| Part Ⅰ:A clinical study of the effects of diabetic peripheral neuropathy on human gaitObjective:Investigate the effects of diabetic peripheral neuropathy on gait parameters and assess the diagnostic value of gait parameters.Methods:120 diabetic patients admitted to the endocrinology department of The Second Affiliated Hospital of Soochow University were recruited.They were divided into DPN group and DC group.The DPN group was comprised of 60 patients,and so was the DC group.Another 20 healthy subjects served as the control group.Participants were asked to walk at their habitual speed along a 10-m corridor which is flat and barrier-free.While the participants were walking,an inertial measurement unit(IMU)was placed over the fourth lumbar vertebra at the back to obtain the spatiotemporal gait parameters.Compared the gait parameters between the three groups,then analyzed the correlations between gait parameters and nerve parameters.Data were processed by the SPSS22.0.Results:There was significant difference between the three groups on velocity(m/s),stride length(m),cadence(step/min)and SDa(au).Spearman correlation analysis showed that the Vibration Perception Threshold Test(VPT)was negatively correlated with gait velocity(m/s),stride length(m),cadence(step/min),SDa(au)and was positively correlated with the double stance(%).The nerve conduction velocity of tibial never was positively correlated with gait velocity(m/s),cadence(step/min)and SDa(au).The nerve conduction velocity of common peroneal nerve was negatively correlated with the double stance(%).Foot Electrochemical Skin Conductivity(FESC)was positively correlated with gait velocity(m/s),stride length(m),cadence(step/min)and SDa(au).Hand Electrochemical Skin Conductivity(HESC)was positively correlated with gait velocity(m/s)and cadence(step/min).Conclusion:Gait parameters were different in DPN patients compared with nonperipheral neuropathy diabetic patients and healthy controls.Portable gait analysis system may be used as a new technique for clinicians to evaluate the peripheral neuropathy in diabetic population and timely intervention could be given to decrease the incidence of fall and diabetic foot.Part II:A meta-analysis of the effects of diabetic peripheral neuropathy on human gaitObjective:Investigate the effects of diabetic peripheral neuropathy on human gait in diabetic patients by conducting a meta-analysis,in the hope of providing evidence to reduce the incidence of diabetic foot and falls.Methods:Related researches concerning the gait of diabetic patients with and without DPN were collected and analyzed by searching PubMed,Embase,Web of Science and CNKI.We used the following search terms:"diabetic neuropathy","DPN","diabetic peripheral neuropath*","gait)","gait characteristic*","gait parameter*","gait disorders","kinematics","gait analysis".The retrieved studies were screened according to the inclusion and exclusion criteria.After that,two researchers independently extracted the data and assessed the quality of the studies included.Statistical analysis was performed by using RevMan 5.3 software and STATA 16.0.Outcomes were represented by forest plots,and the sensitivity analysis was performed by one-by-one division method.I2 was used to assess the heterogeneity.Results:21 studies were included finally,consisting of 499 diabetic neuropathy patients and 467 diabetes controls without neuropathy.Meta-analysis results showed a lower gait velocity(SMD:-0.28,95%CI:-0.41～-0.14;p<0.0001;I2=37%,21 trials),a shorter stride length(SMD:-0.19,95%CI:-0.36～-0.01;p=0.04;I2=39%,11 trials),a longer stride time(WMD:0.04,95%CI:0.01 to 0.06;p=0.006;I2=0%,7 trials),a longer stance time(WMD:0.03,95%CI:0.01 to 0.05;p=0.002;I2=12%,6 trials)and longer stance time proportion(WMD:1.02,95%CI:0.16～1.89;p=0.02;I2.=0%,3 trials)in DPN group,compared with DC group.Conclusion:Diabetic patients with DPN possess a lower gait velocity,a shorter stride length,a longer stride time and a longer stance time. |
