THE EFFECTIVENESS OF NEURODYNAMIC TECHNIQUES FOR UPPER LIMB IN PATIENT WITH DIABETIC MELLITUS HAVING PERIPHERAL NEUROPATHY

M.A. Ali¹, W. Perveen¹, I. Amin², S. Anwar³, A. Akhtar¹, R. Hayat¹

Background: Diabetes is a group of metabolic diseases characterized by hyperglycemia. Diabetic peripheral neuropathy (DPN) is common complication of type II diabetes mellitus. Diabetic neuropathies can present in a variety of sensory problems like numbness, pins and needle like sensation and touch hypoesthesia. Pain is one of the most common symptoms.

Purpose: To find out the effectiveness of neurodynamic exercises in patients with diabetic mellitus having peripheral neuropathy in upper limbs.

Methods: It was a quasi-experimental study. Online Goggle Calculator was used to find out the sample size. Confidence interval was 95% and 0.5 % was margin of error. Total 40 patients were selected in this study. Data was collected from Allama Iqbal memorial Teaching Hospital Sialkot after ethical approval of the proposal. Patients with history of type II diabetes, age above 40 years and with symptoms of peripheral neuropathy of both genders were included. Patients with history of injury or surgery of shoulder joint, adhesive capsulitis, altered mental status and those who refused to participate in the study were excluded. Consecutive sampling technique was used. A neuropathic pain questionnaire Douleur neuropathic (DN 4) was used to collect the data. Pretest and posttest value of peripheral neuropathy pain was calculated. Neurodynamic Tension techniques were applied for 10 second with 2 second rest and 10 repetitions were given in each session with traditional therapy consisted of transcutaneous electrical nerve stimulation (TENS) for 20 minutes. Radial, Ulnar and Median nerves were targeted. Treatment was applied 2-3 sessions per week for 4 weeks.  Paired sample T test was used to compare the pretest and posttest values.

Results: The mean age of the patients was 51.22 + SD 6.712. Before treatment the mean of painful cold was 1.54+.505 and after treatment the mean value of painful cold was 1.18+.389. The pretest mean value of burning sensation was found 1.78+.423 and after applying the neurodynamics exercises the posttest value was decreased to 1.15+362. Pretest Numbness was 1.79+.409 and posttest value was reduced to 1.10+.309. Before the neurodynamic exercises the mean value of pins and needle was 1.72+.452 and after the treatment value was decreased to 1.12+.335. 60% patient had touch hypoesthesia and 40% had not touch hypoesthesia. The pretest value of touch hypoesthesia was 1.62+.493 and posttest was1.15+.366.  Tingling sensation were also present in those patients and their value before treatment was 1.45+.504 and after the treatment the value was reduced to 1.12+.335. The mean value of total pretest was 6.42+1.152 and the mean of total posttest value was 3.68+1.095. P value was (0.00) which was significant value.

Conclusion(s): Neurodynamic exercises were effective in type II diabetic peripheral neuropathy. And can reduce the diabetes associated peripheral neuropathy in upper limb.

Implications: This was a small study at single Centre; future researches may be conducted with larger sample size and multi Centers to generalize the results.

Funding, acknowledgements: No funding was obtained from any source.

Keywords: Neurodynamic techniques, Diabetic peripheral neuropathy (DPN), neuropathic pain.

Topic: Musculoskeletal

Did this work require ethics approval? Yes

Institution: Sialkot College of Physsical Therapy

Committee: SCPT-IRB

Ethics number: SCPT-IRB/2018/410