Najafi Bijan, Talal Talal K, Grewal Gurtej Singh, Menzies Robert, Armstrong David G, Lavery Lawrence A
1 Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
2 Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona, Tucson, AZ, USA.
J Diabetes Sci Technol. 2017 Jul;11(4):693-701. doi: 10.1177/1932296817695338. Epub 2017 Feb 1.
People with diabetic peripheral neuropathy (DPN) often exhibit deteriorations in motor-performance mainly due to lack of plantar-sensation. The study explored effectiveness of plantar electrical-stimulation therapy to enhance motor-performance among people with DPN.
Using a double-blinded model, 28 volunteers with DPN (age: 57.8 ± 10.2 years) were recruited and randomized to either intervention (IG: n = 17) or control (CG: n = 11) group. Both groups received identical plantar-stimulation devices for six weeks of daily use at home; however, only the IG devices were set to deliver stimulation. Balance (ankle, hip, and center of mass [COM] sway) and gait (stride velocity [SV], stride time [ST], stride length [SL], and cadence) were measured using validated wearable sensors. Outcomes were assessed at baseline and at six-week. Clinical assessment including vascular as measured by ankle-brachial-index (ABI) and plantar-sensation as quantified by vibratory plantar threshold (VPT) were also measured at baseline and six weeks.
No difference were observed between groups for baseline characteristics ( P > .050). Posttherapy, ankle and COM sway with eyes open were significantly improved ( P < .05, Cohen's effect size d = 0.67-0.76) in the IG with no noticeable changes in CG. All gait parameters were significantly improved in the IG with highest effect size observed for cadence ( d = 1.35, P = .000). Results revealed improvement in VPT ( P = .004, d = 1.15) with significant correlation with stride velocity improvement ( r = .56, P = .037). ABI was improved in the IG in particulate among those with ABI>1.20 ( P = .041, d = 0.99) Conclusion: This study suggests that daily home use of plantar electrical-stimulation may be a practical means to enhance motor-performance and plantar-sensation in people with DPN.
糖尿病周围神经病变（DPN）患者常因足底感觉缺失而出现运动能力下降。本研究探讨足底电刺激疗法对提高DPN患者运动能力的有效性。
采用双盲模型，招募了28名DPN志愿者（年龄：57.8±10.2岁），随机分为干预组（IG：n = 17）或对照组（CG：n = 11）。两组均在家中每天使用相同的足底刺激装置，为期六周；然而，只有IG组的装置设置为可进行刺激。使用经过验证的可穿戴传感器测量平衡能力（踝关节、髋关节和质心[COM]摆动）和步态（步速[SV]、步幅时间[ST]、步幅长度[SL]和步频）。在基线和六周时评估结果。在基线和六周时还测量了临床评估指标，包括通过踝臂指数（ABI）测量的血管情况以及通过振动足底阈值（VPT）量化的足底感觉。
两组的基线特征无差异（P>.050）。治疗后，IG组睁眼时的踝关节和COM摆动明显改善（P<.05，科恩效应量d = 0.67 - 0.76），而CG组无明显变化。IG组的所有步态参数均有显著改善，步频的效应量最高（d = 1.35，P =.000）。结果显示VPT有所改善（P =.004，d = 1.15），且与步速改善显著相关（r =.56，P =.037）。在ABI>1.20的患者中，IG组的ABI有明显改善（P =.041，d = 0.99）。结论：本研究表明，在家中每日使用足底电刺激可能是提高DPN患者运动能力和足底感觉的一种实用方法。
