Comparison of joint position sense in diabetic and traumatic transtibial amputees and investigation of the relationship between compliance with the prosthesis, balance and functional performance with joint position sense

This study was conducted to compare knee joint position sense in diabetic and traumatic unilateral transtibial amputees, to reveal how diabetic polyneuropathy (DPN) affects knee joint proprioceptive sense, and to examine the relationship of knee joint proprioceptive sense with prosthesis compliance, balance and functional performance. The control group included 14 traumatic transtibial amputees, and the study group included 14 diabetic transtibial amputees. Demographic information, amputation and prosthesis information, and the background and family history of the individuals participating in the study were recorded. In addition to this information, history of diabetes and DPN were recorded in the diabetic group. The participants' muscular strength, lower extremity joint range of motion, and healthy foot were assessed. The Visual Analogue Scale was used to assess phantom and stump pain, the Self-Leeds Neuropathic Symptom and Sign Evaluation Scale was used to assess neuropathic pain; and Semmes-Weinstein Monofilaments were used to assess sensory loss in the participants. Knee joint proprioception was evaluated at 2 target angles, 30° and 60°, on the amputated side (with/without prosthesis) and on the healthy side with inertial measurement unit sensors, static and dynamic balance parameters were evaluated with the force platform, functional performance was evaluated with the 2 Minute Walk Test, the ability to forget their artificial limbs was evaluated with the Forgotten Joint Score, and the use of prosthesis and determination of fit were evaluated with the Trinity Amputation and Prosthesis Experience Scale. It was shown that the diabetic amputees had considerably lower daily prosthesis use duration, the number of prostheses utilized, and percentage of weight transfer to the amputated side compared to traumatic amputees (p<0.05). It was determined that the intact foot of the diabetic amputees varied in terms of color, temperature, edema, calluses, heel cracks and deformity formation compared to traumatic amputees (p<0.05). It was determined that all range of motions of the ankle and flexion ranges of both knee joints, as well as muscle strength surrounding the intact side of ankle, both knee and hip joints, of the diabetic amputees were decreased compared to traumatic amputees (p<0.05). It was found that the knee joint proprioceptive sense evaluated on the lower extremities of the amputee (with/without a prosthesis) and on the intact side of diabetic amputees at two different target angles, 30° and 60°, was considerably lower than that of traumatic amputees (p<0.05). It was determined that static and dynamic balance parameters of diabetic amputees were significantly negatively affected compared to traumatic amputees and they fell more frequently in the last year (p<0.05). While diabetic amputees have lower functional performance levels than traumatic amputees, it has been revealed that traumatic amputees have a significantly greater capacity to adapt to and satisfaction with their prosthesis (p<0.05). It has been shown that knee joint position sense is correlated with prosthesis adaptation, functional performance, and balance parameters (r>0,70) (p<0,05). With this study, it was concluded that the extent and severity of neuropathy may pose a risk for loss of proprioceptive sensation in the knee joint in diabetic transtibial amputees. It has been shown that this loss of joint position sense in diabetic transtibial amputees negatively affects static and dynamic balance parameters and therefore may pose a risk of falling in diabetic amputees. It is critical that healthcare professionals working with diabetic amputees consider the negative effects of DPN when designing a rehabilitation program, as the knee joint position sense has a negative impact on the amputee's prosthesis fit and ability to use the prosthesis, resulting in inadequacy in daily living activities.