老年2型糖尿病患者双重任务行走步态与害怕跌倒的相关性研究

Study on the correlation between double-task walking gait and fear of falls in patients with elderly type 2 diabetics

目的探讨老年2型糖尿病患者在双重任务行走时的步态参数与害怕跌倒之间的关系。方法选取符合条件的225例老年2型糖尿病患者作为研究对象。采用一般情况问卷调查表和单条目问题法进行害怕跌倒评估,采用起立-行走测试评价患者平衡能力,采用可穿戴式步态分析系统测量患者在常速和双重任务行走状况下的几种重要步态参数,探讨双重任务行走步态参数与害怕跌倒之间的相关关系。根据患者是否有害怕跌倒的心理,将患者分成害怕跌倒组(124例)和不害怕跌倒组(101例),对两组的问卷调查情况和步态参数进行比较。结果老年2型糖尿病患者双重任务行走步态与常速行走步态间各种参数差异均有统计学意义(P<0.05);害怕跌倒组和不害怕跌倒组的平衡能力、是否患周围神经病变、是否参加运动锻炼、居住状态及近1年是否跌倒方面经比较差异均有统计学意义(P<0.05),其他一般资料两组之间结果差异无统计学意义(P>0.05);两组人群的行走步态中,步速、步长及步态周期变异性等三个参数差异均有显著性意义(P<0.05),在步频和步态周期两个参数上两组人群之间差异无统计学意义(P>0.05);步速、步长与害怕跌倒程度均呈负相关关系(P<0.05);步态周期变异性与害怕跌倒程度呈正相关(P<0.05);步态周期及步频与害怕跌倒程度相关关系差异无统计学意义(P>0.05)。结论双重任务行走可以有效地评估患者实际的行走步态性能,老年2型糖尿病患者在双重任务行走状况下易发生步态参数变差。患周围神经病变、较少参加运动锻炼、独居及有过跌倒史的人更容易出现害怕跌倒的心理,说明害怕跌倒可能是比跌倒更严重的一个心理健康问题,应引起医护人员及家属的重视,加强对患者的心理干预。

Objective To explore the correlation between double-task walking gait and fear of falls in patients with elderly type 2 diabetics. Methods To select a total of 225 eligible elderly patients with type 2 diabetes as study subjects and the general situation questionnaire and single item problem method were used for fear of fall assessment. The standing-walking test was used to evaluate the patient＇s balance ability. The wearable gait analysis system was used to measure several important steps of the patient under constant speed and dual task walking conditions. The correlation between the dual-task walking gait parameters and fear of falls was explored. Based on the patient＇s fear of falling,the patient was divided into a fearful fall group（ 124 cases） and a fearless fall group（ 101 cases）. The questionnaires result and gait parameters were compared between the two groups. Results There were statistically significant differences in various parameters between the dual task walking gait and the constant walking gait in elderly patients with type 2 diabetes（ P〈0. 05）. The difference in the balance ability,peripheral neuropathy,sports exercise,living status,and whether there was fall experience in the past 1 year in the fearful fall group and fearless fall group was of statistical significance（ P〈0. 05）. There were no statistically significant differences in other general data between the two groups（ P〉0. 05）. In the walking gait of the two groups of people,there were significant differences in three parameters such as pace,step length,and gait cycle variability（ P〈0. 05）. There was no statistical significance in the step frequency and gait period of the two groups（ P〉0. 05）. Step speed,step size and negative degree of fall were negatively correlated（ P〈0. 05）. Gait cycle variability positively correlated with fear of falls（ P〉0. 05）. There was no significant difference in the correlation between gait cycle and cadence and fear of falls（ P〈0. 05）. Conclusion Dual-task walking can effectively evaluate the actual walking gait performance of patients. Elderly patients with type 2 diabetes are prone to have variability of gait parameters under double-task walking conditions. Individuals suffering from peripheral neuropathy,less participating in physical exercise,living alone and having a history of falling are more likely to have a fear of falling. This shows that the fear of falling may be a more serious mental health problem than falling. Attention should be given to this problem by both medical staff and their families to strengthen the psychological intervention of patients.