Generic placeholder image

Current Aging Science

Editor-in-Chief

ISSN (Print): 1874-6098
ISSN (Online): 1874-6128

Clinical Trial

Effect of Multifactorial Balance Rehabilitation Program on Risk of Falls and Functional Fitness in Older Adults with Diabetic Peripheral Neuropathy

Author(s): Garima Gupta, G. Arun Maiya*, Shyamasunder N. Bhat and H. Manjunatha Hande

Volume 16, Issue 3, 2023

Published on: 27 April, 2023

Page: [240 - 247] Pages: 8

DOI: 10.2174/1874609816666230306150844

Price: $65

Abstract

Background: Increasing age and the added disadvantage of diabetic peripheral neuropathy (DPN) put the individual at a higher risk of falls and reduced functional fitness. However, there is a dearth of literature on multifactorial balance intervention, especially targeting the needs of older adults with DPN.

Objective: The current study aimed to determine the effect of a multifactorial balance rehabilitation program on fall risk and functional fitness in older adults with DPN.

Methods: In this pre-post experimental study, 30 independently ambulating older adults (71.2 ± 4.70 years) with DPN, who were at risk of falling (timed up and go score ≥ 9.4 seconds), were recruited. Along with the standard care, all the participants received 12 weeks of the multifactorial balance rehabilitation program.

Results: Fall risk using the Fullerton Advanced Balance scale and functional fitness using the Senior Fitness Test were measured at baseline and after 12 weeks of the intervention. The intervention reduced the risk of falling score significantly (MD = 6.17, p < .001). All six parameters of functional fitness improved after 12 weeks of intervention. The improvement in lower limb strength (MD = 1.53 times), upper limb strength (MD = 2.48 times), endurance (MD = 16.07 seconds), lower limb flexibility (MD = 2.02 inches), upper limb flexibility (MD = 1.47 inches), and dynamic balance (MD = 1.53 seconds) was statistically significant at p < 0.05.

Conclusion: This study provided encouraging evidence about the potential of multifactorial balance rehabilitation to reduce the risk of falling and improve functional fitness in older adults with DPN.

Keywords: Diabetes mellitus, exercise, postural balance, physical therapy modalities, unsteadiness, postural control, rehabilitation.

