Clinical evaluation of painful diabetes peripheral neuropathy in type 2 diabetes patients: Lessons from expatriates in the United Arab Emirates

BACKGROUND

The high prevalence of Type 2 Diabetes (T2D) in the United Arab Emirates makes it imperative to screen and manage diabetes peripheral neuropathy (DPN) as a priority. Considering the high number of expats from different ethnicity a more thorough approach is necessary. Unfortunately, there are very few studies addressing this issue.

METHODS

The study uses the chi-square test to investigate the dependence of the progression of DNP on ethnic origin. The study uses Pearson Correlation to find the association between three prevalent scales used for the measurement of painful diabetes peripheral neuropathy. Student t-test was used further to investigate the significance of the association.

RESULTS

With a p-value (0.004) and p-value (0.015), the study concludes that DPN risk is dependent on the ethnic origin of the residents. The study further found that there is a significant association between three scales for measuring painful diabetes peripheral neuropathy (pDNP), Douleur Neuropathique en 4 questions (DN4), Neurological Symptoms Score (NSS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANNS). The p-value for all pairwise comparisons for the strength of association between scales was found significant at the level of significance 0.05.

CONCLUSION

The study concludes that the risk of DNP is high in Arab-origin residents in UAE and the reasons behind the finding need to be empirically tested to customize its management. The study further finds a significant association between the score of the three scales used for measuring pDNP.

Prediction of peak plantar pressure for diabetic foot: The regressional model

BACKGROUND

The increase in peak plantar pressure could be the most important etiological factor for pathogenesis of a diabetic foot. Thus the fate of a diabetic foot syndrome which is a clinical triad of neurological, vascular and musculoskeletal changes could be biomechanically predictive and preventive using clinical parameters. In the presence of peripheral neuropathy, certain clinical parameters could be severely altered resulting into increased peak plantar pressure. Therefore the aim of the study was to identify the most important clinical parameters for the prediction of peak plantar pressure between neuropathy and non-neuropathy type 2 diabetes mellitus participants.

METHODOLOGY

A total of 380 participants were recruited under the study and divided into two groups (190 each group). The cross-sectional study was conducted at Kasturba Hosipal, Manipal, India. Multiple regression analysis was performed to find the hyperplane of best fit. Stepwise regression was performed with (α entry=0.15 and α removal=0.2) to select the best subset of predictors.

RESULTS

Adjusted R2 of the final model which included the predictors showed 90.8% variability for the dependent variable.

CONCLUSION

The findings from the regression analysis suggested model was found to be strongly significant in predicting the peak plantar pressure between neuropathy and non-neuropathy type 2 diabetes mellitus participants. Since higher values of peak plantar pressure is strongly associated with risk for future diabetic foot complications, it could be suggested that these clinical parameters could be very useful to assess and should be used in routine clinical practice very effectively.

Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

Background

Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Therefore they are prone to develop frequent and often foot problems with a relative high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. Thus the review on study of foot kinematic and kinetic in type 2 diabetes mellitus to understand the biomechanical changes is important.

Methodology

Scientific articles were obtained using electronic databases including Science Direct, CINAHL, Springer Link, Medline, Web of Science, and Pubmed. The selection was completed after reading the full texts. Studies using experimental design with focus on biomechanics of diabetic foot were selected.

Results

The meta-analysis report on gait velocity (neuropathy = 128 and non-diabetes = 131) showed that there was a significantly lower gait velocity in neuropathy participants compared to non-diabetes age matched participants at a high effect level (−0.09, 95 % CI −0.13 to 0.05; p < 0.0001). Regarding knee joint flexion range there was a significant difference between neuropathy and non-diabetes group (4.75, 95 % CI, −7.53 to 1.97, p = 0.0008).

Conclusions

The systematic review with meta-analysis reported significant difference in kinematic and kinetic variables among diabetic with neuropathy, diabetic without neuropathy and non-diabetes individuals. The review also found that the sample size in some studies were not statistically significant to perform the meta-analysis and report a strong conclusion. Therefore a study with higher sample size should be done.

