Effects of Sensorimotor and Gait Training on Balance, Proprioception and Gait in Patients with Diabetic Peripheral Neuropathy
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Background: Diabetic peripheral neuropathy (DPN) is associated with impaired balance, proprioception, and gait, contributing to functional limitations and reduced mobility. Objective: To compare the effects of conventional physiotherapy and combined sensorimotor and gait training on balance, proprioception-related performance, and gait in patients with DPN. Methods: This randomized controlled trial was conducted at Link Medical Center, Lahore, Pakistan. Seventy-two patients with DPN were allocated equally to conventional physiotherapy (n=36) and gait/sensorimotor training (n=36) groups. Outcomes were assessed at baseline, week 6, and week 12 using the Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT), Ten-Meter Walk Test (10MWT), and Pedalo-Sensamove Balance Test. Independent-samples t-tests and repeated-measures ANOVA were used for statistical analysis. Results: At week 12, the gait/sensorimotor group demonstrated higher BBS scores (47.97±4.07 vs. 43.11±4.97; p<0.001) and greater 6MWT distance (461.53±34.35 vs. 387.58±41.93 m; p<0.001). The group also demonstrated shorter 10MWT completion times (4.75±0.73 vs. 6.91±1.29 seconds; p<0.001) and higher Pedalo-Sensamove scores (9.79±0.59 vs. 8.12±0.87; p<0.001). Conclusion: Both groups demonstrated favorable functional changes, with larger observed improvements following combined sensorimotor and gait training. These findings suggest potential additional benefits, although definitive treatment superiority requires further verification of longitudinal effects
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1. Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson DJ, et al. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clin Ther. 2018;40(6):828-849.
2. Elafros MA, Andersen H, Bennett DL, Savelieff MG, Viswanathan V, Callaghan BC, et al. Towards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments. Lancet Neurol. 2022;21(10):922-936.
3. Yovera-Aldana M, Velásquez-Rimachi V, Huerta-Rosario A, More-Yupanqui M, Osores-Flores M, Espinoza R, et al. Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: a systematic review and meta-analysis. PLoS One. 2021;16(5):e0251642.
4. Braffett BH, Gubitosi-Klug RA, Albers JW, Feldman EL, Martin CL, White NH, et al. Risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes. 2020;69(5):1000-1010.
5. Burgess J, Frank B, Marshall A, Khalil RS, Ponirakis G, Petropoulos IN, et al. Early detection of diabetic peripheral neuropathy: a focus on small nerve fibres. Diagnostics (Basel). 2021;11(2):165.
6. Timar B, Timar R, Gaiță L, Oancea C, Levai C, Lungeanu D. The impact of diabetic neuropathy on balance and on the risk of falls in patients with type 2 diabetes mellitus: a cross-sectional study. PLoS One. 2016;11(4):e0154654.
7. Mustapa A, Justine M, Mohd Mustafah N, Jamil N, Manaf H. Postural control and gait performance in the diabetic peripheral neuropathy: a systematic review. Biomed Res Int. 2016;2016.
8. Kraiwong R, Vongsirinavarat M, Hiengkaew V, von Heideken Wågert P. Effect of sensory impairment on balance performance and lower limb muscle strength in older adults with type 2 diabetes. Ann Rehabil Med. 2019;43(4):497-508.
9. Ahmad I, Hussain E, Singla D, Verma S, Ali K. Balance training in diabetic peripheral neuropathy: a narrative review. JSM Diabetol Manag. 2017;2(1):1002.
10. Song CH, Petrofsky JS, Lee SW, Lee KJ, Yim JE. Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technol Ther. 2011;13(8):803-811.
11. Ahmad I, Noohu MM, Verma S, Singla D, Hussain ME. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait Posture. 2019;74:114-120.
12. Melese H, Alamer A, Temesgen MH, Kahsay G. Effectiveness of exercise therapy on gait function in diabetic peripheral neuropathy patients: a systematic review of randomized controlled trials. Diabetes Metab Syndr Obes. 2020;13:2753-2764.
13. Ahmad I, Verma S, Noohu MM, Shareef MY, Hussain ME. Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial. J Musculoskelet Neuronal Interact. 2020;20(2):234-248.
14. Hewston P, Deshpande N. Falls and balance impairments in older adults with type 2 diabetes: thinking beyond diabetic peripheral neuropathy. Can J Diabetes. 2016;40(1):6-9.
15. Ferlinc A, Fabiani E, Velnar T, Gradisnik L. The importance and role of proprioception in the elderly: a short review. Mater Sociomed. 2019;31(3):219.
16. Lu Y, Xing P, Cai X, Luo D, Li R, Lloyd C, et al. Prevalence and risk factors for diabetic peripheral neuropathy in type 2 diabetic patients from 14 countries: estimates of the INTERPRET-DD study. Front Public Health. 2020;8:534372.
17. Nozawa K, Ikeda M, Kikuchi S. Association between HbA1c levels and diabetic peripheral neuropathy: a case-control study of patients with type 2 diabetes using claims data. Diabetes Ther. 2022;9(3):403-414.
18. Pai YW, Tang CL, Lin CH, Lin SY, Lee IT, Chang MH. Glycaemic control for painful diabetic peripheral neuropathy is more than fasting plasma glucose and glycated haemoglobin. Diabetes Metab. 2021;47(1):101158.
19. Salsabili H, Bahrpeyma F, Esteki A. The effects of task-oriented motor training on gait characteristics of patients with type 2 diabetes neuropathy. J Diabetes Metab Disord. 2015;15:1-10.
20. Gandhi M, Fargo E, Prasad-Reddy L, Mahoney KM, Isaacs D. Diabetes: how to manage diabetic peripheral neuropathy. Drugs Context. 2022;11.
21. McMorrow R, Nube VL, Manski-Nankervis JA. Preventing diabetes-related foot ulcers through early detection of peripheral neuropathy. Aust J Gen Pract. 2022;51(11):833-838.
22. Khdour MR. Treatment of diabetic peripheral neuropathy: a review. J Pharm Pharmacol. 2020;72(7):863-872.
23. Win MMTM, Fukai K, Nyunt HH, Hyodo Y, Linn KZ. Prevalence of peripheral neuropathy and its impact on activities of daily living in people with type 2 diabetes mellitus. Nurs Health Sci. 2019;21(4):445-453.
24. Zhao P, Ding C, Fu X, Zhang Y, Gu J, Hu J, et al. Ultrasound exploration of muscle characteristic changes and diabetic peripheral neuropathy in diabetic patients. J Clin Ultrasound. 2022;50(9):1403-1411.
25. Tummanapalli SS, Issar T, Kwai N, Pisarcikova J, Poynten AM, Krishnan AV, et al. A comparative study on the diagnostic utility of corneal confocal microscopy and tear neuromediator levels in diabetic peripheral neuropathy. Clin Exp Res. 2020;45(8):921-930.