Graphical Abstract
[1]
Kyriazis M. Aging as “Time-Related Dysfunction”: A perspective. Front Med 2020; 7: 371.
[http://dx.doi.org/10.3389/fmed.2020.00371] [PMID: 32850891]
[2]
Milanović Z, Jorgić B, Trajković N, Sporiš G, Pantelić S, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging 2013; 8: 549-56.
[http://dx.doi.org/10.2147/CIA.S44112] [PMID: 23723694]
[3]
Donat Tuna H, Ozcan Edeer A, Malkoc M, Aksakoglu G. Effect of age and physical activity level on functional fitness in older adults. Eur Rev Aging Phys Act 2009; 6(2): 99-106.
[http://dx.doi.org/10.1007/s11556-009-0051-z]
[4]
Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol 2019; 4(1): 143-53.
[http://dx.doi.org/10.1002/lio2.252] [PMID: 30828632]
[5]
Yoshida S. A global report on falls prevention: Epidemiology of falls, ageing and life course family and community health World Health Organization. 2007. Available from : www.who.int/ageing/projects/1.Epidemiology of falls in older age.pdf
[6]
Pitchai P, Dedhia H, Bhandari N, Krishnan D, D’Souza NJ, Bellara J. Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population - A descriptive study. Indian J Public Health 2019; 63(1): 21-6.
[http://dx.doi.org/10.4103/ijph.IJPH_332_17] [PMID: 30880733]
[7]
Hewston P, Deshpande N. Falls and balance impairments in older adults with type 2 diabetes: Thinking beyond diabetic peripheral neuropathy. Can J Diabetes 2016; 40(1): 6-9.
[http://dx.doi.org/10.1016/j.jcjd.2015.08.005] [PMID: 26778679]
[8]
Priya TMV, Rajarajeswari A, Sivakumar R. Effectiveness of training on postural stablity in mild to moderate diabetic neuropathy patients. Indian J Public Health Res Dev 2019; 10(8): 780-5.
[http://dx.doi.org/10.5958/0976-5506.2019.01985.5]
[9]
du Plessis R, Dembskey N, Bassett SH. Effects of an isometric exercise training program on muscular strength, ankle mobility, and balance in patients with diabetic peripheral neuropathy in the lower legs in South Africa. Int J Diabetes Dev Ctries 2022; 1-6.
[http://dx.doi.org/10.1007/s13410-022-01068-1] [PMID: 35400974]
[10]
Almurdhi MM, Brown SJ, Bowling FL, et al. Altered walking strategy and increased unsteadiness in participants with impaired glucose tolerance and Type 2 diabetes relates to small-fibre neuropathy but not vitamin D deficiency. Diabet Med 2017; 34(6): 839-45.
[http://dx.doi.org/10.1111/dme.13316] [PMID: 28103405]
[11]
Irandoust K, Taheri M, Mirmoezzi M, et al. The effect of aquatic exercise on postural mobility of healthy older adults with endomorphic somatotype. Int J Environ Res Public Health 2019; 16(22): 4387.
[http://dx.doi.org/10.3390/ijerph16224387] [PMID: 31717625]
[12]
Tilling LM, Darawil K, Britton M. Falls as a complication of diabetes mellitus in older people. J Diabetes Complicat 2006; 20(3): 158-62.
[http://dx.doi.org/10.1016/j.jdiacomp.2005.06.004] [PMID: 16632235]
[13]
Vinik AI, Camacho P, Reddy S, et al. Aging, diabetes, and falls. Endocr Pract 2017; 23(9): 1120-42.
[http://dx.doi.org/10.4158/EP171794.RA] [PMID: 28704101]
[14]
Timar B, Timar R. Gaiță L, Oancea C, Levai C, Lungeanu D. The impact of diabetic neuropathy on balance and on the risk of falls in patients with type 2 diabetes mellitus: A cross-sectional study. PLoS One 2016; 11(4): e0154654.
[15]
Tander B. Balance performance and fear of falling in older patients with diabetics: A comparative study with non-diabetic elderly. FTR -. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2016; 62(4): 314-22.
[http://dx.doi.org/10.5606/tftrd.2016.77861]
[16]
Riandini T, Wee HL, Khoo EYH, et al. Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes. Acta Diabetol 2018; 55(2): 155-64.
[http://dx.doi.org/10.1007/s00592-017-1077-8] [PMID: 29185052]
[17]
IDF IDF Diabetes Atlas. (10th ed.), International Diabetes Federation 2021.
[18]
Kim EJ, Arai H, Chan P, Chen L-K. Strategies on fall prevention for older people living in the community: A report from a round-table meeting in IAGG 2013. J Clin Gerontol Geriatr 2013; 6(2): 39-44.
