Evaluation of Limited Joint Mobility of the Hand and Associated Factors among Diabetic and Non Diabetic Patients in a Tertiary Care Hospital in Southern Ethiopia: A Case-control Study

Abstract

Introduction: Limited Joint Mobility (LJM) is one of the long- term complications of Diabetes Mellitus (DM). It is a widespread problem among patients with DM, affecting more than two- thirds of diabetic patients. It is known that LJM predominantly affects the mobility of upper limb joints, especially those of the hand, and is often neglected until hand deformity is severe enough to interfere with daily life. Even though various studies in developed countries have revealed a significantly higher rate of LJM among diabetic patients, there is limited evidence in developing countries, specifically in Ethiopia. Aim: To assess LJM of the hand and associated factors among diabetic and non diabetic patients. Materials and Methods: A hospital-based, case control study was conducted on 240 participants in Arba Minch General Hospital, Southern Ethiopia from November 2018 to May 2019. The range of flexion and extension motions of individual hand joints {wrist, Metacarpophalangeal (MCP), first Interphalangeal (IP), Proximal Interphalangeal (PIP), and Distal Interphalangeal (DIP)} were measured by using a Goniometer. The collected data was entered into Epi (Epidemiological) Info version 3.2 and transferred to Statistical Package for Social Sciences (SPSS) version 20.0 for analysis. An independent t-test was conducted to compare the mean and standard deviations of hand joint motions among diabetic and non diabetic groups. Logistic regression was used to assess the association between the dependent and independent factors. The p-value <0.05 was considered as statistically significant. Results: A total of 234 participants (response rate of 97.5% ,117 diabetic cases and 117 non diabetic controls) were included in the study. The magnitude of LJM among diabetic cases was 17.1%, whereas in non diabetic controls, it accounted for 4.3%. The composite score mean (±SD) of hand flexion in diabetic patients was 1088.75±860, which is significantly lower (p<0.05) than in non diabetic patients, 1117.75±82.880, and hand extension in diabetic patients was 227.98±87.220, which was significantly lower than in non diabetic patients, 276.96±78.180. Age >50 years (AOR: 3.9 (1.14-13.36) with p=0.03) and co- morbidity with hypertension {AOR: 3.26 (1.02-10.41) with p=0.04} were identified as significant associated factors for LJM in diabetic patients. Conclusion: In diabetic patients, flexion and extension movements of hand joints were significantly reduced compared to those of non diabetic patients. Advanced age and co- morbidity with hypertension were significantly associated with LJM in the current study.