Advisor Information
Sara Myers
Presentation Type
Poster
Start Date
1-3-2019 10:45 AM
End Date
1-3-2019 12:00 PM
Abstract
Peripheral arterial disease (PAD) is a vascular disease where atherosclerotic blockages restrict blood flow to muscles in the lower extremities. Diabetes is a common co-morbid condition in PAD and has been shown to increase the risk of lower extremity amputation compared to PAD without diabetes. Although there is a clear pathological relationship between diabetes and PAD, the gait mechanics involved remain indistinct. Therefore, the purpose of this study was to determine whether the presence of diabetes in addition to PAD results in greater functional impairment during ambulation. Twenty-three subjects with PAD and twelve controls consented to participate in the research. The subjects were divided into three groups: PAD and no comorbidities (PAD-NC), PAD with diabetes (PAD-D), and healthy controls. Reflective markers were placed in anatomical locations captured with a 12-camera motion capture system (Motion Analysis Corp, Santa Rosa, CA). Kinematics (60 Hz) and kinetics (600 Hz) were captured using Cortex software (Motion Analysis Corp, Santa Rosa, CA) while subjects walked over ground in pain free and pain conditions. Subjects walked over force plates (AMTI, Watertown, MA, USA) for 5 trials in each condition. Marker position data was exported and analyzed using MATLAB (Mathworks, Inc., Natick, MA) and Visual 3D (Germantown, MD, USA). A mixed ANOVA was used to determine the main effect for group (PAD-NC and PAD-D) and condition (pain free and pain) and Bonferroni was used in the case of significant interactions. Additionally, independent t-tests were used to compare means between control and PAD groups at baseline.
In the comparisons with PAD patients, an effect of condition was found for stride length, (F1, 20=4.75, p=0.041), and ankle power generation, (F1, 21=8.15, p=0.009) for PAD groups where both values decreased from the pain free to pain condition. No main effect of group or any interaction of group and condition were found. Regarding the comparisons to controls, ankle power generation was greater in controls with significant differences (M=2.59, SE=.13) from PAD-NC (M=2.04, SE=.42, p=.007) and PAD-D (M=1.96, SE=.58, p=.009). Hip flexor moment was also greater in controls (M=-0.93, SE=0.06) but was only significantly different from PAD-D (M=-0.67, SE=0.08, p=0.012). Another significant difference between controls (M=-0.45, SE=0.05) and PAD-D (M=-0.25, SE=0.06, p=0.017) was found for knee power. These results suggest that the PAD-D group has more differences than PAD-NC from healthy controls during pain-free ambulation. Lack of significant group effects between PAD-NC and PAD-D indicates that the mechanisms driving gait deficiencies in patients with PAD are larger than the addition of diabetes on biomechanical variables during locomotion.
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Gait alterations in peripheral arterial disease are not worsened by the presence of diabetes
Peripheral arterial disease (PAD) is a vascular disease where atherosclerotic blockages restrict blood flow to muscles in the lower extremities. Diabetes is a common co-morbid condition in PAD and has been shown to increase the risk of lower extremity amputation compared to PAD without diabetes. Although there is a clear pathological relationship between diabetes and PAD, the gait mechanics involved remain indistinct. Therefore, the purpose of this study was to determine whether the presence of diabetes in addition to PAD results in greater functional impairment during ambulation. Twenty-three subjects with PAD and twelve controls consented to participate in the research. The subjects were divided into three groups: PAD and no comorbidities (PAD-NC), PAD with diabetes (PAD-D), and healthy controls. Reflective markers were placed in anatomical locations captured with a 12-camera motion capture system (Motion Analysis Corp, Santa Rosa, CA). Kinematics (60 Hz) and kinetics (600 Hz) were captured using Cortex software (Motion Analysis Corp, Santa Rosa, CA) while subjects walked over ground in pain free and pain conditions. Subjects walked over force plates (AMTI, Watertown, MA, USA) for 5 trials in each condition. Marker position data was exported and analyzed using MATLAB (Mathworks, Inc., Natick, MA) and Visual 3D (Germantown, MD, USA). A mixed ANOVA was used to determine the main effect for group (PAD-NC and PAD-D) and condition (pain free and pain) and Bonferroni was used in the case of significant interactions. Additionally, independent t-tests were used to compare means between control and PAD groups at baseline.
In the comparisons with PAD patients, an effect of condition was found for stride length, (F1, 20=4.75, p=0.041), and ankle power generation, (F1, 21=8.15, p=0.009) for PAD groups where both values decreased from the pain free to pain condition. No main effect of group or any interaction of group and condition were found. Regarding the comparisons to controls, ankle power generation was greater in controls with significant differences (M=2.59, SE=.13) from PAD-NC (M=2.04, SE=.42, p=.007) and PAD-D (M=1.96, SE=.58, p=.009). Hip flexor moment was also greater in controls (M=-0.93, SE=0.06) but was only significantly different from PAD-D (M=-0.67, SE=0.08, p=0.012). Another significant difference between controls (M=-0.45, SE=0.05) and PAD-D (M=-0.25, SE=0.06, p=0.017) was found for knee power. These results suggest that the PAD-D group has more differences than PAD-NC from healthy controls during pain-free ambulation. Lack of significant group effects between PAD-NC and PAD-D indicates that the mechanisms driving gait deficiencies in patients with PAD are larger than the addition of diabetes on biomechanical variables during locomotion.