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

Item does not contain fulltextAIMS/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-123446/1/1 maart 201

Effects of second-generation and indoor sports surfaces on knee joint kinetics and kinematics during 45° and 180° cutting manoeuvres, and exploration using statistical parametric mapping and Bayesian analyses

Purpose: The aim of the current investigation was to examine the influence of second generation (2G) and indoor surfaces on knee joint kinetics, kinematics, frictional and muscle force parameters during 45° and 180° change of direction movements using statistical parametric mapping (SPM) and Bayesian analyses. Methods: Twenty male participants performed 45° and 180° change of direction movements on 2G and indoor surfaces. Lower limb kinematics were collected using an eight-camera motion capture system and ground reaction forces were quantified using an embedded force platform. ACL, patellar tendon and patellofemoral loading was examined via a musculoskeletal modelling approaches and the frictional properties of the surfaces were examined using ground reaction force information. Differences between surfaces were examined using SPM and Bayesian analyses. Results: Both SPM and Bayesian analyses showed that ACL loading parameters were greater in the 2G condition in relation to the indoor surface. Conversely, SPM and Bayesian analyses confirmed that patellofemoral/ patellar tendon loading alongside the coefficient of friction and peak rotational moment were larger in the indoor condition compared to the 2G surface. Conclusions: This study indicates that the indoor surface may improve change of direction performance owing to enhanced friction at the shoe-surface interface but augment the risk from patellar tendon/ patellofemoral injuries; whereas the 2G condition may enhance the risk from ACL pathologies