Relationship between range of motion of foot joints and amount of physical activity in middle-aged male diabetic patients

13301甲第4996号博士（保健学）金沢大学博士論文要旨Abstract 以下に掲載：The Journal of Physical Therapy Science 31(7) pp.540-544 2019. IPEC. 共著者：Nobumasa Matsui, Hiroichi Miaki, Takashi Kitagawa, Takao Nakagaw

Relationship between range of motion of foot joints and amount of physical activity in middle-aged male diabetic patients

13301甲第4996号博士（保健学）金沢大学博士論文本文Full 以下に掲載：The Journal of Physical Therapy Science 31(7) pp.540-544 2019. IPEC. 共著者：Nobumasa Matsui, Hiroichi Miaki, Takashi Kitagawa, Takao Nakagaw

日本人糖尿病患者の足部関節可動域における性別と年齢の影響

Although patients with diabetes often are well known to have limited mobility in theirankle joints, limited information is available regarding how this effect is distributed bygender or age. This study was performed to address these questions. The subjects weredivided into four groups, i.e., 28 male diabetic older (MDO) patients (age range, 50 - 69years), 14 male diabetic young (MDY) patients (age range, 30 - 49 years), 10 femalediabetic older (FDO) patients (age range, 50 - 69 years), and 10 healthy male controlsubjects (age range, 50 - 69 years). Control age and gender matched (CAG) means thatthe control subjects matched with MDO patients in gender and age. The parametersexamined were passive range of motion of plantar flexion and dorsiflexion of the anklejoint, flexion and extension of the first metatarsophalangeal joint, and pronation as wellas supination of the subtalar joint. Each range of motion was compared across all fourgroups. The ankle ranges of motion for the MDO, MDY, FDO, and CAG groups were55.4° ± 8.4°, 56.8° ± 6.9°, 60.7° ± 9.5°, and 69.1° ± 9.2°, respectively. The MDO andMDY groups had significantly decreased capability in this regard compared with the CAGgroup. In contrast, the first metatarsophalangeal ranges of motion for the MDO, MDY,FDO, and CAG groups were 82.9° ± 9.6°, 86.7° ± 13.7°, 90.2° ± 11.6°, and 96.3° ± 8.9°,respectively. The MDO group had significantly lower values than the CAG group, but therewas no significant difference in the subtalar range of motion between these two groups.This study suggested that limited ankle joint mobility may occur in female diabetic patientsindependent of age

糖尿病患者における足部関節可動域と動脈硬化指標の関係

Foot ulcers cause gait disturbances, decreased quality of life, and high rates of mortality in diabetic patients. High plantar pressure and failure of peripheral circulation dynamics have been mentioned as risk factors for diabetic foot ulcers. It has been reported that plantar pressure is affected by the limited joint mobility （LJM） of foot joints. Therefore, preventing LJM of foot joints is important for prevention of diabetic foot ulcers. Failure of peripheral circulation dynamics can be evaluated by measuring brachial-ankle pulse wave velocity （baPWV）. The LJM of foot joints and arteriosclerosis are involved in the etiology of diabetic foot ulcers, but there have been no studies regarding the relationship between these two factors. We investigated the relationship between the range of motion （ROM） of foot joints and baPWV in diabetic patients.The study population consisted of 48 diabetic patients admitted to hospital for glycemic control and diabetes education. The LJM parameters measured were passive ROM of plantar flexion and dorsiflexion of the ankle joint, flexion and extension of the first metatarsophalangeal joint, and pronation and supination of the subtalar joint. baPWV was measured using an automated device. Pearsonʼs and partial correlation coefficients of patientsʼ baPWV and ROM values were calculated. The control conditions were age, gender, diabetes condition （diabetes duration, HbA1c levels, and diabetic polyneuropathy）, and arteriosclerosis status （systolic and diastolic blood pressure）.The mean age of the subjects was 57.4±11.8 years. ROM values for ankle, first metatarsophalangeal, and subtalar joints were 56.9°±8.8°, 89.7°±11.8°, and 27.0°±7.1°, respectively. Partial correlation analysis revealed a negative correlation between baPWV and ankle ROM （r=－0.35, p=0.03） after controlling for age, sex, systolic and diastolic blood pressure, diabetes duration, HbA1c level, and diabetic polyneuropathy. No significant associations of these outcomes were found in other joints.In diabetic patients, baPWV and ankle ROM were significantly negatively correlated when controlling for factors such as age, systolic and diastolic blood pressure, diabetes duration, HbA1c level, and diabetic polyneuropathy. However, additional studies are needed to draw clinical conclusions.糖尿病性足部潰瘍は歩行障害、QOL の低下、死亡率の上昇を引き起こす。糖尿病性足部潰瘍の危険因子として高すぎる足底圧と末梢循環動態の障害が報告されている。足底圧は、足部関節の可動域制限の影響を受けることが示されている。従って、足部関節の関節可動域制限を予防することは、糖尿病性足部潰瘍の予防において重要である。末梢循環動態は、上腕 ‐ 足首脈波速度（baPWV）で評価できる。足部関節の可動域制限および動脈硬化は糖尿病性足部潰瘍に個々に関与しているが、両者の関係は不明である。そこで本研究の目的は、糖尿病患者の足部関節の関節可動域と baPWV の関係を調べることとした。対象は、血糖コントロールと糖尿病教育のために入院した 48 人の糖尿病患者とした。測定された関節可動域は、足関節の背屈および底屈、第1中足趾節間関節の屈曲および伸展、および距骨下関節の回内および回外方向の他動関節可動域とした。baPWV は専用の自動計測装置で測定した。対象の baPWV および各関節の関節可動域のピアソンおよび偏相関係数を計算した。偏相関係数の統制条件は、年齢、性別、糖尿病の状態（糖尿病罹病期間、 HbA1c 値および糖尿病性多発性神経障害）および動脈硬化に関連する値（収縮期血圧および拡張期血圧）とした。対象の平均年齢は 57.4 ± 11.8 歳であった。足関節、第 1 中足趾節間関節、距骨下関節の関節可動域は、それぞれ 56.9 ± 8.8°、89.7 ± 11.8°、27.0 ± 7.1°であった。偏相関分析は、年齢、性別、収縮期血圧および拡張期血圧、糖尿病期間、HbA1c 値および糖尿病性多発性神経障害の有無で制御した後、baPWV と足関節の関節可動域との間に負の相関を示した（r = -0.35、p = 0.03）。他の関節では有意な関連は認められなかった。糖尿病患者では、年齢、収縮期および拡張期血圧、糖尿病期間、HbA1c 値および糖尿病性多発性神経障害の因子で統制しても、baPWV および足関節の関節可動域は有意に負の相関関係を認めた。しかしながら、臨床的結論を引き出すためにはさらなる研究が必要である

