No participant was lost to the follow-up.
Stability test of posture with biofeedback
The results of the assessment of balance and movement coordination parameters using the postural stability test under eye control are presented in Table 2.
Tab.2. Results of biofeedback posture test for study group (B) and control (K).
Variable
|
Descriptive statistic for biofeedback posture test
|
Study group (B)
|
Control group (K)
|
N
|
Average
|
Median
|
SD
|
CI -95.00%
|
CI - 95.00%
|
N
|
Average
|
Median
|
SD
|
CI -95.00%
|
CI - 95.00%
|
before
|
after
|
before
|
after
|
before
|
after
|
before
|
after
|
before
|
after
|
GSI
|
37
|
2,79
|
1,26
|
2,7
|
1,2
|
0,5
|
0,34
|
0,41
|
0,28
|
0,65
|
0,44
|
41
|
1,1
|
1
|
0,25
|
0,2
|
0,31
|
FPI
|
37
|
1,66
|
0,77
|
1,5
|
0,7
|
0,57
|
0,36
|
0,46
|
0,29
|
0,74
|
0,47
|
41
|
0,7
|
0,7
|
0,21
|
0,17
|
0,27
|
MLI
|
37
|
0,88
|
0,54
|
0,8
|
0,5
|
0,36
|
0,19
|
0,3
|
0,15
|
0,47
|
0,24
|
41
|
0,52
|
0,5
|
0,15
|
0,11
|
0,17
|
Statistical analysis using the Mann-Whitney U test showed statistically significantly worse results for all three stability indexes in patients with diabetes compared to healthy subjects. For both the overall stability index and the index of frontal-posterior and medial-lateral stability, the p-value was less than 0.05 (Fig. 1, 2, 3).
Testing Wilcoxon couples showed statistically significant improvement in static balance with visual control in subjects with type II diabetes (study group) who received training with biological feedback. A statistically significant improvement was observed for all 3 stability indices, p < 0.05 (Figs. 4, 5, 6).
Posture stability test with closed eyes
In Table 3. the descriptive statistics for the pre- and post-training group and descriptive statistics for the control group were presented.
Tab. 3. Results of test of posture stability with closed eyes for the study group (B) and control (K).
Variable
|
Descriptive statistics for the closed eyes
|
Study group (B)
|
Control group (K)
|
N
|
Average
|
Median
|
SD
|
CI -95.00%
|
CI- 95.00%
|
N
|
Average
|
Median
|
SD
|
CI -95.00%
|
CI - 95.00%
|
before
|
after
|
before
|
after
|
before
|
after
|
before
|
after
|
before
|
after
|
GPI
|
37
|
4,44
|
3,29
|
4,5
|
3,1
|
0,61
|
0,37
|
0,5
|
0,3
|
0,8
|
0,48
|
41
|
2,27
|
2,3
|
0,36
|
0,3
|
0,47
|
FPI
|
37
|
2,84
|
2
|
3
|
2
|
0,67
|
0,37
|
0,55
|
0,3
|
0,88
|
0,47
|
41
|
1,11
|
1,1
|
0,21
|
0,17
|
0,27
|
MLI
|
37
|
1,15
|
0,78
|
1,1
|
0,7
|
0,33
|
0,27
|
0,27
|
0,22
|
0,43
|
0,35
|
41
|
0,53
|
0,5
|
0,15
|
0,12
|
0,18
|
Analysis of the results showed statistically significant disturbances in the parameters of balance and motor coordination in group B patients in relation to group K. Furthermore statistically significant differences in the overall anterior, posterior and medial-lateral stability index (p < 0, 05). The results are shown in Figs. 7, 8, 9.
Analysis of the results obtained from the study group before and after 3 months of training showed a statistically significant improvement (p < 0.05) for all three stability indicators (Figs. 10, 11, 12).
Fall risk test
Table 4. represents the statistical analysis for two groups of participants for a fall risk test (RF), which consisted of maintaining the center of gravity at one point on an unstable substrate.
Tab. 4. Statistics for the fall risk test (RF) for the study (B) and control (K) groups.
