减压装置对糖尿病周围神经病变患者静态和动态平衡的影响:系统评价。
Effects of offloading devices on static and dynamic balance in patients with diabetic peripheral neuropathy: A systematic review.
机构信息
Center for Human Movement Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Rev Endocr Metab Disord. 2021 Jun;22(2):325-335. doi: 10.1007/s11154-020-09619-9. Epub 2021 Jan 16.
Patients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk. The aim of this systematic review is to investigate the effects of plantar offloading devices used for ulcer prevention on their role in static and dynamic balance control in patients with DPN. PubMed and Embase were systematically searched using relevant search terms. After title selection, abstract selection, and full-text selection only five articles could be included for further analysis. Two articles included static balance measurements, two articles included dynamic balance measurements, and one article included both. Results suggested that static balance control is reduced when rocker bottom shoes and different insole configurations are used, however, toe-only rockers showed less evidence for reduced static balance control. There was no evidence for reduced dynamic balance control in combination with offloading devices. However, these results should be interpreted with care, since the number of studies was very small and the quality of the studies was moderate. Future research should evaluate balance in combination with different offloading devices, so that clinicians subscribing them are more aware of their potential unwanted consequences.
患有糖尿病周围神经病变 (DPN) 的患者通常脚部和踝关节的体感信息减少,感知能力改变。体感信息是运动控制的反馈,失去体感会导致步态和站立时足底压力模式发生改变。减压装置用于降低足底峰值压力,预防糖尿病足溃疡。然而,减压装置可能会对静态和动态平衡产生负面影响。由于 DPN 患者已经存在较高的跌倒风险,减压装置可能会增加这种风险,因此了解这些不良影响非常重要。本系统评价的目的是研究用于预防溃疡的足底减压装置对 DPN 患者静态和动态平衡控制的作用。使用相关检索词对 PubMed 和 Embase 进行了系统检索。经过标题筛选、摘要筛选和全文筛选,只有 5 篇文章可进一步分析。其中 2 篇文章包含静态平衡测量,2 篇文章包含动态平衡测量,1 篇文章同时包含这两种测量。结果表明,当使用鞋底为弧形的鞋子和不同的鞋垫结构时,静态平衡控制会降低,而仅足趾的弧形鞋底则显示出较少的静态平衡控制降低的证据。与减压装置结合使用时,没有证据表明动态平衡控制会降低。然而,由于研究数量非常少,研究质量中等,这些结果应谨慎解释。未来的研究应该评估不同减压装置结合时的平衡情况,以便临床医生在开此类装置时更清楚地了解其潜在的不良后果。