[19]
Rehab N. Effect of ankle proprioceptive training on gait and risk of fall in patients with diabetic neuropathy  A randomized controlled trial. Int J Diabetes Res 2019; 2(1): 40-5.
[20]
Ahmad I, Noohu MM, Verma S, Singla D, Hussain ME. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait Posture 2019; 74(74): 114-20.
[http://dx.doi.org/10.1016/j.gaitpost.2019.08.018] [PMID: 31499405]
[21]
Abdelbasset WK, Alrawaili SM, Nambi G, Yassen E, Moawd SA, Ahmed AS. Therapeutic effects of proprioceptive exercise on functional capacity, anxiety, and depression in patients with diabetic neuropathy: A 2-month prospective study. Clin Rheumatol 2020; 39(10): 3091-7.
[http://dx.doi.org/10.1007/s10067-020-05086-4] [PMID: 32300897]
[22]
Veena Kirthika S, Padmanabhan K, Sudhakar S, Aravind S, Senthil Kumar N, Nabeena N. A single blind, single center, two group pretest-posttest randomized controlled trial to determine the efficacy of vestibular rehabilitation and conventional balance training programmes in the management of diabetic peripheral neuropathy. Biomed 2018; 38(1): 132-6.
[23]
Song CH, Petrofsky JS, Lee SW, Lee KJ, Yim JE. Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technol Ther 2011; 13(8): 803-11.
[http://dx.doi.org/10.1089/dia.2011.0036] [PMID: 21561371]
[24]
Kutty NAM, Majida NAL. Effects of multisensory training on balance and gait in persons with type 2 diabetes: A randomised controlled trial. Disabil CBR Incl Dev 2013; 24(2): 79.
[http://dx.doi.org/10.5463/dcid.v24i2.206]
[25]
Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 2006; 35 (Suppl. 2): ii7-ii11.
[http://dx.doi.org/10.1093/ageing/afl077] [PMID: 16926210]
[26]
Pope J, Helwig K, Morrison S, et al. Multifactorial exercise and dance-based interventions are effective in reducing falls risk in community-dwelling older adults: A comparison study. Gait Posture 2019; 70: 370-5.
[http://dx.doi.org/10.1016/j.gaitpost.2019.03.030] [PMID: 30959428]
[27]
Cho YH, Mohamed O, White B, Singh-Carlson S, Krishnan V. The effects of a multicomponent intervention program on clinical outcomes associated with falls in healthy older adults. Aging Clin Exp Res 2018; 30(9): 1101-10.
[http://dx.doi.org/10.1007/s40520-018-0895-z] [PMID: 29372541]
[28]
Farlie MK, Molloy E, Keating JL, Haines TP. Clinical markers of the intensity of balance challenge: Observational study of older adult responses to balance tasks. Phys Ther 2016; 96(3): 313-23.
[http://dx.doi.org/10.2522/ptj.20140524] [PMID: 26183587]
[29]
Rose DJ, Lucchese N, Wiersma LD. Development of a multidimensional balance scale for use with functionally independent older adults. Arch Phys Med Rehabil 2006; 87(11): 1478-85.
[http://dx.doi.org/10.1016/j.apmr.2006.07.263] [PMID: 17084123]
[30]
Jeon YJ, Kim GM. Comparison of the Berg Balance Scale and fullerton advanced balance scale to predict falls in community-dwelling adults. J Phys Ther Sci 2017; 29(2): 232-4.
[http://dx.doi.org/10.1589/jpts.29.232] [PMID: 28265146]
[31]
Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist 2013; 53(2): 255-67.
[http://dx.doi.org/10.1093/geront/gns071] [PMID: 22613940]
[32]
Langhammer B, Stanghelle JK. The Senior Fitness Test. J Physiother 2015; 61(3): 163.
[http://dx.doi.org/10.1016/j.jphys.2015.04.001] [PMID: 26044346]
[33]
Bhattacharya PK, Deka K, Roy A. Assessment of inter-rater variability of the Senior Fitness Test in the geriatric population: A community based study. Int J Biol Adv Res 2016; 7(5): 208.
[http://dx.doi.org/10.7439/ijbar.v7i5.3249]
[34]
Hesseberg K, Bentzen H, Bergland A. Reliability of the senior fitness test in community-dwelling older people with cognitive impairment. Physiother Res Int 2015; 20(1): 37-44.
[http://dx.doi.org/10.1002/pri.1594] [PMID: 24925585]
[35]
Rikli RE, Jones CJ. Senior Fitness Test Manual 2nd Ed; Human Kinetics: . 2002. Available from : [https://us.humankinetics.com/products/senior-fitness-test-manual-2nd-edition
