Use of time-to-boundary to assess postural instability and predict functional mobility in people with diabetes mellitus and peripheral neuropathy

Frank E DiLiberto; Deborah A Nawoczenski; Josh Tome; Patrick O McKeon

doi:10.1016/j.gaitpost.2020.10.016

Use of time-to-boundary to assess postural instability and predict functional mobility in people with diabetes mellitus and peripheral neuropathy

Gait Posture. 2021 Jan:83:141-146. doi: 10.1016/j.gaitpost.2020.10.016. Epub 2020 Oct 20.

Authors

Frank E DiLiberto¹, Deborah A Nawoczenski², Josh Tome³, Patrick O McKeon⁴

Affiliations

¹ University of Rochester, School of Nursing, 255 Crittenden Blvd, Rochester, NY, 14642, USA. Electronic address: frank.diliberto@rosalindfranklin.edu.
² University of Rochester, Department of Orthopaedics, 601 Elmwood Ave, Rochester, NY, 14642, USA. Electronic address: dnawoczenski@ithaca.edu.
³ Ithaca College, Movement Analysis Lab, School of Health Sciences and Human Performance, 953 Danby Road, Ithaca, NY, 14850, USA. Electronic address: jtome@ithaca.edu.
⁴ Ithaca College, Department of Exercise and Sport Sciences, School of Health Sciences and Human Performance, 953 Danby Road, Ithaca, NY, 14850, USA. Electronic address: pmckeon@ithaca.edu.

PMID: 33147553
DOI: 10.1016/j.gaitpost.2020.10.016

Abstract

Background: People with diabetes mellitus and peripheral neuropathy (DMPN) often have balance and mobility deficits. Time-to-boundary (TTB) is a parameter of postural control that combines position and velocity center of pressure data. While not previously investigated, assessment of TTB may provide new insight regarding postural control in people with DMPN.

Research question: Is TTB reduced and related to a measure of mobility in people with DMPN?

Methods: Thirteen people with DMPN without fall history and 13 healthy matched controls participated in this case-control study. Participants stood in double-limb stance on a force plate. The anterior-posterior and medial-lateral center of pressure position and velocity relative to the boundaries of the base of support were used to calculate TTB (s). Lower values indicate less postural control. Time-to-failure during single-limb stance was a secondary measure of postural control. Time to complete the Timed Up and Go (TUG) was our measure of mobility. Longer TUG times correspond to decreased mobility, strength, and balance. Independent t-tests or Mann-Whitney U tests were conducted to assess group differences. Bivariate correlations between task outcomes were conducted.

Results: Anterior-posterior TTB and single-limb stance times were shorter in people with DMPN (p ≤ 0.04). TUG times were longer in the DMPN group (p = 0.04). In the DMPN group, inverse relationships were observed between TTB and TUG (anterior-posterior R² = .34; medial-lateral R² = .49; both p = 0.01), but not between single-limb stance times and TTB or TUG.

Significance: TTB was a sensitive measure of postural control in people with DMPN. The detected relationship between TTB and TUG newly establishes TTB as a clinically meaningful indicator of balance and function. Study findings may serve to further guide balance screening and rehabilitation efforts in people with DMPN.

Keywords: Balance; Diabetes mellitus; Peripheral neuropathy; Postural control.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Diabetes Mellitus / physiopathology*
Diabetic Neuropathies / physiopathology*
Female
Humans
Joint Instability / physiopathology*
Male
Middle Aged
Postural Balance / physiology*