A biomechanical comparison of the traditional squat, powerlifting squat, and box squat

The purpose of this study was to compare the biomechanics of the traditional squat with 2 popular exercise variations commonly referred to as the powerlifting squat and box squat. Twelve male powerlifters performed the exercises with 30, 50, and 70% of their measured 1 repetition maximum (1RM), with instruction to lift the loads as fast as possible. Inverse dynamics and spatial tracking of the external resistance were used to quantify biomechanical variables. A range of significant kinematic and kinetic differences (p < 0.05) emerged between the exercises. The traditional squat was performed with a narrow stance, whereas the powerlifting squat and box squat were performed with similar wide stances (48.3 ± 3.8, 89.6 ± 4.9, 92.1 ± 5.1 cm, respectively). During the eccentric phase of the traditional squat, the knee traveled past the toes resulting in anterior displacement of the system center of mass (COM). In contrast, during the powerlifting squat and box squat, a more vertical shin position was maintained, resulting in posterior displacements of the system COM. These differences in linear displacements had a significant effect (p < 0.05) on a number of peak joint moments, with the greatest effects measured at the spine and ankle. For both joints, the largest peak moment was produced during the traditional squat, followed by the powerlifting squat, then box squat. Significant differences (p < 0.05) were also noted at the hip joint where the largest moment in all 3 planes were produced during the powerlifting squat. Coaches and athletes should be aware of the biomechanical differences between the squatting variations and select according to the kinematic and kinetic profile that best match the training goals.

Effect of load positioning on the kinematics and kinetics of weighted vertical jumps

One of the most popular exercises for developing lower-body muscular power is the weighted vertical jump. The present study sought to examine the effect of altering the position of the external load on the kinematics and kinetics of the movement. Twenty-nine resistance-trained rugby union athletes performed maximal effort jumps with 0, 20, 40, and 60% of their squat 1 repetition maximum (1RM) with the load positioned (a) on the posterior aspect of the shoulder using a straight barbell and (b) at arms' length using a hexagonal barbell. Kinematic and kinetic variables were calculated through integration of the vertical ground reaction force data using a forward dynamics approach. Performance of the hexagonal barbell jump resulted in significantly (p < 0.05) greater values for jump height, peak force, peak power, and peak rate of force development compared with the straight barbell jump. Significantly (p < 0.05) greater peak power was produced during the unloaded jump compared with all trials where the external load was positioned on the shoulder. In contrast, significantly (p < 0.05) greater peak power was produced when using the hexagonal barbell combined with a load of 20% 1RM compared with all other conditions investigated. The results suggest that weighted vertical jumps should be performed with the external load positioned at arms' length rather than on the shoulder when attempting to improve lower-body muscular performance.

A biomechanical analysis of straight and hexagonal barbell deadlifts using submaximal loads

The purpose of the investigation was to compare the kinematics and kinetics of the deadlift performed with 2 distinct barbells across a range of submaximal loads. Nineteen male powerlifters performed the deadlift with a conventional straight barbell and a hexagonal barbell that allowed the lifter to stand within its frame. Subjects performed trials at maximum speed with loads of 10, 20, 30, 40, 50, 60, 70, and 80% of their predetermined 1-repetition maximum (1RM). Inverse dynamics and spatial tracking of the external resistance were used to quantify kinematic and kinetic variables. Subjects were able to lift a heavier 1RM load in the hexagonal barbell deadlift (HBD) than the straight barbell deadlift (SBD) (265 ± 41 kg vs. 245 ± 39 kg, p < 0.05). The design of the hexagonal barbell significantly altered the resistance moment at the joints analyzed (p < 0.05), resulting in lower peak moments at the lumbar spine, hip, and ankle (p < 0.05) and an increased peak moment at the knee (p < 0.05). Maximum peak power values of 4,388 ± 713 and 4,872 ± 636 W were obtained for the SBD and HBD, respectively (p < 0.05). Across the submaximal loads, significantly greater peak force, peak velocity and peak power values were produced during the HBD compared to during the SBD (p < 0.05). The results demonstrate that the choice of barbell used to perform the deadlift has a significant effect on a range of kinematic and kinetic variables. The enhanced mechanical stimulus obtained with the hexagonal barbell suggests that in general the HBD is a more effective exercise than the SBD.

