength and proprioception) and cognitive-behavioural factors (fear of falls) should be considered when treating diabetic patients with gait alterations. Therapists should apply these findings when developing specific fall prevention and treatment programmes.
确定 2 型糖尿病患者步态改变的相关临床因素。
对 76 例糖尿病患者进行临床检查和室外焦油和鹅卵石地面步态评估。我们分别计算了在不同地形上行走速度（绩效指标）和步态变异性（跌倒风险指数）的差异。使用相关系数和线性回归分析探讨了与临床因素的关联。
在柏油路面上的平均行走速度为 4.5 +/- 0.6 公里/小时，在鹅卵石路面上为 3.9 +/- 0.8 公里/小时（P < 0.001）。CVGCT 从柏油路面上的 2.6 +/- 0.9%增加到鹅卵石路面上的 5.1 +/- 2.8%（P < 0.001）。回归分析显示，行走速度下降的 36%与最大等长下肢力量的平均值呈比例解释（22.2%；P < 0.01）、对跌倒的恐惧（7.4%；P < 0.01）和参与者感知的振动阈值（6.4%；P < 0.01）。此外，当参与者从柏油路面过渡到鹅卵石路面时，平均最大等长力量解释了步态周期时间变异系数增加的 11.8%（P < 0.01）。
本研究表明，在治疗步态改变的糖尿病患者时，应考虑生理（力量和本体感觉）和认知行为因素（对跌倒的恐惧）。治疗师在制定特定的跌倒预防和治疗计划时应应用这些发现。
