足底触觉刺激改善糖尿病老年患者的足部感觉和步速：一项临床试验。
Plantar Cutaneous Sensory Stimulation Improves Foot Sensibility and Gait Speed in Older Adults With Diabetes: A Clinical Trial.
机构信息
Fabiana Magalhães Navarro-Peternella, PhD, is Assistant Professor, Department of Physiotherapy, Integrado University Center, Campo Mourão; and Unifamma University Center, Maringá, Paraná, Brazil. Elen Ferraz Teston, DNP, MSN, is a nurse, Health Science Department, Federal University Mato Grosso do Sul, Brazil. Beatriz Maria dos Santos Santiago Ribeiro, RN, is a Master's Student of Nursing, State University Londrina, Brazil. Sonia Silva Marcon, PhD, is Professor, Department of Nursing, State University Maringá, Brazil. The authors have disclosed no financial relationships related to this article. Submitted December 14, 2018; accepted in revised form March 13, 2019.
出版信息
Adv Skin Wound Care. 2019 Dec;32(12):568-573. doi: 10.1097/01.ASW.0000604196.79133.68.
OBJECTIVE
To determine the effect of an intervention involving muscular ankle strengthening and feet sensory stimuli to improve gait speed and balance in older adults with diabetes mellitus type 2 (DM2).
DESIGN
A clinical trial with concealed allocation, assessor blinding, and intention-to-treat analysis.
PARTICIPANTS
The trial enrolled 66 people 60 years or older with DM2 who were physically independent (did not require assistance with activities of daily living).
INTERVENTION
The experimental group performed 12 weeks of plantiflexor and dorsiflexor muscle strengthening exercises with resistance bands, proprioceptive exercises on balance boards and a buoy, and plantar sensory stimulation with bristle brushes and cloths, as well as general foot care instructions. The control group received foot care instructions only.
OUTCOME MEASURES
The primary outcome was plantar cutaneous sensibility as measured with Semmes-Weinstein monofilaments. Secondary outcomes included muscular strength (plantar flexion and dorsiflexion torque as measured with an isokinetic dynamometer), gait speed, and balance (total displacement area, mediolateral displacement, anteroposterior displacement, mediolateral displacement speed, and anteroposterior displacement speed) on right and left bipedal and unipedal supports.
RESULTS
In comparison with the control group, the experimental group demonstrated improved plantar cutaneous sensibility on the right foot (3.46 points; 95% confidence interval [CI], 3.85-9.80), left foot (3.46 points; 95% CI, 4.06-9.76), and an increase in gait speed (0.15 m/s; 95% CI 0.12-0.42). There were no meaningful changes in participants' ankle muscle strength or balance.
CONCLUSIONS
This study showed that plantar cutaneous sensory stimulation can improve foot sensibility and increase the gait speed of older adults with DM2. However, there were no meaningful dorsiflexor or plantiflexor gains after 12 weeks.
目的
确定一项涉及肌肉踝关节强化和足部感觉刺激的干预措施对 2 型糖尿病（DM2）老年患者的步态速度和平衡的影响。
设计
一项采用隐藏分组、评估者盲法和意向治疗分析的临床试验。
参与者
试验纳入了 66 名年龄在 60 岁及以上、身体独立（无需日常生活活动辅助）的 DM2 患者。
干预
实验组进行了 12 周的跖屈肌和背屈肌强化练习，使用阻力带、平衡板和浮筒进行本体感受练习，以及使用毛刷和布进行足底感觉刺激，同时提供一般足部护理指导。对照组仅接受足部护理指导。
结局测量
主要结局为 Semmes-Weinstein 单丝测量的足底皮肤感觉。次要结局包括肌肉力量（等速测力计测量的跖屈和背屈扭矩）、步态速度和平衡（双侧和单足支撑时的总位移面积、横向位移、前后位移、横向位移速度和前后位移速度）。
结果
与对照组相比，实验组右足（3.46 分；95%置信区间 [CI]，3.85-9.80）、左足（3.46 分；95% CI，4.06-9.76）的足底皮肤感觉得到改善，且步态速度提高（0.15 m/s；95% CI 0.12-0.42）。参与者的踝关节肌肉力量或平衡无明显变化。
结论
本研究表明，足底皮肤感觉刺激可以改善 DM2 老年患者的足部感觉，并提高其步态速度。然而，12 周后，背屈肌或跖屈肌的力量并没有明显增加。
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