Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Margaret M. and Albert B. Alkek Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.
Gait Posture. 2021 Jul;88:161-166. doi: 10.1016/j.gaitpost.2021.05.022. Epub 2021 May 27.
Cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) are at increased risk of falls and developing fear of falling (FoF). Although FoF may continue to impair motor performance and increase the risk of falling even further, this association remains unexplored in CIPN.
Does high FoF in patients with CIPN further deteriorate motor performance beyond the impairment from CIPN-related sensory deficits?
In this secondary analysis of data collected from two clinical trials, gait parameters during habitual walking condition and postural sway parameters during 30-second quiet standing (eye-open and eyes-closed) were compared among older participants (≥ 65 years) with CIPN and high FoF (CIPN FoF+; n=16), older participants with CIPN and low FoF (CIPN FoF-; n=19) and normal older controls (i.e., non-cancer, non-diabetic, non-neurologic, and non-orthopedic; n=16). We measured gait and postural sway parameters using wearable sensors (BioSensics, Newton, MA, USA), and FoF severity using the Falls Efficacy Scale-International.
The largest between-group differences were found in gait speed. The CIPN FoF + group had significantly slower gait speed (0.78 ± 0.21 m/s) than the CIPN FoF- (0.93 ± 0.17 m/s) and normal control groups (1.17 ± 0.13 m/s) (all p < .05; effect sizes = 0.79 and 2.23, respectively). We found a significant association between gait speed and FoF severity (R2 = 0.356; p < .001) across all participants with CIPN. Among participants with CIPN, no significant differences in postural sway parameters were found between the CIPN FoF+and CIPN FoF- groups.
Our results suggest that gait performance further deteriorates in patients with CIPN and high FoF beyond the impairment from CIPN-related sensory deficits. Our results also suggest further research is needed regarding FoF, and fall risk, as FoF is a simple tool that healthcare providers can use in clinical practice.
患有化疗引起的周围神经病（CIPN）的癌症患者跌倒和发生跌倒恐惧（FoF）的风险增加。尽管 FoF 可能会继续损害运动表现并进一步增加跌倒风险，但在 CIPN 中，这种关联仍未得到探索。
患有 CIPN 的患者中 FoF 较高是否会进一步恶化运动表现，超出 CIPN 相关感觉缺陷的损害？
在两项临床试验中收集的数据的二次分析中，我们比较了患有 CIPN 和 FoF 较高（CIPN FoF+；n=16）、患有 CIPN 和 FoF 较低（CIPN FoF-；n=19）以及正常老年对照组（即非癌症、非糖尿病、非神经病学和非骨科；n=16）的老年人在习惯性行走条件下的步态参数和在 30 秒安静站立（睁眼和闭眼）期间的姿势摆动参数。我们使用可穿戴传感器（BioSensics，牛顿，MA，美国）测量步态和姿势摆动参数，并使用跌倒效能量表-国际版测量 FoF 严重程度。
组间差异最大的是步态速度。CIPN FoF+组的步态速度明显较慢（0.78 ± 0.21 m/s），低于 CIPN FoF-组（0.93 ± 0.17 m/s）和正常对照组（1.17 ± 0.13 m/s）（均 p<.05；效应量分别为 0.79 和 2.23）。我们发现所有患有 CIPN 的患者的步态速度与 FoF 严重程度之间存在显著关联（R2=0.356；p<.001）。在患有 CIPN 的患者中，CIPN FoF+和 CIPN FoF-组之间的姿势摆动参数无显著差异。
我们的研究结果表明，患有 CIPN 和 FoF 较高的患者的步态表现进一步恶化，超出了 CIPN 相关感觉缺陷的损害。我们的研究结果还表明，需要进一步研究 FoF 和跌倒风险，因为 FoF 是医疗保健提供者在临床实践中可以使用的简单工具。
