Footsteps Toward Understanding Fall Risk and Quality of Life in People with Diabetic Peripheral Neuropathy

Abstract

As of 2010, diabetes affected nearly 25.8 million people in the United States, an increase of 25% from 2005. Nearly half of these individuals experience diabetic peripheral neuropathy (DPN), a serious complication of diabetes. DPN influences how these individuals experience the world around them. Sensory abnormalities and sometimes motor dysfunction in the lower extremities are known to increase fall risk and decrease quality of life in these individuals. However, little is known about whether or not current fall risk assessment tools are effective or useful for identifying fall risk in people that have DPN. In addition, relatively few studies have attempted to identify factors that may relate to this increased fall risk and decreased quality of life in people with DPN. Chapter 2 details the research conducted to compare the ability of 4 fall risk assessment tools to accurately discriminate between fallers and nonfallers, who were categorized according to recent fall history. The 4 tools that were compared included the Functional Reach Test (FRT), Timed Up and Go (TUG), Berg Balance Scale (BBS) and the Dynamic Gait Index (DGI). These tools performed poorly when traditional cut-off scores were used; however, the use of modified cut-off scores substantially improved the discriminative ability of these tools. The TUG performed the best, followed by the DGI, BBS and then the FRT. Additional research validating the use of these tools and/or new tools that are more specific to people with DPN needs to be conducted. Fall risk is a complex, multifaceted issue that has been extensively studied in populations other than people with DPN. Chapter 3 details research conducted with the aim of identifying factors that relate to fall history, which may also relate to risk for future falls, specifically in people with DPN. The data suggest that physical activity levels, fear of falling, and balance and gait deficits relate to fall history and may play a role in fall risk for people with DPN. Additional studies that use larger samples of people with DPN need to be conducted to confirm these new findings and to more fully understand the nature of the relationship between these factors and fall risk. Health related quality of life (HRQOL) is a targeted outcome measure because it is meaningful to patients. The aim of the research associated with Chapter 4 was to identify specific factors that relate to HRQOL in people with DPN. This research confirmed previous findings that pain relates to HRQOL but did not support findings that neuropathy severity relates to HRQOL in people with DPN. The current body of work also extended previous findings in other populations to people with DPN, namely, that fear of falling and physical activity levels also relate to HRQOL. As with the factors related to fall history in Chapter 3, additional research needs to be conducted to more fully understand how these factors influence HRQOL in people with DPN. This body of work has added new knowledge to the previously understudied areas of fall risk and quality of life in people with DPN. Although this new knowledge is important, it does not fully explain all aspects of these issues for people with DPN. Additional research is needed to more fully understand fall risk and quality of life in people with DPN and, ultimately, to effectively prevent falls and improve quality of life for these individuals.