Contemporary training practices in elite British powerlifters: survey results from an international competition

The primary objective of this study was to investigate current powerlifting training methods in light of anecdotal evidence purporting increased similarity with the explosive training practices of weightlifters. The study also assessed the prevalence of contemporary training practices frequently recommended for powerlifters in the popular literature. A 20-item survey was distributed to 32 elite British powerlifters at an International competition. The subject group included multiple national, international, and commonwealth champions and record holders. Based on 2007 competition results, the average Wilks score of the group was 450.26 +/- 34.7. The response rate for the surveys was 88% (28 of 32). The survey was sectioned into 6 areas of inquiry: a) repetition speed, b) explosive training load, c) resistance materials used, d) adjunct power training methods, e) exercise selection, and f) training organization. The results demonstrate that the majority of powerlifters train with the intention to explosively lift maximal and submaximal loads (79 and 82%, respectively). Results revealed that 39% of the lifters regularly used elastic bands and that 57% incorporated chains in their training. Evidence for convergence of training practices between powerlifters and weightlifters was found when 69% of the subjects reported using the Olympic lifts or their derivatives as part of their powerlifting training. Collectively, the results demonstrate that previous notions of how powerlifters train are outdated. Contemporary powerlifters incorporate a variety of training practices that are focused on developing both explosive and maximal strength.

The response of the nucleus pulposus of the lumbar intervertebral discs to functionally loaded positions

STUDY DESIGN

Asymptomatic volunteers underwent magnetic resonance imaging to investigate how different positions affect lumbar intervertebral discs.

OBJECTIVE

To quantify sagittal migration of the lumbar nucleus pulposus in 6 functional positions.

SUMMARY OF BACKGROUND DATA

Previous studies of the intervertebral disc response in the sagittal plane were limited to imaging of recumbent positions. Developments of upright magnetic resonance imaging permit investigation of functional weight-bearing positions.

METHODS

T2-weighted sagittal scans of the L1-L2 to L5-S1 discs were taken of 11 volunteers in standing, sitting (upright, flexed, and in extension), supine, and prone extension. Sagittal migration of the nucleus pulposus was measured (mm) as distance from anterior disc boundary to peak pixel intensity. Lumbar lordosis (Cobb angle) was measured in each position.

RESULTS

Fifteen comparisons between positions showed significant positional effects (14 at L4-L5, L5-S1, the most mobile segments). Prone extension and supine lying induced significantly less posterior migration than sitting. Flexed and upright sitting, significantly more than standing at L4-L5, as did flexed sitting compared with extended.

CONCLUSION

These results support for the first time the validity of clinical assumptions about disc behavior in functional positions: sitting postures may increase risk of posterior derangement, and prone and supine may be therapeutic for symptoms caused by posterior disc displacement.

Harmonic analysis of force platform data in normal and cerebral palsy gait

BACKGROUND

Examination of force platform data during gait is usually carried out in the time domain and is limited to selected points on the force-time graphs. Harmonic analysis allows examination of the whole waveform and has a greater potential for assessing the effects of treatment options. Therefore, the objectives of this study were to show the benefits of using harmonic analysis to determine the variability and symmetry of force platform data in normal and cerebral palsy gait.

METHODS

Harmonic analysis was carried out on the foot to ground reaction force data recorded from a group of cerebral palsy children and a matched control group when they walked at their preferred walking speed. Statistical tests were used to assess this frequency domain data and to validate the reconstructed force-time curves.

FINDINGS

The differences in the frequency domain parameters between the cerebral palsy and control groups were significant. The mediolateral force was the most variable and asymmetric parameter in the control group. Cerebral palsy gait was more variable and more asymmetric than normal gait.

INTERPRETATION

This study has shown that the force platform data derived from clinical gait analysis can reveal more useful information in the frequency domain than the limited time domain information commonly used for analysing this type of data.

The variability of force platform data in normal and cerebral palsy gait

OBJECTIVE

To determine the natural variability and symmetry of force platform parameters in normal and cerebral palsy gait.

DESIGN

Force platform data has been analysed using coefficient of variation, analysis of variances and symmetry index.

BACKGROUND

It is important to establish the natural variability of force platform data so that changes in gait due to natural variability and those due to intervention can be determined.

METHODS

Force platform data and walking speed were recorded in 15 normal volunteers and 11 children with cerebral palsy on 3 consecutive days. Five recordings were made of each leg on each day.

RESULTS

The force platform parameters in both groups showed greater asymmetry in the horizontal plane. In the cerebral palsy group significant asymmetry was found in all 3 directions. The variation of the vertical ground reaction force peaks (Fz1 and Fz3) and of the anterior-posterior negative peak (Fy3) for both groups was low. Fz3 was the most reproducible force parameter. The other force parameters showed high variability and are not considered reliable measures of gait. The temporal parameters and the walking speed were reproducible measures.

CONCLUSIONS

Only selected ground reaction force parameters showed acceptable stability and reproducibility. Therefore caution has to be taken in the selection of these parameters, when assessing the effects of any intervention on cerebral palsy gait.