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Zacharia S.1, Seeboruth K.2, Roslene H.3, Steciuk D.2
1University of Mauritius, Department of Health Sciences, Moka, Mauritius, 2APSA International, Palladium, Mauritius, 3Mount Carmel College, Bangalore, India
Background: Disappointment is a common feeling among Diabetic Peripheral Neuropathy (DPN) patients, when symptoms do not improve through simple exercises.This study was to investigate simple cost efficient methods to revive sensorimotor functions among chronic diabetic foot patients.
Purpose: The study assessed if a combination of structured aerobic exercises,limb positions and contrast bath could improve microcirculation of superficial tissues, followed by electrical stimulation therapy (EST), could improve sensorimotor nerve functions.
Methods: Patients were already enrolled at a diabetic foot clinic in Mauritius following foot screening. All patients with sensorimotor symptoms over a period of one year were referred for neurorehabilitation at the clinic.Patients were given a
(i) structured home program
(a) any one aerobic exercise of the patients choice
(b) gravity related positional changes of the affected limb (Beugers exercise) and
(c) superficial tissue temperature changes (Contrast bath therapy). As symptoms improved over 2 weeks the stress was increased gradually.
(ii) Structured clinical program involved electrical stimulation therapy (EST) over the nerves of the affected limbs. The sittings for EST was gradually reduced and patients were weaned off EST by the end of 3 months. Primary outcomes were Nottingham assessment of Functional Foot Care (NAFF), Lanss Pain scale,Nottingham Tactile Assessment scale and Performance Oriented Assessment of Gait prior to the therapeutic program,during the program and one year after the program.
Results: 42 patients consented for the study and were randomized to the neurorehabilitation program of which 30 patients met the criterias. Data collected was analysed using SPSS software (v.20).
Pearsons correlation coefficient between patients age and possible relationship with their individual NAFF score is found out to be -0.017 and not statistically significant (p >0.05) . Wilcoxon signed-rank test was performed to determine whether the patients pain level changed after the treatment program over a period of 3 weeks , 2 months and 3 months. The test shows that the treatment program does elicit a statistically significant change in neuropathic pain in patients with existing pain (p 0.05). Friedman test was performed to determine whether there was any improvement in sensory functions with exercises for microcirculation in the diabetic foot over a period of 1 year. The test showed there was significant improvement in sensory functions after 1 year of treatment. Wilcoxon signed-rank test was performed to determine whether there is a possibility of reviving motor and sensory nerve functions of gait through electric stimulation therapy after 3 months of the program. The test elicited a statistically significant (p 0.05) change in reviving the motor and sensory nerve functions with better functional mobility compared to the pretreatment program.Patients with varicose veins required to strictly use pressure stockinette´s to avoid engourgement as circulation improved with exercises.This program also proved to be cost effective.
Conclusion(s): Therefore a customized and structured neurorehabilitation program, if used with caution, can be easy and cost-effective to carry out in the community especially among patients of low income group.
Implications: It was also noted that symptoms re-appeared if aerobic exercises were not continued regularly following 3 month therapeutic program.
Funding acknowledgements: APSA is a funded non profit organisation that supports research.
Topic: Disability & rehabilitation
Ethics approval: Committee formed at APSA International Foot care clinic approved the study.
All authors, affiliations and abstracts have been published as submitted.
