Diabetic Peripheral Neuropathy
Conditions
Keywords
Feldenkrais, Task Oriented Gait Training, Balance, Proprioception, Neuropathy
Brief summary
Diabetic Peripheral Neuropathy (DPN) causes balance problems, falls, and sensory loss in the feet. This study compares two non-drug exercise programs to see which works better. The first program is Feldenkrais exercises, which focus on movement awareness and retraining the brain. The second program is Task Oriented Gait Training, which practices specific walking tasks. Researchers will measure balance, joint position sense, touch sensation, fear of falling, and quality of life. Forty participants will be split into two groups. The study will last 12 weeks.
Detailed description
This study is a single-blinded, randomized clinical trial. Forty participants with Diabetic Peripheral Neuropathy (DPN) will be recruited from Shahid Heera's Health Clinic and Madinah Teaching Hospital in Faisalabad. Participants will be screened using the Michigan Neuropathy Screening Instrument (MNSI). Inclusion criteria include participants aged 45-55 years with type 1 or type 2 diabetes, a history of at least one fall in the past six months, a body mass index between 18.5 and 29.9, controlled blood glucose levels, and a Berg Balance Scale score between 21 and 40. Participants will be excluded if they have foot ulcers, lower leg amputation, Charcot foot, retinopathy, hypertension, or are already receiving rehabilitation. Eligible participants will be randomly allocated into two groups of twenty using a computer-generated method. Group A will receive Feldenkrais exercises. Group B will receive Task Oriented Gait Training. Both groups will attend two sessions per week for twelve weeks. Each session lasts sixty minutes, consisting of a ten-minute warm-up, a forty-to-forty-five-minute main exercise session, and a ten-minute cool-down. Outcome measures will be recorded at baseline, the sixth week, and the twelfth week. The primary outcome measures are static and dynamic balance (Berg Balance Scale), ankle joint proprioception (joint position sense test), and tactile sensation (monofilament test). The secondary outcome measures are somatosensory postural control (Cumulative Somatosensory Impairment Index), fear of falling (Fall Efficacy Scale), self-awareness learning (educational brochure), and quality of life (SF-36 Questionnaire). SPSS version 20 will be used for statistical analysis.
Interventions
This intervention includes 16 specific movement lessons (e.g., turning improvement, weight transference, sensing the feet, walking in tandem). The protocol is derived from Mazuelas et al. 2024. Sessions are 40 minutes, twice a week for 12 weeks, guided by a physiotherapist.
OTHERTask Oriented Gait Training
This intervention includes functional tasks such as walking with reduced base of support, obstacle crossing, and ramp walking. The protocol is derived from Salsabili et al. 2015. Sessions are 45 minutes, twice a week for 12 weeks.
OTHERbaseline warm up and cool down Exercises
Warm up exercises: Warm up exercises before the start of training exercises for about ten minutes. These include: • Leg swings (forward and backward) • Side to side leg swings • Leg kicks 20 reps/side • Standing on tip toes • Mild stretching Cool down exercises: Cool Down exercises after the end of training exercises for about ten minutes to induce relaxation. These include: • Deep breathing exercise • Abdominal breathing exercise • Leg swings • Standing on tip toes • Mild stretching
Sponsors
University of Faisalabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
45 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Age ranges from 45-55 years * Diagnosed type 1 and type 2 diabetes * Suffered from a fall in last 6 months * MNSI Questionnaire scored \> 2/13 * MNSI physical assessment scored \> 4/10 * BMI = 18.5 - 29.9 * Controlled blood glucose level * Berg Balance scale = 21-40 * Willingness to participate and provide consent
Exclusion criteria
* Presence of ulcers at foot * Lower leg amputation * Charcot foot * Retinopathy * Hypertension * Already receiving rehabilitation * History of trauma or fracture * Any related orthopedic conditions * CVS related conditions * Autonomic neuropathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Berg Balance Scale Score | Baseline, Week 6, Week 12 | The Berg Balance Scale (BBS) measures static and dynamic balance. It contains 14 items scored from 0 to 4. Total score ranges from 0 to 56. Higher scores indicate better balance. |
| Change in Ankle Joint Proprioception | Baseline, Week 6, Week 12 | Measured using the Joint Position Sense Test (JPST) with a goniometer. The participant actively reproduces a target joint angle. The difference in degrees between the target and the reproduction is recorded. Smaller differences indicate better proprioception. |
| Change in Tactile Sensation | Baseline, Week 6, Week 12 | Measured using the Semmes-Weinstein Monofilament (10g). The filament is applied to 10 sites on the plantar surface of the foot. The number of correctly detected applications out of 10 is recorded. Higher scores indicate better sensation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Cumulative Somatosensory Impairment Index (CSII) | Baseline, Week 6, Week 12 | Measures somatosensory postural control and functional awareness. Scale range and specific scoring will be calculated per the CSII manual. |
| Change in Fear of Falling | Baseline, Week 6, Week 12 | Measured using the Fall Efficacy Scale (FES). Participants rate confidence in performing 10 activities without falling. Scores range from 10 (high confidence) to 100 (low confidence). |
| Change in Quality of Life | Baseline, Week 6, Week 12 | Measured using the SF-36 Questionnaire. This tool assesses physical and mental health across 8 domains. Scores are transformed into a scale from 0 to 100. Higher scores indicate better quality of life. |
| Self-Awareness Learning Adherence | Week 12 | Measured by the return of a structured educational brochure checklist. Participants report if they performed prescribed home self-learning activities. |
Countries
Pakistan
Outcome results
None listed