title: Clinical factors associated with gait alterations in diabetic patients.
abstract: OBJECTIVE
  To identify clinical factors associated with gait alterations in patients with Type 2 diabetes.
  
  
  METHODS
  A sample of 76 diabetic patients underwent clinical examination and an outdoor gait assessment on tarred and cobblestoned terrains. We calculated respective differences in gait speed (performance measure) and gait variability (fall risk index) on changing terrains. Associations with clinical factors were investigated using correlation coefficients and linear regression analysis.
  
  
  RESULTS
  The mean walking speed on the tarred pathway was 4.5 +/- 0.6 km/h and 3.9 +/- 0.8 km/h on the cobblestone pathway (P < 0.001). The CVGCT increased from 2.6 +/- 0.9% on the tarred pathway to 5.1 +/- 2.8% on the cobblestone pathway (P < 0.001). Regression analysis showed that 36% of the decrease in gait speed was explained proportionally by the mean of maximal isometric lower limb strength (22.2%; P < or = 0.01), fear of falls (7.4%; P < or = 0.01) and participants' perceived vibration threshold (6.4%; P < or = 0.01). Moreover, mean maximal isometric strength explained 11.8% (P < or = 0.01) of the increase of the coefficient of variation of the gait cycle time when participants changed from tarred terrain to cobblestones.
  
  
  CONCLUSIONS
  This study indicated that both physiological (strength and proprioception) and cognitive-behavioural factors (fear of falls) should be considered when treating diabetic patients with gait alterations. Therapists should apply these findings when developing specific fall prevention and treatment programmes.
authors.affiliation: Department of Neurosciences, Geneva University Hospital and University of Geneva, Geneva 1211, Switzerland. lara.allet@hcuge.ch
authors.forename: L
authors.initials: L
authors.lastname: Allet
authors.forename: S
authors.initials: S
authors.lastname: Armand
authors.forename: R A
authors.initials: RA
authors.lastname: de Bie
authors.forename: A
authors.initials: A
authors.lastname: Golay
authors.forename: Z
authors.initials: Z
authors.lastname: Pataky
authors.forename: K
authors.initials: K
authors.lastname: Aminian
authors.forename: E D
authors.initials: ED
authors.lastname: de Bruin
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology*; D012307:Risk Factors; D013647:Task Performance and Analysis