Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial

Imagem de Miniatura
Arquivos
art_SARTOR_Effects_of_strengthening_stretching_and_functional_training_on_2014.PDF (292.5 KB)
Citações na Scopus
90
Tipo de produção
article
Data de publicação
2014
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BIOMED CENTRAL LTD
Autores
GIACOMOZZI, Claudia
Citação
BMC MUSCULOSKELETAL DISORDERS, v.15, article ID 137, 13p, 2014
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. AIM: To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. Methods: A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Results: Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Conclusions: Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy.
Palavras-chave
Diabetic neuropathies, Rehabilitation, Exercise therapy, Walking, Randomized controlled trial, Foot, Ankle, Musculoskeletal manipulation
URI
https://observatorio.fm.usp.br/handle/OPI/7483
Referências
  1. Abboud RJ, 2000, CLIN BIOMECH, V15, P37, DOI 10.1016/S0268-0033(99)00038-8
  2. Allet L, 2008, DIABETES-METAB RES, V24, P173, DOI 10.1002/dmrr.809
  3. Andreassen CS, 2006, DIABETES, V55, P806, DOI 10.2337/diabetes.55.03.06.db05-1237
  4. Armstrong D G, 1998, J Foot Ankle Surg, V37, P303
  5. Bacarin TA, 2009, CLINICS, V64, P113, DOI 10.1590/S1807-59322009000200008
  6. Bakker K, 2012, DIABETES-METAB RES, V28, P225, DOI 10.1002/dmrr.2253
  7. Bland M, 2009, CLINSTAT SOFTWARE
  8. Bus SA, 2008, DIABETES-METAB RES, V24, pS162, DOI 10.1002/dmrr.850
  9. Campbell K, 1987, ASME INT COMP ENG C
  10. Cavanagh PR, 2011, PLAST RECONSTR SURG, V127, p248S, DOI 10.1097/PRS.0b013e3182024864
  11. DEMPSTER WT, 1967, AM J ANAT, V120, P33, DOI 10.1002/aja.1001200104
  12. Fernando M, 2013, CLIN BIOMECH, V28, P831, DOI 10.1016/j.clinbiomech.2013.08.004
  13. Fiolkowski Paul, 2003, J Foot Ankle Surg, V42, P327, DOI 10.1053/j.jfas.2003.10.003
  14. Frykberg RG, 1998, DIABETES CARE, V21, P1714, DOI 10.2337/diacare.21.10.1714
  15. Giacomozzi C, 2002, DIABETES CARE, V25, P1451, DOI 10.2337/diacare.25.8.1451
  16. Goldin A, 2006, CIRCULATION, V114, P597, DOI 10.1161/CIRCULATIONAHA.106.621854
  17. Goldsmith JR, 2002, J AM PODIAT MED ASSN, V92, P483
  18. Greenman RL, 2005, DIABETES CARE, V28, P1425, DOI 10.2337/diacare.28.6.1425
  19. Haukoos JS, 2007, ACAD EMERG MED, V14, P662, DOI 10.1197/j.aem.2006.11.037
  20. Headlee DL, 2008, J ELECTROMYOGR KINES, V18, P420, DOI 10.1016/j.jelekin.2006.11.004
  21. Kendall F, 2005, TESTING FUNCTION POS
  22. Kjaer M, 2004, PHYSIOL REV, V84, P649, DOI 10.1152/physrev.00031.2003
  23. McPoil T G, 1985, J Orthop Sports Phys Ther, V7, P69
  24. MUELLER MJ, 1989, PHYS THER, V69, P453
  25. Mueller MJ, 1989, PHYS THER, V69, P459
  26. Pataky Z, 2010, DIABETIC MED, V27, P61, DOI 10.1111/j.1464-5491.2009.02875.x
  27. Pham H, 2000, DIABETES CARE, V23, P606, DOI 10.2337/diacare.23.5.606
  28. POWELL LE, 1995, J GERONTOL A-BIOL, V50, pM28
  29. Rao S, 2010, GAIT POSTURE, V31, P251, DOI 10.1016/j.gaitpost.2009.10.016
  30. Rao ST, 2007, CLIN BIOMECH, V22, P464, DOI 10.1016/j.clinbiomech.2006.11.013
  31. Richardson JK, 2001, ARCH PHYS MED REHAB, V82, P205, DOI 10.1053/apmr.2001.19742
  32. Sacco ICN, 2003, CLIN BIOMECH, V18, P426, DOI 10.1016/S0268-0033(03)00043-3
  33. Sacco ICN, 2009, CLIN BIOMECH, V24, P687, DOI 10.1016/j.clinbiomech.2009.05.003
  34. SALTZMAN CL, 1995, J ORTHOP SPORT PHYS, V21, P354
  35. Sartor CD, 2012, BMC MUSCULOSKEL DIS, V13, DOI 10.1186/1471-2474-13-36
  36. Stess RM, 1997, DIABETES CARE, V20, P855, DOI 10.2337/diacare.20.5.855
  37. Tesfaye S, 2010, DIABETES CARE, V33, P2285, DOI 10.2337/dc10-1303
  38. Trombini-Souza F, 2011, GAIT POSTURE, V34, P126, DOI 10.1016/j.gaitpost.2011.03.026
  39. Twisk J, 2002, J CLIN EPIDEMIOL, V55, P329, DOI 10.1016/S0895-4356(01)00476-0
  40. van Schie C H M, 2005, Int J Low Extrem Wounds, V4, P160, DOI 10.1177/1534734605280587
  41. Van Schie CHM, 2004, DIABETES CARE, V27, P1668, DOI 10.2337/diacare.27.7.1668
  42. VEVES A, 1992, DIABETOLOGIA, V35, P660, DOI 10.1007/BF00400259
  43. Waaijman R, 2013, DIABETES CARE, V36, P1613, DOI 10.2337/dc12-1330
  44. Winter D.A., 1991, BIOMECHANICS MOTOR C
  45. York RM, 2009, PM&R, V1, P434, DOI 10.1016/j.pmrj.2009.03.001

Coleções
Artigos e Materiais de Revistas Científicas - FM/MFT
Artigos e Materiais de Revistas Científicas - LIM/34
Artigos e Materiais de Revistas Científicas - ODS/03