大腿四頭筋の超音波画像を用いた等尺性膝関節伸展筋力の推定

Muscle echo intensity (EI) determined by ultrasonography has recently been reported asan index of intramuscular fat. The muscle thickness (MT) and EI of the quadriceps femorismuscle were reported to be influenced by the muscle strength (MS) of the knee extensors.This study was performed to investigate whether the MT and EI of the quadriceps femorisare associated with the MS of knee extensors, and to establish a predictive formula for themaximal isometric MS of knee extensors.Forty healthy volunteers 20-59 years old were included in this study. The maximalisometric MS of knee extensors on the dominant extremity was measured at kneeflexion of 60°, and was defined as the maximal value over three repeated measurements.Transverse ultrasound images of the quadriceps on the dominant extremity were obtainedwith a B-mode ultrasound imaging device and multi-frequency linear transducer. Duringmeasurements, the participants were completely relaxed and sat comfortably withthe knee flexed at 90°. A 10-MHz transducer with gain of 58 dB was used during allmeasurements. The transducer was positioned perpendicular to the longitudinal axis ofthe quadriceps femoris, at the midpoint between the anterior superior iliac spine andthe proximal end of the patella. The same investigator then obtained three consecutiveimages. The subcutaneous fat thickness, MT of each muscle, and EI of each muscle wereanalyzed from three images acquired for the rectus femoris (RF) and vastus intermedius(VI), and the mean values of the three measurements were recorded. Pearson’s andSpearman’s correlation coefficients were calculated to investigate the relationships betweensubcutaneous fat thickness, MT, EI, physical characteristics, and MS. Stepwise multipleregression analysis was then performed with MS value as the dependent variable, and thecharacteristics of the participants and values from the ultrasound images as independentvariables. In addition, multiple regression analysis was performed in two groups dividedaccording to age, i.e., the young adult group and the middle-aged group.There were no significant differences in height, weight, BMI, or muscle circumferencebetween the young adult group and middle-aged group. MS showed significant negativecorrelations with subcutaneous fat thickness, RFEI, and VIEI, and significant positivecorrelations with height, weight, circumference, RFMT, and VIMT. Stepwise regressionanalysis identified height and VIMT as factors significantly associated with MS (adjustedR2 = 0.65). Height and VIMT contributed to MS in young and middle-aged individuals

Structured Rehabilitation Program for Multidirectional Shoulder Instability in a Patient with Ehlers-Danlos Syndrome

Patients with Ehlers-Danlos syndrome (EDS) present many musculoskeletal disorders. The purpose of this case report was to describe the effectiveness of a scapular motor control program for a patient with multidirectional severe shoulder instability due to EDS, with 6-month follow-up. The patient was a 14-year-old female with EDS hypermobile type who suffered recurrent shoulder dislocation. Her chief complaints were bilateral shoulder discomfort and instability during writing motion. In the early part of intervention, she was prescribed exercise therapy for multidirectional instability (MDI) with orthosis. In the latter part of intervention, she was instructed in the scapular motor control program. Active and passive range of motion (ROM), sulcus sign, and Rowe score for shoulder instability were measured at baseline and at 3, 6, and 12 months after interventions. The shoulder ROM and instability score were improved after 6-month intervention. The findings from this report indicate that the scapular motor control program for shoulder instability would be effective even for patients with EDS hypermobile type. A patient who could not increase passive ROM due to dislocation is also able to achieve fair function of the shoulder joint instead of increasing active ROM. These positive outcomes indicate the possibility of benefit from the scapular motor control program for an MDI patient with EDS as a conservative treatment