Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial

J Manipulative Physiol Ther. 2014 May;37(4):242-52. doi: 10.1016/j.jmpt.2013.09.007. Epub 2014 Mar 20.

Abstract

Objective: The purpose of this study was to evaluate the effectiveness of the application of analyzing treadmill, muscle strengthening, and balance training compared with a standard care intervention in patients with diabetic neuropathy.

Methods: Twenty-seven patients, 63% female (mean ± standard deviations age, 72 ±9 years), with diabetic neuropathy randomly assigned to receive a multimodal manual treatment approach including analyzing treadmill with feedback focused, isokinetic dynamometric muscle strengthening, and balance retraining on dynamic balance platform or a standard care intervention for activities targeted to improve endurance, manual exercises of muscle strengthening, stretching exercises, gait, and balance exercises (5 weekly over 4 weeks). This study was designed as a double-blind, randomized clinical trial. Measures were assessed at pretreatment, 4 weeks posttreatment, and 2-month follow-up.

Results: No important baseline differences were observed between groups. At the end of the treatment period, the experimental group showed a significant increase in gait endurance in a 6-minute walk test, 65.6 m (F[2.0] = 9.636; P = .001). In addition, the 6-minute walk test increased after the intervention, and an even greater difference was found at follow-up (P = .005) for the standard care group. The Functional Independence Measure in both groups increased (P < .01) and continued until the follow-up in the standard care group (P = .003).

Conclusions: The results suggest that the experimental rehabilitation program showed positive effects on the gait endurance after 4 weeks of treatment, whereas it did not produce significant improvements of the gait speed. Both the treatments produced significant improvement of functionalities of the patient.

Keywords: Gait Disorders; Muscle Strength; Neuropathy; Walking.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diabetic Neuropathies / physiopathology
  • Diabetic Neuropathies / rehabilitation*
  • Disability Evaluation
  • Double-Blind Method
  • Exercise / physiology
  • Exercise Test
  • Feedback
  • Female
  • Gait Disorders, Neurologic / rehabilitation
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength / physiology
  • Muscle Strength Dynamometer
  • Physical Endurance / physiology
  • Physical Therapy Modalities*
  • Postural Balance / physiology