Dr William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
J Diabetes Sci Technol. 2021 Nov;15(6):1352-1360. doi: 10.1177/1932296820979970. Epub 2020 Dec 23.
Fall-risk assessments for patients with diabetes fail to consider reactive responses to balance loss. The purpose of this study was to assess the feasibility of using a simple clinical tool to evaluate the impact of diabetes and fall history on reactive balance in older adults.
We recruited 72 older adults with and without diabetes. Postural perturbations were applied by a waist-mounted spring scale. Stepping thresholds (STs) in the anterior and posterior directions were defined as the lowest spring-loads that induced a step. Balance was assessed via the National Institutes of Health Toolbox Standing Balance Test, and lower extremity sensation was assessed using vibratory perception threshold and Semmes-Weinstein monofilaments. Fall history over the past year was self-reported. Cox regressions and analysis of variance were used to compare hazard rates for stepping and observed STs between groups.
Anterior STs were elicited in 42 subjects and posterior STs in 65 subjects. Hazard rates for posterior ST were significantly affected by diabetes, with greater hazards for fallers with diabetes versus control fallers and nonfallers, after accounting for balance and sensory loss. For those who stepped, ST was lower in the posterior direction for the diabetes group. Additionally, anterior but not posterior ST was lower in all fallers vs all nonfallers.
The waist-mounted spring scale is a clinically implementable device that can assess ST in older adults with diabetes. Using the device, we demonstrated that ST was affected by diabetes and could potentially serve as a fall-risk factor independent of balance or sensory loss.
针对糖尿病患者的跌倒风险评估未能考虑到对平衡丧失的反应性。本研究旨在评估使用简单临床工具评估糖尿病和跌倒史对老年人反应性平衡的影响的可行性。
我们招募了 72 名有或无糖尿病的老年人。通过腰部安装的弹簧秤施加姿势扰动。前后向的步出阈值（ST）定义为引起步出的最低弹簧负载。平衡通过 NIH 工具箱站立平衡测试进行评估，下肢感觉通过振动感觉阈值和 Semmes-Weinstein 单丝进行评估。过去一年的跌倒史通过自我报告。Cox 回归和方差分析用于比较两组之间的步出和观察到的 ST 的危险率。
42 名受试者引出了前向 ST，65 名受试者引出了后向 ST。考虑到平衡和感觉丧失，糖尿病对后向 ST 的危险率有显著影响，糖尿病跌倒者的危险率高于对照组跌倒者和非跌倒者。对于那些步出的人，糖尿病组后向 ST 较低。此外，所有跌倒者的前向 ST 均低于所有非跌倒者，但后向 ST 并非如此。
腰部安装的弹簧秤是一种可在有糖尿病的老年人中实施的临床可行设备。使用该设备，我们证明 ST 受到糖尿病的影响，并且可能独立于平衡或感觉丧失成为跌倒风险因素。
