Lai Yun-Ru, Chiu Wen-Chan, Ting Chi-Ping, Chiang Yi-Fang, Lin Ting-Yin, Chiang Hui-Ching, Huang Chih-Cheng, Lu Cheng-Hsien
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 833, Taiwan.
Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Neuroeng Rehabil. 2025 Jun 2;22(1):123. doi: 10.1186/s12984-025-01644-6.
Traditional screening methods for diabetic peripheral neuropathy (DPN) can be time-consuming in community settings. Balance and gait impairments are common in individuals with DPN, but these functional impairments are often not detectable with standard neurological examinations. This study aimed to examine whether quantitative balance and gait assessment could serve as a viable alternative screening tool for DPN.
All participants were recruited from a community-based daycare center and underwent peripheral nerve function assessments, including the Toronto Clinical Neuropathy Score (TCNS), sural nerve conduction studies (amplitude and velocity) for large fiber function, and Sudoscan testing for small fiber function. Subsequently, participants underwent balance and gait assessments, including static postural sway measurements and gait analysis of spatiotemporal parameters and joint range of motion (ROM) assessment during walking.
Of the 146 participants, 35 had diabetes, including 22 with DPN, while 111 were healthy controls. Participants with DPN demonstrate increased postural sway velocity and total path length, along with reduced gait speed, shorter stride length, and decreased range of motion in hip flexion and extension. The logistic regression analysis identified diabetes duration and postural sway velocity as the only significant predictors of DPN presence. Postural sway velocity demonstrated strong correlations with elevated TCNS, reduced sural sensory nerve action potential and sensory nerve conduction velocity, and lower Sudoscan values in hands and feet. Additionally, receiver operating characteristic analysis yielded a sensitivity of 68.2%, specificity of 85.5%, and an area under the curve of 0.76, with a cut-off value of 0.98 cm/s.
Balance and gait impairments are prevalent among participants with DPN. This study supports the integration of balance and gait assessments into community-based screening protocols to facilitate early identification and intervention. Postural sway velocity emerged as a practical early biomarker for the screening of DPN.
在社区环境中，传统的糖尿病周围神经病变（DPN）筛查方法可能耗时较长。平衡和步态障碍在DPN患者中很常见，但这些功能障碍通常无法通过标准的神经学检查检测出来。本研究旨在探讨定量平衡和步态评估是否可作为DPN的一种可行的替代筛查工具。
所有参与者均从社区日托中心招募，接受外周神经功能评估，包括多伦多临床神经病变评分（TCNS）、腓肠神经传导研究（幅度和速度）以评估大纤维功能，以及Sudoscan测试以评估小纤维功能。随后，参与者接受平衡和步态评估，包括静态姿势摆动测量以及步行时的时空参数步态分析和关节活动范围（ROM）评估。
146名参与者中，35人患有糖尿病，其中22人患有DPN，111人为健康对照。DPN患者表现出姿势摆动速度和总路径长度增加，同时步态速度降低、步幅缩短以及髋关节屈伸活动范围减小。逻辑回归分析确定糖尿病病程和姿势摆动速度是DPN存在的唯一显著预测因素。姿势摆动速度与升高的TCNS、降低的腓肠感觉神经动作电位和感觉神经传导速度以及手足较低的Sudoscan值密切相关。此外，受试者工作特征分析得出敏感性为68.2%，特异性为85.5%，曲线下面积为0.76，截断值为0.98 cm/s。
平衡和步态障碍在DPN参与者中普遍存在。本研究支持将平衡和步态评估纳入基于社区的筛查方案，以促进早期识别和干预。姿势摆动速度成为筛查DPN的一种实用的早期生物标志物。
