Diabetic patients are known to have the low quality of life (QoL).
Patients
with diabetic peripheral neuropathy (DPN) have worse health-related quality of life (HRQoL) compared to
patients without DPN, partly mediated by functional status parameters.
Effective interventions targeting functional status may be beneficial in
improving HRQoL in these patients.
Diabetic patients are known to have the low quality of life
(QoL). Diabetic peripheral neuropathy (DPN) accounts to be a most common
complication in diabetes patients affecting almost 50% of the diabetics. Distal
symmetric sensorimotor polyneuropathy is the most common type of peripheral
neuropathy which causes sensory loss in a glove and stocking pattern. Patients
with DPN are more prone foot infections and ulcerations which may, in turn,
lead to an amputation and may be death.
Patients with DPN are known to have the more reduced health-related
quality of life (HRQoL). Previous studies have reported that DPN patients tend
to suffer from reduced proprioceptive senses, ankle mobility, range of motion
and muscle strength. Individuals with DPN also results in reduced balance gait
and mobility alterations and increased risk of falls. However, it is unclear,
that these functional deficits in individuals with DPN are associated with, and
responsible for, reduction in HRQoL.
Therefore, the present study determined the reduction in
HRQoL associated with DPN, identify functional deficits among patients with
DPN. They hypothesized that patients with DPN have functional deficits compared
with non-DPN diabetic patients, and these deficits account for the reduction of
HRQoL.
Rationale behind the research:
None of the study evaluated the
association of functional deficits in individuals with DPN with reduction in
HRQoL.
Therefore, Riandini T et. al.
conducted this study to quantify the reduction in HRQoL associated with DPN,
identify functional deficits among patients with DPN in terms of muscle
strength, range of motion, balance functional tasks, and balance confidence,
and examine the role of these functional deficits in the reduction of HRQoL.
Objective:
To quantify the reduction in HRQoL
associated with DPN, identify functional deficits among patients with DPN in
terms of muscle strength, range of motion, balance functional tasks, and
balance confidence, and examine the role of these functional deficits in the
reduction of HRQoL.
Study outcome measures:
EQ-5D-5L: The EQ-5D-5L is a generic measure of HRQoL, comprising a
health descriptive component and a visual analogue scale (VAS). The health
descriptive component consists of five dimensions, one each on mobility,
self-care, usual activities, pain/discomfort, and anxiety/depression. Each item
has five levels of response: no problem, slight problem, moderate problem,
severe problem, and extreme problem. EQ-5D scores can be summarized into a
single index value, the health utility score, using population preference
weights. This index ranges between 0 and 1, where 1 represents perfect health
and 0 represents death.
Time period: Write the time
period at which outcomes were studied like baseline, 2 weeks and 6 weeks.
Study Outcomes
Participants with DPN had lower ankle dorsiflexion strength (right −0.74 lbs, 95% CI −1.54, 0.06 lbs, p=0.068; left −0.92 lbs, 95% CI −1.71, −0.13 lbs, p=0.023) and great toe extensor strength (right −1.2 lbs, 95% CI −1.92, −0.48 lbs, p=0.001; left −1.08 lbs, 95% CI −1.75, −0.41 lbs, p=0.002), poorer performance on TUG test (2.07s, 95% CI 0.92, 3.22s, p<0.001) and FTSTS test (1.87s, 95% CI 0.12, 3.61s, p=0.036), as well as greater body sway velocity while standing with eyes closed (0.50mm/s, 95% CI 0.19, 0.81mm/s, p=0.002). They also had significantly lower health utility score (−0.10 points, 95% CI −0.15, −0.06s, p<0.001) compared to participants without DPN. HRQoL differed in DPN and non-DPN groups in all dimensions except pain/discomfort.
Figure 1: SEM analysis of HRQoL predictors
This study demonstrated that patients with DPN had a significantly lower
HRQoL and lowered functional status compared to those having diabetes without
DPN. Mean utility score in the non-DPN group in this study was similar to that
reported in Europe among people with diabetes patients without complications
(mean=0.74, SD=0.27). The utility scores in the DPN group in this study,
however, were comparable to the scores reported in patients with other
conditions from this region, such as breast cancer (mean=0.78, SD=0.16),
age-related macular degeneration (mean=0.89, SD=0.14), and end-stage renal
disease (mean=0.60, SD=0.21). It is evident that the impact of DPN on HRQoL
could be similar or even worse than other severe conditions.
In the present study, domains of mobility, self-care, usual activity as
well as anxiety were associated with DPN, while the pain was not. It was shown
that DPN is associated with significant reduction in HRQoL, with greatest
declines seen in the physical function/ mobility and pain domains. The recent
findings are also consistent with previous work in this area. From this study,
it is well recognized that DPN leads to specific sensorimotor deficits, with
consequent limitations in balance or postural stability, functional strength,
gait, and mobility. However, few previous studies have empirically demonstrated
the link between either specific neurological deficits or functional measures
with HRQoL in individuals with DPN. To our knowledge, only one previous pilot
study has reported on this relationship, finding significant associations
between HRQoL (assessed by EQ-5D-3L) and functional mobility in older patients
with diabetes. While the role of functional status in HRQoL has been previously
demonstrated in patient populations with known functional disability, like the
elderly and those with multiple sclerosis.
In this study, the authors investigate the role of functional status in
patients with DPN on HRQoL and examine the inter-relationships between DPN,
functional status, and HRQoL.
The actual relationships among these variables could be complicated and reciprocal. For example, it is possible that lower HRQoL in patients with diabetes may alter their self-care and diabetes management behaviors, which in turn could put them at higher risk of developing complications and further decrease HRQoL. In our analysis, balance confidence was significantly correlated with functional status measures and dominated the relationship with HRQoL as the most reliable predictor. Based on our results, the mediating paths from FTSTS to ABC score and from ABC score to HRQoL were both significant. This might explain why FTSTS became non-significant when ABC score was included and suggests mediation between FTSTS and HRQoL by balance confidence. ABC score, however, did not mediate the relationship between body sway velocity and HRQoL; therefore, balance confidence appears to be a mediator of certain functional measures only. In many studies, HRQoL was also associated with socioeconomic factors. Similar associations have been reported previously in patients with diabetes and underline the need for tailored clinical-social interventions in specific subgroups to improve health outcomes. However, since most studies have been cross-sectional, it is also unclear whether employment and income levels are the cause or effect of DPN and HRQoL status.
The patients with DPN tend to have
significantly lower HRQoL. Results indicate that increased functional status
and balance confidence may prove to be useful
in improving HRQoL in individuals with DPN.
Interventions improving functional status and balance confidence might
be useful to improve HRQoL in individuals with DPN. As reduction in HRQoL
contributes greatly to the burden of the disease, interventions to improve
HRQoL should be aggressively investigated.
Acta Diabetol. 2017 Nov 28.
Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes
Tessa Riandini et al.
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