A novel half-squat position approach for improved balance assessment for Type 2 Diabetes Mellitus patients

Abstract

Aim. Falls among the elderly, particularly those with type 2 diabetes mellitus (T2DM), often occur during dynamic activities rather than static standing. Traditional balance assessments, such as the Romberg test, do not fully capture real-life fall risks. This study proposes a novel half-squat position for balance assessment, reflecting functional movements like stair climbing and sitting. We hypothesized that the risk of falling in the half-squat position would be comparable to that observed on soft surfaces. Methods. A total of 102 T2DM patients from rural Cluj County, Romania, were evaluated using the BTS P-WALK baropodometric platform. Measurements of the body’s center of mass (Area, Speed, and Length) were taken under various conditions (hard vs. soft surfaces, eyes open vs. closed, half-squat). Statistical analyses involved the Shapiro-Wilk test and the Wilcoxon signed-rank test. Significant differences (p<.000) were observed in most variables, except for length and speed when comparing hard eyes-closed (EC) and half-squat (H-Sqt) conditions. Both the barycenter area and sway speed increased. On a hard surface, path length and speed showed little change between the H-Sqt and EC positions. The H-Sqt position revealed balance impairments that were not apparent during static tests, such as increased reliance on vision and impaired proprioception. Growing evidence supports that dynamic and functional assessments are more effective in predicting the real-life fall risk of patients with type 2 diabetes mellitus (T2DM). This suggests that the required stability levels were similar. The data show that the H-Sqt imposes postural control demands comparable to those of a soft surface, highlighting its importance in balance assessments. Integrating the H-Sqt into balance evaluation protocols could improve fall risk prediction for elderly T2DM patients, especially those with diabetic neuropathy. Future studies should apply this method to larger populations and explore variations such as the EC H-Sqt to further improve balance assessment strategies.