Sartor Cristina D, Hasue Renata H, Cacciari Lícia P, Butugan Marco K, Watari Ricky, Pássaro Anice C, Giacomozzi Claudia, Sacco Isabel C N
Physical Therapy, Speech and Occupational Therapy Dept, School of Medicine, University of São Paulo, 51, Cidade Universitária, São Paulo, SP, Brazil.
BMC Musculoskelet Disord. 2014 Apr 27;15:137. doi: 10.1186/1471-2474-15-137.
Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy.
To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait.
A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle.
Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05).
Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy.
ClinicalTrials.gov Identifier: NCT01207284, registered in 20th September 2010.
尽管足部肌肉骨骼缺陷在糖尿病性多发性神经病患者中普遍存在，但预防医学很少涉及。
研究强化、伸展和功能训练对步态中足部翻转过程的影响。
设计了一项由盲法评估者进行的双臂平行组随机对照试验。招募了55名年龄在45至65岁之间、被诊断为糖尿病性多发性神经病的患者。对分配到干预组的26名患者进行每周两次、为期12周的足踝和步态训练练习，而分配到对照组的29名患者接受推荐的标准医疗护理：糖尿病药物治疗和足部护理指导。两组在12周后进行评估，干预组在随访时（24周）进行评估。主要结局包括步态中足部翻转变化，包括峰值压力（PP）。次要结局包括六个足部区域的压力峰值时间（TPP）和压力时间积分（PTI）、平均压力中心（COP）速度、矢状面踝关节运动学和动力学、内在和外在肌肉功能以及足踝功能测试。
尽管干预组的主要结局（PP）在六个足部区域下显示出无统计学意义的变化，但意向性分析比较显示足跟撞击变软（足跟TPP延迟，p = 0.03），前足接触的离心控制更好（踝关节伸肌力矩降低，p < 0.01；踝关节背屈功能增加，p < 0.05），相对于前足内侧，前足外侧接触更早（TPP提前，p < 0.01），以及拇趾参与增加（PP和PTI增加，p = 0.03）和脚趾（PTI增加，中等效应量）。还观察到COP平均速度较慢（p = 0.05），以及足踝整体功能增加（p < 0.05）。在大多数情况下，随访后这些值恢复到基线水平（p < 0.05）。
干预谨慎地将足部翻转改变为更符合生理的过程，这得到了足底压力分布改善和足踝复合体功能状况更好的支持。持续监测足部状况和患者教育是必要的，并且有助于保护因多发性神经病而受损的足部肌肉和关节的完整性。
ClinicalTrials.gov标识符：NCT01207284，于2010年9月20日注册。
Zotero 插件