Metabolic Syndrome and Fall Risk

 说明： 代谢综合征(METS)是一组危险因素的集合，包括腹型肥胖、高血压、高脂血症和高血糖，高血糖是心血管疾病和糖尿病的已知危险因素。然而，也有越来越多的文献支持METs与神经病变之间的联系。虽然众所周知，糖尿病和糖尿病前期通常与疼痛的感觉运动小纤维神经病变有关，但很少有人知道，患有METS的人也患有类似的疼痛小纤维神经病变，通常也涉及自主神经系统。此外，有早期证据表明，METS是跌倒的独立危险因素(1)。然而，目前尚不清楚有针对性的运动和平衡训练计划是否能成功降低这类患者的跌倒风险。拟议的研究试点项目将根据METS和自主神经病变的证据评估参与者跌倒的风险，这是一种有效和敏感的动态站立平衡测试(2)。首次在该人群中评估的其他终点测量包括在仪表式步态垫(GaitRite)上执行的动态步态指数(DGI)。然后参与者将被随机分到标准护理组和接受关于跌倒风险和预防的教育，或者是有针对性的平衡运动干预组。[两组将每周举行一次集体课，运动干预组]将接受家庭平衡锻炼计划的指导，每周进行三次锻炼。在12周的干预期后，参与者将被重新评估，以确定与没有参加平衡运动计划的标准护理组相比，平衡运动干预在降低跌倒风险方面是否成功。此外，参与者将在基线和干预后完成自我效能感测量。不同的终点措施将作为该试点的一部分进行评估 研究确定在这一人群中，哪种评估工具是平衡表现和跌倒风险的最合适工具。这一新信息将用于设计未来的临床试验。TE申请者Lindsay Zilliox博士是巴尔的摩VAMC的神经学家和马里兰大学神经学系的助理教授，最近完成了她的临床培训，并有参与退伍军人管理局的历史。这个为期5年的CDA-2将使她能够通过与James Russell博士的持续指导，在临床研究以及自主测试的使用和解释方面获得更多技能，她曾与James Russell博士合作进行退伍军人管理局资助的研究试验，并与他一起发表了几篇同行评议的期刊文章。此外，她将与物理治疗和康复系的共同导师马克·罗杰斯博士合作，通过研究平衡和运动的神经运动控制来补充她在周围神经疾病领域的知识。她不仅将与罗杰斯博士和他的同事合作，还将参加物理康复科学研究生院提供的课程和研讨会。第三位导师迈克尔·特林博士将提供临床试验方法学方面的专业知识。这是一个新颖而独立的研究项目，这一经历将为她提供必要的工具，使她成为一名独立的退伍军人管理局研究员。

 DESCRIPTION: The metabolic syndrome (MetS) is a collection of risk factors including abdominal obesity, hypertension, hyperlipidemia, and hyperglycemia that is a known risk factor for cardiovascular disease and diabetes. However, there is also a growing body of literature that supports the association of the MetS and neuropathy. While it is well recognized that diabetes mellitus and pre-diabetes are commonly associated with a painful sensorimotor small fiber neuropathy it is less commonly known that individuals with the MetS also suffer from a similar painful small fiber neuropathy that often involves the autonomic nervous system as well. In addition, there is early evidence that the MetS is an independent risk factor for falls (1). However, it is not known if a targeted exercise and balance training program would be successful in reducing the fall risk in this patient population. The proposed research pilot project will assess participants with evidence of the MetS and autonomic neuropathy for fall risk as measured by the Four Square Step Test (FSST), which is a valid and sensitive test of dynamic standing balance (2). Additional endpoint measures that will be evaluated for the first time in this population include the Dynamic Gait Index (DGI) performed on an instrumented gait mat (GaitRite). The participants will then be randomized to either a standard care group and received education regarding fall risk and prevention or a targeted balance exercise intervention group. [Both groups will meet once a week for a group class and the exercise intervention group] will be instructed in a home balance exercise program to perform three times a week. After a 12 week intervention period the participants will be reassessed to determine if the balance exercise intervention was successful in reducing fall risk compared to the standard care group who did not participant in the balance exercise program. In addition the participants will complete self-efficacy measures at baseline and after the intervention. The different endpoint measures will be evaluated as part of this pilot study to determine which is the most appropriate assessment tool of balance performance and fall risk in this population. This new information will be used to design future clinical trials. Te applicant, Dr. Lindsay Zilliox, is a Neurologist at the Baltimore VAMC and an Assistant Professor in the Department of Neurology at the University of Maryland who recently completed her clinical training and has a history of involvement within the VA. This 5 year CDA-2 will allow her to gain additional skills in clinical research as well as the use and interpretation of autonomc testing through ongoing mentorship with Dr. James Russell, with whom she has worked on VA funded research trials and published several peer-reviewed journal articles with. In addition she will work with a co-mentor, Dr. Mark Rogers in the Department of Physical Therapy and Rehabilitation, to complement her knowledge in the field of peripheral nerve disease with research in neuromotor control of balance and locomotion. She will not only collaborate with Dr. Rogers and his colleagues, but participate in coursework and seminars that are offered through the Graduate School of Physical Rehabilitation Science. A third mentor, Dr. Michael Terrin, will provide expertise in clinical trial methodology. This is a novel and independent research project and the experience will provide her with the necessary tools to establish herself as an independent VA researcher.