[36]
Schlenstedt C, Brombacher S, Hartwigsen G, Weisser B, Möller B, Deuschl G. Comparing the fullerton advanced balance scale with the mini-bestest and berg balance scale to assess postural control in patients with Parkinson’s disease. Arch Phys Med Rehabil 2015; 96(2): 218-25.
[http://dx.doi.org/10.1016/j.apmr.2014.09.002] [PMID: 25261718]
[37]
Schlenstedt C, Brombacher S, Hartwigsen G, Weisser B, Möller B, Deuschl G. Comparison of the fullerton advanced balance scale, mini-bestest, and berg balance scale to predict falls in Parkinson disease. Phys Ther 2016; 96(4): 494-501.
[http://dx.doi.org/10.2522/ptj.20150249] [PMID: 26381806]
[38]
Mansano Pletsch AH, de Souza Borges NC, Villar DM, et al. Does sensorimotor training influence neuromuscular responses, balance, and quality of life in diabetics without a history of diabetic distal polyneuropathy? J Bodyw Mov Ther 2021; 27: 148-56.
[http://dx.doi.org/10.1016/j.jbmt.2021.01.012] [PMID: 34391226]
[39]
Win MMTM, Fukai K, Nyunt HH, Linn KZ. Hand and foot exercises for diabetic peripheral neuropathy: A randomized controlled trial. Nurs Health Sci 2020; 22(2): 416-26.
[http://dx.doi.org/10.1111/nhs.12676] [PMID: 31876991]
[40]
Handsaker JC, Brown SJ, Petrovic M, et al. Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy. J Diabetes Complications 2019; 33(10): 107404.
[http://dx.doi.org/10.1016/j.jdiacomp.2019.07.001] [PMID: 31371130]
[41]
Mendes R, Sousa N, Themudo-Barata J, Reis V. Impact of a community-based exercise programme on physical fitness in middle-aged and older patients with type 2 diabetes. Gac Sanit 2016; 30(3): 215-20.
[http://dx.doi.org/10.1016/j.gaceta.2016.01.007] [PMID: 26900099]
[42]
Yoosefinejad AK, Hadadi M, Eslamloo P. Evaluating the responsiveness of the fullerton advanced balance scale in patients with lymphedema secondary to breast cancer surgery. Lymphology 2019; 52(2): 61-70.
[http://dx.doi.org/10.2458/lymph.4627] [PMID: 31525827]
[43]
Hernandez D, Rose DJ. Predicting which older adults will or will not fall using the Fullerton Advanced Balance scale. Arch Phys Med Rehabil 2008; 89(12): 2309-15.
[http://dx.doi.org/10.1016/j.apmr.2008.05.020] [PMID: 18976981]
[44]
Kruse RL, LeMaster JW, Madsen RW. Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: “feet first” randomized controlled trial. Phys Ther 2010; 90(11): 1568-79.
[http://dx.doi.org/10.2522/ptj.20090362] [PMID: 20798179]
[45]
Allet L, Armand S, de Bie RA, et al. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia 2010; 53(3): 458-66.
[http://dx.doi.org/10.1007/s00125-009-1592-4] [PMID: 19921145]
[46]
Muir SW, Berg K, Chesworth BM, Klar N, Speechley M. Modifiable risk factors identify people who transition from non-fallers to fallers in community-dwelling older adults: A prospective study. Physiother Can 2010; 62(4): 358-67.
[http://dx.doi.org/10.3138/physio.62.4.358] [PMID: 21886376]
[47]
Pfeifer LO, De Nardi AT, da Silva LXN, Botton CE, do Nascimento DM, Teodoro JL, et al. Association between physical exercise interventions participation and functional capacity in individuals with type 2 diabetes: A systematic review and meta-analysis of controlled trials Sport Med - Open. 2022; 8(1): 34. Available from: https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-022-00422-1
[48]
Vancini RL, dos Santos Andrade M, Andre Barbosa de Lira C, Theodoros Nikolaidis P, Knechtle B. Is it possible to age healthy performing ultra-endurance exercises?Int J Sport Stud Heal 2022.Feb 2; 4(1): 1-4. Available from:. https://brief.land/intjssh/articles/122900.html
[http://dx.doi.org/10.5812/intjssh.122900]
[49]
Zhao Y, Chung PK, Tong TK. Effectiveness of a balance-focused exercise program for enhancing functional fitness of older adults at risk of falling: A randomised controlled trial. Geriatr Nurs 2017; 38(6): 491-7.
[http://dx.doi.org/10.1016/j.gerinurse.2017.02.011] [PMID: 28359614]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy