M. Goyal1, A.J. Samuel2, A. Mittal3
1Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India, 2Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Neurosciences and Pediatric Neurology, Ambala, India, 3Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Radiodiagnosis & Imaging, Ambala, India
Background: Physical exercises and electrotherapy has been used as conservative non – pharmacological interventions in the management of painful chronic distal symmetric lower extremity sensorimotor diabetic peripheral neuropathy (DPN) in Type 2 diabetes mellitus (T2DM) patients. The evidence gathered from the systematic reviews of either exercise (aerobic, resistance, or combination of both, balance exercises) or electrotherapy interventions remains inconclusive and limited.
Purpose: The purpose of the review was to systematically and quantitatively synthesize the literature on the effectiveness of physiotherapy interventions on pain, quality of life, and nerve conduction velocity in patients with diabetic peripheral neuropathy (DPN).
Methods: PubMed, Scopus, and PEDro databases were searched using relevant search terms and Boolean operators to screen the studies' eligibility up to March 2020 from the inception. Following the PRISMA guidelines for reporting systematic reviews, full-text articles were included. The systematic review protocol was registered in PROSPERO 2020 CRD42020175926 on 28th April 2020. Two authors independently performed data extraction quality assessment using PEDro. Meta-analysis was done using the RevMan ver. 5.3 software. Higgins I2 and Chi-square (Tau2) statistical tests were used to assess heterogeneity.
Results: Total ten randomized controlled trial studies were included in the review; a meta-analysis of nine studies was done. Combination therapy (exercises and electrotherapy) proved to be more effective than control in improving the pain (ORs 0.59; 95% confidence interval [95%CI], 0.10 to 3.51; P=0.56; I2 = 20%). Exercise therapy was not significantly effective as compared to the control group in improving nerve conduction velocity and quality of life (ORs 1.21; 95% confidence interval [95% CI], .55 to 2.66; P=0.63; I2=11%). The overall treatment effect of electrotherapy was not statistically different as compared to control (ORs 0.80; 95% confidence interval [95%CI], 0.27 to 2.42; P=0.70; I2 =54%) on pain and quality of life (P=0.90).
Conclusion(s): This meta-analysis proved the effectiveness of the combination of exercise therapy and electrotherapy to improve the pain significantly in the DPN patients as compared to control in T2DM induced DPN patients. The results of randomized trials are not significantly different in terms of interventions (exercise therapy and electrotherapy) on nerve conduction and quality of life.
Implications: Further clinical trials are needed to explore the benefit of physiotherapy interventions on these outcomes, due to observed heterogeneity among the included studies.
Funding, acknowledgements: None
Keywords: Diabetic peripheral neuropathy, Diabetes mellitus, Quality of life
Topic: Neurology
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: is a systematic or narrative review
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