| Sensori-motor deficit due to diabetic peripheral neuropathy (DPN) alters the quality of obstacle–crossing
which may increase the risk of falling. The aim of this study was to compare inter-joint coordination (IJC)
during obstacle-crossing between people with DPN and healthy controls. Fifteen DPN and 15 healthy
people crossed over obstacles with heights of 10% and 20% of the subject’s leg length. The mean absolute
relative phase (MARP) and deviation phase (DP) of both leading and trailing limbs were used to calculate
the phase dynamic and variability of IJC. Furthermore, correlation between Berg Balance Scale (BBS), Fall
Efficacy Scale (FES-I), Timed Up and Go (TUG) and MARP, DP were assessed in DPN group. There was no
significant interaction between group and obstacle height on measured variables. However, Group had
significant main effect on DP of hip-knee in leading limb (p < 0.05). Additionally, the main effects of
the obstacle’s height were significant on MARP of hip-knee of trailing limb (p < 0.01) and knee-ankle
in leading limb (p < 0.05). FES-I was significantly correlated to hip-knee and knee-ankle MARPs of leading
limb for crossing over 20% and knee-ankle MARP for crossing over 10% height obstacle (r = 0.68, 0.69,
0.59, respectively, p < 0.05). This score was also significantly correlated with hip-knee DP of both trailing
and leading limbs when crossing 10% obstacle (r = 0.59, 0.57, respectively, p < 0.05). In conclusion, IJC
during obstacle-crossing was less variable and more out-of-phase, as a result of DPN and obstacle height,
respectively. Moreover, when crossing over lower obstacles, fear of falling is related to IJC dynamics and
variability of more proximal segment, especially in the leading limb. |