The gait and balance of patients with diabetes can be improved: a randomised controlled trial

L Allet, S Armand, R A de Bie, A Golay, D Monnin, K Aminian, J B Staal, E D de Bruin, L Allet, S Armand, R A de Bie, A Golay, D Monnin, K Aminian, J B Staal, E D de Bruin

Abstract

Aims/hypothesis: Gait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients.

Methods: This was a randomised controlled trial (n=71) with an intervention (n=35) and control group (n=36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up.

Results: The trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p<0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down.

Conclusions/interpretation: Specific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients' physical activity levels and quality of life.

Trial registration: ClinicalTrials.gov NCT00637546

Funding: This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/

Figures

Fig. 1
Fig. 1
Flow chart with detailed description of recruitment, number of drop-outs and reasons for not continuing. The flow chart is based on the CONSORT Statement recommendations in a previous publication [45]
Fig. 2
Fig. 2
Plots illustrating the baseline difference of (a) gait speed, (b) CVGCT, (c) POMA score, (d) time to walk over a beam, (e) Biodex sway index (level 6) and (f) fear of falls for each group at baseline (BA), after the intervention (PI) and at the 6-month follow-up (FU). Values are adjusted mean and 95% CI. White squares and dotted line, control group; black circles and continuous line, intervention group

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