ECSS Paris 2023: OP-MH31
INTRODUCTION: Diabetes and Chronic Kidney Disease (CKD) are two distinct pathologies with a common complication: the peripheral neuropathy (PN) defined as a progressive degeneration of sensory and motor neurons, leading to a wide range of painful symptoms while impairing force production capacity. PN can affect more than 50% of these patients. If PN is not identified in time, it can worsen and may require limb amputation, which is a dramatical burden for patients and society. Among the diagnostic tests available, clinical assessments suffer from time-consuming protocols and a high variability due to human subjectivity, while electrophysiological tests remain difficult-to-access and can only detect large axons only, in the later stages. Our recent findings suggest that the quantification of postural balance and single-leg balance time has been shown to accurately predict diabetes-related PN. Therefore, the aim of the current study is to validated these previous results and to collect diversified physical and balance performance tests in order to determine whether physical performances can accurately predict PN in individuals with diabetes and CKD. METHODS: The study is prospective and interventional. Inclusions lasted from February to May 2025 in endocrinology and nephrology outpatients’ unit. The inclusion criteria require participants to be aged between 60 and 80 years, with a body mass index ≤35 kg.m-2 and a diagnosis of diabetes (type I or II) and/or CKD with a renal function <30 ml/min not in dialysis. The exclusion criteria include disabling cognitive, neurological, musculoskeletal, osteoarticular comorbidities or recent lower limb fractures. Participants were tested for PN using the validated Michigan Neuropathy Screening Instrument. They performed 6 tests in order to quantify walking abilities, proprioceptive performances and lower-limb muscle force: 10m walk test, timed-up and go, joint position sense, star excursion balance test, balance tests and ankle muscles strength assessment. The predictive equation will be developed using a regression method. RESULTS: Given the previous results reporting a very high area under the ROC curve (0.960), a high specificity (97.4%) with moderate sensitivity (77.8%) using balance tests compared to clinical diagnosis, the expected results of the present study, focusing even more on proprioceptive capabilities, are promising. CONCLUSION: Due to the limited availability and reliability of screening tools, many patients live with undiagnosed PN, which can lead to severe consequences in the event of foot injuries or bedsores. Physical performance declines even in the early stages of PN, accompanied by intrinsic foot muscle remodeling and gait impairments. A systematic, low-cost, rapid, and validated method for estimating PN risk would facilitate timely medical referral, thereby reducing the physical and socioeconomic burden of undiagnosed PN in patients with diabetes and CKD.
Read CV Antoine ChatrenetECSS Paris 2023: OP-MH31
INTRODUCTION: Gait disorders are frequent in people with multiple sclerosis (PwMS) and the use of robotic devices as exoskeletons has been proposed as effective for gait rehabilitation. Previous studies showed an inverse relationship between the intensity of exercise and the improvement in walking speed. Furthermore, benefits of a low-intensity training have been observed from clinical, muscular and hemodynamic perspective in several neurologic conditions. For this reason, this study aims to evaluate the effects of a low-intensity RAGT at progressively increasing intensity (LowRAGT) compared to conventional RAGT and OGT in PwMS and moderate to severe walking impairment. METHODS: In this randomized control trial, we recruited PwMS aged 18-65 years with disability rate defined by an Expanded Disability Status Scale score 6-7. All participants received three weekly treatment sessions of 3 hours each for 4 weeks. In the first two hours of treatment, each patient received a personalized, intensive, and task-specific rehabilitative intervention. During the last hour, subjects received specific gait training according to the assignment group. Subjects allocated to the LowRAGT group received gait rehabilitation on the Lokomat device set at 60% robotic assistance, 50% load suspension, and a speed initially set at 1.0 km/h, with progressive increments of 0.1 km/h at each training session. The working time consisted of bouts of 3 minutes of work alternated by 1 minute of recovery, to be repeated 8 times. Subjects allocated to the RAGT group received gait rehabilitation on the Lokomat device, and the parameters for setting the machine was determined on patients characteristics; the effective duration of treatment was 30 minutes. Subjects allocated to the OGT group received one-hour supervised walking training session. Mobility, walking function, balance, and patient-reported outcomes measures (PROMs) were assessed before and after treatment and at the three-month follow-up. RESULTS: One-hundred twenty-two PwMS were screened and twenty-four were enrolled (17 female, median age 55 years). All the enrolled subjects safely completed the study protocol. Significative improvements in walking function at post treatment evaluation were recorded only in LowRAGT and OGT group (endurance +30m, speed +0.11m/s, p<0.05); mobility (-2.12s, p<0.05), and balance (+7pts, p<0.05) improved in all three groups, without differences between them. At the three-month follow-up only the PwMS in the LowRAGT group retained improvements in walking endurance (+27m, p<0.05), mobility (-1.97s, p<0.05), and balance (+6.5pts, p<0.05). CONCLUSION: Mobility and gait improvements represent a realistic and achievable goal in PwMS and severe walking impairment. LowRAGT and OGT are effective in improving walking function, mobility, and balance; the retention of treatment effects at the three-month follow-up makes the LowRAGT a valuable strategy to maintain positive changes over time, also outside the rehabilitation setting.
Read CV Andrea BaroniECSS Paris 2023: OP-MH31
INTRODUCTION: Fibromyalgia (FM) is a chronic disease characterized by chronic widespread pain, fatigue, unrefreshing sleep, cognitive and gastrointestinal disorders, anxiety, depression, headaches, and dizziness. Such symptoms often incapacitate patients, hindering their ability to engage physical activity (PA), perform daily living tasks and are associated with significant impairment in perceived function and reduced physical performance. This study aimed to assess the association of spontaneous physical activity, performance on a set of functional tests, health-related quality of life (HRQoL) and the impact of the disease in women with FM based on their employment status and in comparison with healthy women. METHODS: A cross-sectional observational study was carried out, in which 81 women with FM aged 52,06±9,21 years were evaluated. PA level (sedentary, light, moderate, moderate to vigorous, and vigorous) was assessed using triaxial accelerometery. Physical fitness was assessed using the 6-min walk test, handgrip strength and the 8 feet up and go test, and HRQoL domains and the overall disease impact were assessed using the 36-item Short-Form Health Survey (SF36) and Revised Fibromyalgia Impact Questionnaire (FIQR) respectively. An ANOVA analysis was performed to assess group differences. RESULTS: Participants were divided into four groups: 1) Women with FM who are actively working (n=28); 2) Women with FM on sick leave and claiming disability (n=17); 3) Women with FM with permanent work disability (n=13); and 4) A control group of sedentary women without FM (n=23). Patients with FM showed less PA level and more sedentary time than control women. Moreover, participants with FM performed worse than control women in all the fitness tests studied (p<0.05). Regarding groups with FM, handgrip strength test showed significant differences between actively working group and claiming disability group (p<0.05). No significant differences were found between FM groups in the 6MWT and 8 feet up and go test. CONCLUSION: Women with FM show less level of PA, more sedentary time and significantly worse results than healthy women in the 6mwt, handgrip, and 8 feet up and go tests. This battery of tests has been shown to be capable of distinguishing between women with the condition and those without it. Furthermore, strength appears to be the key component for differentiating between subgroups based on employment status, as promising results have been observed between the active group and the group claiming disability.
Read CV José Luis SocorroECSS Paris 2023: OP-MH31