Brognara Lorenzo, Sempere-Bigorra Mar, Mazzotti Antonio, Artioli Elena, Julián-Rochina Iván, Cauli Omar
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy.
Nursing Department, University of Valencia, 46010, Valencia, Spain.
J Tissue Viability. 2023 Nov;32(4):516-526. doi: 10.1016/j.jtv.2023.10.002. Epub 2023 Oct 13.
To investigate the cross-sectional association between deep and superficial diabetic neuropathy, postural impairment assessed by wearable inertial sensors, and the risk of fall among patients with diabetic foot.
Diabetic patients attending a University Podiatric Clinic were evaluated for the presence of deep and superficial peripheral neuropathy in sensory tests. Postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated haemoglobin concentration and fasting glycaemia. The postural parameters measured were the anteroposterior and medio-lateral sway of the center of mass (CoM) and the sway area (area traveled by the CoM per second). The results were analyzed through a logistic regression model to assess those posture variables mostly significantly associated with neuropathy and risk of fall scales.
A total of 85 patients were evaluated. Spearman's rank correlation coefficients showed a strong and significant relationship (p < 0.05) between deep diabetic neuropathy assessed by Semmes-Weinstein monofilament, diapason and biothensiometer and postural alterations, whereas no significant correlations between superficial (painful sensitivity) neuropathy and the postural parameters. The sway path of the displacement along the anterior-posterior axis recorded during tests performed with eyes open and feet close together were significantly (p < 0.05) correlated with a poor glycemic (glycated haemoglobin concentration) control and each other with all diabetic neuropathy tests, fall risk scales, muscular weakness, ankle joint limitation and history of ulcers.
The results support the existence of a strong association between alterations of the deep somato-sensitive pathway (although depending on the tool used to measure peripheral neuropathy), glycemic control and balance impairments assessed using a wearable sensors. Wearable-based postural analysis might be part of the clinical assessment that enables the detection of balance impairments and the risk of fall in diabetic patients with diabetic peripheral neuropathy.
研究深部和浅部糖尿病神经病变、通过可穿戴惯性传感器评估的姿势障碍与糖尿病足患者跌倒风险之间的横断面关联。
对在大学足病诊所就诊的糖尿病患者进行感觉测试，以评估深部和浅部周围神经病变的存在情况。使用可穿戴惯性传感器评估姿势障碍，分别通过Tinetti量表和Downton指数评估平衡/步态及跌倒风险。通过糖化血红蛋白浓度和空腹血糖测量血糖控制情况。测量的姿势参数包括质心（CoM）的前后和中外侧摆动以及摆动面积（CoM每秒移动的面积）。通过逻辑回归模型分析结果，以评估那些与神经病变和跌倒风险量表最显著相关的姿势变量。
共评估了85例患者。Spearman等级相关系数显示，通过Semmes-Weinstein单丝、音叉和生物感觉计评估的深部糖尿病神经病变与姿势改变之间存在强且显著的关系（p<0.05），而浅部（疼痛敏感性）神经病变与姿势参数之间无显著相关性。在睁眼双脚并拢进行测试期间记录的沿前后轴位移的摆动路径与血糖（糖化血红蛋白浓度）控制不佳显著相关（p<0.05），并且与所有糖尿病神经病变测试、跌倒风险量表、肌肉无力、踝关节受限和溃疡病史均显著相关。
结果支持深部躯体感觉通路改变（尽管取决于用于测量周围神经病变的工具）、血糖控制与使用可穿戴传感器评估的平衡障碍之间存在强关联。基于可穿戴设备的姿势分析可能是临床评估的一部分，有助于检测糖尿病周围神经病变患者的平衡障碍和跌倒风险。