Variable
|
Descriptive statistics for the fall risk test
|
Study group (B)
|
Control group (K)
|
N
|
Average
|
Median
|
SD
|
CI -95.00%
|
CI - 95.00%
|
N
|
Average
|
Median
|
SD
|
CI -95.00%
|
CI - 95.00%
|
before
|
after
|
before
|
after
|
before
|
after
|
before
|
after
|
before
|
after
|
RF
|
37
|
5,18
|
3,87
|
5
|
3,7
|
0,93
|
0,52
|
0,76
|
0,43
|
1,2
|
0,68
|
41
|
2,72
|
2,8
|
0,38
|
0,31
|
0,49
|
The Mann-Whitney U test showed a statistically significant increase in the risk of falling in people with diabetes compared to healthy individuals (Figs. 13,14). Statistically significant decrease in the risk of falling was observed in the study group who had undergone training with biofeedback (p < 0.05).
Correlations
In Table 5. Spearman rank correlation results are shown for the study group prior to the training session. Significant correlations were found, where the significance factor p was less than 0.05. There was a correlation between the age of patients and the values of general and anterior-posterior stability index during the postural stability test. With the increasing age, the value of GPI, FPI and MLI index values increased during post-biofeedback posture testing. It was observed that with the increase in BMI, the risk of falling in people with diabetes increased.
Tab.5. Spearman rank correlations (p <0.05) for the study group prior to the training session.
Variable
|
|
|
|
|
|
|
|
|
|
|
1,00
|
0,04
|
0,33
|
0,62
|
0,13
|
0,22
|
0,22
|
0,44
|
0,23
|
|
0,04
|
1,00
|
-0,08
|
-0,00
|
-0,22
|
0,01
|
0,18
|
-0,00
|
0,41
|
|
0,33
|
-0,08
|
1,00
|
0,26
|
0,57
|
0,28
|
-0,20
|
0,09
|
-0,13
|
|
0,62
|
-0,00
|
0,26
|
1,00
|
0,07
|
0,25
|
0,37
|
0,27
|
-0,14
|
|
0,13
|
-0,22
|
0,57
|
0,07
|
1,00
|
-0,08
|
-0,27
|
-0,18
|
-0,09
|
|
0,22
|
0,01
|
0,28
|
0,25
|
-0,08
|
1,00
|
0,40
|
0,01
|
-0,05
|
|
0,22
|
0,18
|
-0,20
|
0,37
|
-0,27
|
0,40
|
1,00
|
-0,05
|
-0,12
|
|
0,44
|
-0,00
|
0,09
|
0,27
|
-0,18
|
0,01
|
-0,05
|
1,00
|
0,30
|
|
0,23
|
0,41
|
-0,13
|
-0,14
|
-0,09
|
-0,05
|
-0,12
|
0,30
|
1,00
|
The assessment of the relationship between individual characteristics of diabetic patients subjected to balance training with the help of the Biodex platform is presented in Table 6. It was observed that, with increasing age, balance parameters, in a static setting with opened and closed eyes, and the mean muscle strength, for both knee flexors and extensors were decreased. Analysis showed that, with the deterioration of static balance during biofeedback testing, the strength of the tested muscle groups decreased. Patients with greater BMI showed an increased risk of falling.
Tab.6. Spearman rank correlations (p <0.05) for the study group after the training session
Variable
|
|
|
|
|
|
|
|
|
|
|
1,00
|
0,04
|
0,52
|
0,57
|
0,73
|
0,34
|
0,09
|
0,49
|
0,26
|
|
0,04
|
1,00
|
-0,16
|
-0,02
|
-0,05
|
0,01
|
-0,02
|
0,03
|
0,44
|
|
0,52
|
-0,16
|
1,00
|
0,59
|
0,39
|
0,15
|
0,01
|
0,24
|
0,11
|
|
0,57
|
-0,02
|
0,59
|
1,00
|
0,57
|
0,11
|
0,06
|
0,30
|
0,04
|
|
0,73
|
-0,05
|
0,39
|
0,57
|
1,00
|
0,21
|
0,04
|
0,42
|
0,23
|
|
0,34
|
0,01
|
0,15
|
0,11
|
0,21
|
1,00
|
0,30
|
-0,03
|
-0,05
|
|
0,09
|
-0,02
|
0,01
|
0,06
|
0,04
|
0,30
|
1,00
|
-0,28
|
0,15
|
|
0,49
|
0,03
|
0,24
|
0,30
|
0,42
|
-0,03
|
-0,28
|
1,00
|
0,07
|
|
0,26
|
0,44
|
0,11
|
0,04
|
0,23
|
-0,05
|
0,15
|
0,07
|
1,00
|