# Test-Retest Reliability of Kinematic Parameters of Timed Up and Go in People with Type 2 Diabetes
## 4 Discussion
This is relevant since a previous study showed that patients with diabetic neuropathy have worse health-related quality of life and lower functional status than patients without diabetic neuropathy [21]. Neuropathy leads to balance impairments [22], gait and mobility alterations [23; 24] and an increased risk of falls [25]. In addition, patients with T2 DM seem to be more susceptible to falls and consequently to bone fractures [26; 27; 28]. Due to the relevance of diabetic neuropathy in patients with T2 DM, future studies aimed at improving physical conditioning variables should consider that the smallest clinically relevant improvement may be higher in T2 DM patients with this complication. To our knowledge, this is the first study to assess the reliability of TUG according to the severity of neuropathy. Only one previous study has evaluated the reliability of TUG in the diabetic population [29]. That study was conducted on a sample of 18 older adults with T2 DM, and no classification of the participants was performed. Furthermore, that study only evaluated the time needed to complete the TUG and not any other measure such as the duration of walking phases or kinetic parameters. Comparing results from the present study with those obtained by [PERSON], [PERSON], [PERSON], [PERSON] and [PERSON] [29], both studies report excellent reliability. However, the ICC and %SEM from that study were 0.98 and 3.5%, respectively, whereas the present study reports an ICC of 0.927 and a %SEM of 4.52. Therefore, the reliability is slightly lower in this study, which may be linked to the greater heterogeneity of the sample in the current study. In this regard, it must be noted that the study by [PERSON], [PERSON], [PERSON], [PERSON] and [PERSON] [29] was conducted on 18 older adults with T2 DM, while the current one was conducted with 56 adults aged 65.35 (8.56) years. The current study reported not only the SEM but also the SRD, which is extremely relevant for clinicians and researchers since it indicates whether the differences obtained as a consequence of an intervention program could be considered clinically important [30]. A previous study in T2 DM [29] established the SRD for the TUG at 9.8%, whereas in the present study the SRD was 12.55%. This difference could be also explained by the heterogeneity of the sample in the current study. In this regard, the results from the previous study were limited to older adults. Thus, those studies conducted with samples comprised of adults (but not limited older adults) had no information about the reliability and the minimal clinically important difference to interpret their results. Therefore, the current study was needed since it is the first to provide reliability information in a sample comprised of adults (not limited to older adults). Test-retest analyses have been also reported in kinematic parameters, taking into account the heel and the forefoot forces during the TUG. The results revealed that the reliability of the heel and forefoot forces could be considered as excellent, so future studies can confidently use this as a measurement to evaluate gait patterns in T2 DM patients. People with diabetic neuropathy often have balance problems while performing common activities such as walking or ascending/descending stairs [31]. Furthermore, the postural mechanisms at the ankle joints are impaired in diabetic neuropathy patients during quiet standing [32]. Thus, postural instability and gait imbalance in diabetic neuropathy may contribute to a high risk of fall incidence, especially in the geriatric population [7; 31]. Therefore, future studies should be focused on the implementation of interventions aimed to modify gait parameters to reduce the risk of falling in T2 DM patients. The current study provides useful information in order to interpret changes achieved after a specific program, stating the minimal clinically relevant change for kinetic and kinematic variables. The present study has two main limitations.