Characteristics of the gait initiation phase in older adults with diabetic peripheral neuropathy compared to control older adults

Background: Gait is deteriorated in older adults with diabetic peripheral neuropathy; however, too little is known about the gait initiation phase. We aimed to determine if gait initiation variables are more sensitive in identifying the extent to which diabetic peripheral neuropathy impacts gait. Methods: We examined steps, distance, speed and dynamic balance in the gait initiation phase using a validated algorithm based on wearable sensors in 38 older adults with diabetic peripheral neuropathy and 33 non-diabetic, non-neurologic, non-orthopedic control older adults (≥65 years) under single-task and dual-task gait conditions. Findings: During the single-task gait condition, the largest differences between the two groups were found in gait initiation steps and dynamic balance (66.7% more steps and 57.2% poorer balance for the diabetic group; effect size = 1.08 and 1.11, respectively; all p < 0.05), while gait speed had a medium effect (10.9% slower for the diabetic group; effect size = 0.54; p < 0.05). Although gait deteriorated for both groups during the dual-task gait condition compared to the single-task gait condition, effect sizes of the between-group differences remained similar. The differences in gait initiation steps and dynamic balance between the two groups were independent of gait speed. Interpretation: Gait initiation steps and dynamic balance may be more sensitive than gait speed for detecting gait deterioration due to diabetic peripheral neuropathy. Given the association between gait initiation and risk for fall, our findings suggest that gait initiation variables may be important outcomes for clinical management of diabetic peripheral neuropathy.