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Differences in Fall Risk Factors Between Adults With Diabetes and Those Without Who Are Homebound

Migliarese, Sara James PT, PhD, NCS

Topics in Geriatric Rehabilitation: April/June 2017 - Volume 33 - Issue 2 - p 118–126
doi: 10.1097/TGR.0000000000000146
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Background and Purpose: Adults with type II diabetes are at higher risk for falls than their nondiabetic peers. The purpose of this study was to identify the differences in factors that influence fall risk between adults who are homebound and are diabetic (DM) and adults who are nondiabetic and homebound (NDM) in a population identified at high risk for falls.

Methods: Five factors were collected that impact fall risk for 279 homebound adults during an initial physical therapy evaluation. Participants were identified as having high fall risk by a physician referring them for home health physical therapy.

The sample was subdivided into those with diabetes (73 type II diabetic [DM] adults) and those without diabetes (206 nondiabetic [NDM] adults). Factors previously identified as influential for fall risk included sensation on the soles of the feet, lower extremity neuropathic pain, sensory integration scores on the modified Clinical Test of Sensory Interaction and Balance (mCTSIB), dynamic balance measured by the Dynamic Gait Index, and balance confidence as measured by the Modified Falls Efficacy Scale. Data were compared between diabetic and nondiabetic groups, between 5 age categories, and between blended diagnostic cohorts with and without protective foot sensation. All cohorts were divided into age categories of 47 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 to 98 years of age.

Results and Discussion: A significant difference was found between DM and NDM cohorts in monofilament scores for foot sensation (P = .003, DM mean = 5.9, NDM mean = 7.4, mean difference =−1.47, standard error = 0.48). All other risk factors for falling trended toward increased severity in the diabetic group but were not statistically significant. Significant differences were noted between participants with protective foot sensation and those without it for scores in all 4 positions of the mCTSIB (position 1, P = .011; position 2, P = .001; position 3, P = .02; and position 4, P = .029), total mCTSIB score (P = .001), the Dynamic Gait Index score (P = .002), and neuropathic pain (P = .001) but not for the Modified Falls Efficacy Scale score.

Conclusions: Sensation on the soles of the feet represented the best differentiator between fall risk factors when comparing homebound adults with diabetes with those without diabetes. Clinicians performing a fall risk assessment on homebound adults should recognize the variability in fall risk and perform thorough multifactorial evaluations regardless of the absence or presence of the diagnosis of diabetes, including a minimum of sensory testing and the mCTSIB that were sensitive to variations in age and protective sensation.

Department of Physical Therapy, Winston-Salem State University, Winston-Salem, North Carolina.

Correspondence: Sara Migliarese, PT, PhD, NCS, Department of Physical Therapy, Winston-Salem State University, 601 S. Martin Luther King Jr Dr, Winston-Salem, NC 27110 (

Dr Kathleen Williams, PhD, Professor and Associate Dean for Undergraduate Studies, Department of Kinesiology, The University of North Carolina at Greensboro, contributed hours of patience and mentorship during the completion of this study. Dr Lynn Millar, Chair of the Doctor of Physical Therapy program, Winston-Salem State University, provided invaluable assistance for data analysis for this project.

Grant funding was not received during any portion of this research project. The results of this project were presented at the APTA Combined Sections Meeting in February 2010 and at the APTA EXPAAC meeting in July 2010.

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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