Department of Endocrinology, Linköping University Hospital, Linköping, Sweden.
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
J Diabetes Res. 2020 Mar 11;2020:4172635. doi: 10.1155/2020/4172635. eCollection 2020.
The aims of the current study were (1) to determine the prevalence of upper extremity impairments (UEIs) in patients with type 1 diabetes by clinical investigation; (2) to investigate if self-reported impairments were concordant with clinical findings and if key questions could be identified; and (3) to investigate if answers to our self-reported questionnaire regarding UEIs are reliable.
Patients with type 1 diabetes were invited to participate in a cross-sectional study of clinical and self-reported (12 items) UEIs in adjunction to ordinary scheduled clinical visit. Before the visit, a questionnaire on UEIs was filled in twice (test-retest) followed by clinical testing at the planned visit.
In total, 69 patients aged 45 ± 14 years and with diabetes duration 26 ± 15 were included in the study. In the clinical examination, two-thirds (65%) of the patients showed one or more UEI, with failure to perform hand against back as the most common clinical finding (40%) followed by positive Phalen's test (27%), Tinel's test (26%), and Prayer's sign (24%). UEIs observed by clinical examination were often bilateral, and multiple impairments often coexisted. Self-reported shoulder stiffness was associated with impaired shoulder mobility and with Prayer's sign. Self-reported reduced hand strength was associated to lower grip force, Prayer's sign, trigger finger, fibrosis string structures, and reduced thenar strength as well as reduced shoulder mobility. In addition, self-reporting previous surgery of carpal tunnel and trigger finger was associated with several clinical UEIs including shoulder, hand, and finger. The test-retest of the questionnaire showed a high agreement of 80-98% for reported shoulder, hand, and finger impairments.
UEIs are common in type 1 diabetes. Self-reported shoulder stiffness and reduced hand strength might be used to capture patients with UEIs in need of clinical investigation and enhanced preventive and therapeutic strategies, as well as rehabilitative interventions.
本研究的目的是：(1)通过临床调查确定 1 型糖尿病患者上肢功能障碍(UEI)的患病率；(2) 调查自我报告的障碍是否与临床发现一致，并确定关键问题；(3) 调查我们关于 UEI 的自我报告问卷的答案是否可靠。
邀请 1 型糖尿病患者参加一项横断面研究，内容为临床和自我报告的(12 项)UEI，以及常规预约的临床就诊。在就诊前，患者两次填写 UEI 问卷(测试-重测)，然后在计划就诊时进行临床检查。
共有 69 名年龄 45 ± 14 岁、糖尿病病程 26 ± 15 岁的患者纳入研究。在临床检查中，三分之二(65%)的患者出现一种或多种 UEI，最常见的临床发现是手不能背到后(40%)，其次是 Phalen 征阳性(27%)、Tinel 征阳性(26%)和 Prayer 征阳性(24%)。临床检查发现的 UEI 常为双侧，且多种障碍常同时存在。自我报告的肩部僵硬与肩部活动受限和 Prayer 征有关。自我报告的手部力量减弱与握力降低、Prayer 征、扳机指、纤维性条索结构以及大鱼际肌力减弱和肩部活动受限有关。此外，自我报告的腕管和扳机指手术史与包括肩部、手部和手指在内的几种临床 UEI 有关。问卷的测试-重测显示，报告的肩部、手部和手指障碍的一致性很高，为 80-98%。
UEI 在 1 型糖尿病中很常见。自我报告的肩部僵硬和手部力量减弱可能用于发现需要临床调查和强化预防和治疗策略以及康复干预的 UEI 患者。
