Diabetes Complications
Conditions
Brief summary
This study aims to compare the effectiveness of Isometric Strengthening Exercises versus Transcutaneous Electrical Nerve Stimulation in the management of shoulder pain among individuals with diabetes mellitus.
Detailed description
Shoulder pain is a prevalent musculoskeletal issue in individuals with diabetes, linked to chronic hyperglycemia and altered collagen structure, leading to mobility restrictions and impaired quality of life. Despite its commonality, there is limited research on specific physiotherapy interventions, particularly isometric strengthening exercises and transcutaneous electrical nerve stimulation. Investigating these interventions is crucial due to the unique pain thresholds and healing issues in diabetic patients. This study aims to provide evidence on how isometric exercises and Transcutaneous Electrical Nerve Stimulation influence pain modulation and functional recovery, potentially optimizing rehabilitation strategies. The findings could support non-pharmacological treatments, reduce reliance on analgesics, and improve patient outcomes in managing shoulder pain in diabetic populations.
Interventions
OTHERIsometric exercise
Isometric shoulder exercises include flexion, extension, abduction, internal and external rotation. The protocol involves holding each position for 10 seconds, resting for 5 seconds, and performing 10 repetitions in 3 sessions per week over 6 weeks. Each exercise begins from a standing position with the elbow bent at 90 degrees and a towel used for support against a wall or door frame, ensuring minimal movement and maintaining good posture throughout.
OTHERTranscutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation Application Parameters: * Frequency: 80-100 Hertz * Pulse duration: 100-150 microseconds * Duration: 30 minutes * 3 sessions/week for 6 weeks Electrodes placed over the anterior and posterior shoulder.
1. Ultrasound Therapy: Administered at 3 MHz and 1.4 W/cm² for 5 minutes to improve shoulder tissue extensibility and blood circulation before exercises. 2. Codman's Pendular Exercises: Gentle passive mobilization of the glenohumeral joint is performed by allowing the affected arm to hang, aiming to reduce stiffness and pain. 3. Range of motion Exercises: Conducted within a pain-free range, progressively increasing intensity to encourage compliance. 4. Finger Ladder Exercise: Active-assisted technique for shoulder elevation, involving walking fingers up a wall. 5. Shoulder Joint Stretching Exercises: Targeting capsular tightness to improve flexibility and range of motion. Each exercise is performed in three sets of five repetitions, at least twice daily.
Sponsors
Kafrelsheikh University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
40 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age between 40-65 years, diagnosed as type 2 diabetes mellitus for at least 5 years * Clinical diagnosis of unilateral frozen shoulder in the painful or stiff stage. * Limitation of passive and active range of motion in external rotation, abduction, and flexion. * Shoulder pain for at least 3 months.
Exclusion criteria
* Previous shoulder surgery or fracture. * Cervical radiculopathy or neurological disorders. * Rheumatoid arthritis or severe osteoarthritis. * Cardiac pacemaker. * Received corticosteroid injection within the last 3 months. * diabetes mellitus type 1 * Participants with Vitamin B12 or D deficiency * Osteoarthritis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of shoulder range of motion | At baseline and after 6 weeks | Shoulder range of motion (ROM) for flexion, abduction, and external rotation was measured using an electrogoniometer. Participants were positioned according to standardized measurement procedures, and each movement was assessed within the participant's pain-free range. Three consecutive measurements were obtained for each motion, and the average value was recorded in degrees (°) for statistical analysis to improve measurement reliability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| assessment of pain intensity | At baseline and after 6 weeks | In visual analogue scale assessment, patients were asked to place a vertical mark along a horizontal line to indicate their current degree of pain at rest and during activity, where 0 indicated 'no pain' and 100 indicated 'worst pain'. |
| assessment of activity of daily living of the upper limb | At baseline and after 6 weeks | The Disabilities of the Arm, Shoulder, and Hand questionnaire is an outcome measure designed to evaluate upper extremity functionality in daily activities, applicable to various musculoskeletal pathologies. Comprising 30 items, it measures disability and symptoms by assessing difficulties faced in physical, social, and work-related tasks, as well as their effects on sleep and self-perception regarding upper extremity issues. Patients respond using a five-point Likert scale, with scores from 1 (no difficulty) to 5 (unable to perform activity). The Disabilities of the Arm, Shoulder, and Hand questionnaire score ranges from 0 (no disability) to 100 (severest disability), and a score cannot be computed if more than three items are missing. |
Countries
Egypt
Contacts
CONTACTTairq Eisi Hedaiban Alharbi, physical therapist
Outcome results
None listed