title: Implementing a clinical assessment protocol for sensory and skeletal function in diabetic neuropathy patients at a university hospital in Brazil.
abstract: OBJECTIVE
  Physiotherapy can contribute towards recovering or preventing physical and sensory alterations in diabetic neuropathy patients. Our objective was to create and apply a protocol for functional assessment of diabetic neuropathy patients' lower limbs, to guide future physiotherapy.
  
  
  METHODS
  Clinical study at the University Hospital and teaching/research center of Universidade de São Paulo.
  
  
  METHODS
  An intentional sample of diabetic neuropathy patients was utilized. The protocol was divided into: (1) preliminary investigation with identification of relevant clinical diabetes and neuropathy characteristics; (2) thermal, tactile and proprioceptive sensitivity tests on the feet; (3) evaluations of muscle function, range of motion, lower limb function, foot anthropometry.
  
  
  RESULTS
  The patients' mean age was 57 years, and they had had the diagnosis for 13 years on average. Distal numbness and tingling/prickling were present in 62% and 67%, respectively. There were tactile sensitivity alterations above the heel in 50%, with thermal sensitivity in 40% to 60%. The worst muscle function test responses were at the triceps surae and foot intrinsic muscles. Longitudinal plantar arches were lowered in 50%. Decreased thermal and tactile sensitivity of the heels was found. There was a general reduction in range of motion.
  
  
  CONCLUSIONS
  The results provided detailed characterization of the patients. This protocol may be easily applied in healthcare services, since it requires little equipment, at low cost, and it is well understood by patients.
authors.affiliation: Hospital Universitário, Centro de Docência e Pesquisa, Universidade de São Paulo, São Paulo, Brazil. icnsacco@usp.br
authors.forename: Isabel de Camargo Neves
authors.initials: Ide C
authors.lastname: Sacco
authors.forename: Silvia Maria Amado
authors.initials: SM
authors.lastname: João
authors.forename: Denise
authors.initials: D
authors.lastname: Alignani
authors.forename: Daniela Kinoshita
authors.initials: DK
authors.lastname: Ota
authors.forename: Cristina Dallemole
authors.initials: CD
authors.lastname: Sartor
authors.forename: Leda Tomiko
authors.initials: LT
authors.lastname: Silveira
authors.forename: Aline Arcanjo
authors.initials: AA
authors.lastname: Gomes
authors.forename: Regeane
authors.initials: R
authors.lastname: Cronfli
authors.forename: Márcia
authors.initials: M
authors.lastname: Bernik
mesh_terms: D000328:Adult; D001938:Brazil; D002985:Clinical Protocols; D017719:Diabetic Foot / Q000175:diagnosis / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009460:Neurologic Examination / Q000379:methods*; D015203:Reproducibility of Results; D020886:Somatosensory Disorders / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation