Outcomes of and Lessons Learned from Patients with Severe COVID-19 in a Long-term Acute Care Hospital

Abstract

Research Objectives: To evaluate and compare static and dynamic balance as well as a gait in individuals with and without diabetic neuropathy.Design: Case-control study design. Setting: University setting. Participants: The study included a convenience sample of 13 individuals with type 2 DM (7 males, 6 females) with a mean age of 62.77AE11.9 years. Participants were grouped as neuropathy group (NG) (nZ6) or non-neuropathy group (NNG) (nZ7) based on 10-gram Semmes monofilament test results. Interventions: No intervention. Main Outcome Measures: Center of Pressure (COP) sway using a force plate in normal stance and Romberg stance, with eyes open and closed conditions. Clinically balance was assessed using the Mini-BESTest (anticipatory, reactive, sensory orientation, and dynamic gait). Gait parameters (velocity, stride, and step length) were assessed using the GAITRite. Results: Significant condition effects were found for total displacement (F Z9.14, pZ.006), amplitude anterior/posterior (F Z9.01, pZ.007), amplitude medial/lateral (F Z10.49, pZ.004), area (F Z19.24, p < 001), velocity anterior/posterior (F Z11.12, pZ.003) and velocity medial/lateral ((F Z13.03, pZ.002) for Romberg stance eyes closed condition in Neuropathy group. No significant group effect, condition effect, and interaction were found in the normal width stance. The Mini-BESTest components and gait parameters did not have any significant difference between the groups. There were no significant differences between the self-reported activity levels of the NG and NNG participants (UZ14.5; pZ.30). NG participants had significantly higher weight (pZ .035) than the NNG participants.Conclusions: This study demonstrates the importance of visual compensation for participants with neuropathy in a narrow stance as reflected through COP sway in Romberg's stance with eyes closed. Though the neuropathy group can maintain a similar level of gait and balance, when the base of support decreased, they need to rely on visual compensatory strategies. The neuropathy group had higher weights than the non-neuropathy participants even with similar activity levels. In addition to rehabilitative measures, there is a need for teaching visual compensatory strategies and weight reduction program for patients with diabetic neuropathy.