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A novel proprioceptive rehabilitation program: a pilot randomized controlled trail as an approach to address proprioceptive deficits in patients with diabetic polyneuropathy
Malwanage KT, Liyanage E, Weerasinghe V, Antonypillai C, Nanayakkara I
PLoS ONE 2024 Jul;19(7):e0305055
clinical trial
9/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Diabetic polyneuropathy (DPN) is a notable microvascular complication of DM, affecting 16% to 66% globally. DPN often leads to proprioceptive deficits in the lower limbs (LL), leading to impaired functional performance. However, evidence supporting proprioceptive rehabilitation programs (PRP) for DPN remains scarce. AIMS: This pilot study aims to evaluate the effectiveness of a novel 12-week PRP on LL static and dynamic proprioception and shed light on the potential benefits of PRP for DPN population. METHODS: Randomized Controlled Trail was conducted among 30 DPN patients (age 53.25 +/- 7.72 years, BMI 24.01 +/- 1.41 and DM duration 9.48 +/- 6.45 years), randomly allocated to intervention (n = 15) or control (n = 15) groups. The intervention group received PRP 3 times/week for 12 weeks. The control group received no exercise. Both groups received regular diabetic care. Static and dynamic proprioception of both LL were assessed at baseline, 6 weeks and 12 weeks. Position-reposition test was used to assess ankle joint position sense by obtaining difference between target and reproduced angles. Error in detecting knee angle and speed were obtained by performing Lower Limb Matching and Sense of Movement tests respectively to assess dynamic proprioception. RESULTS: Two-way ANOVA and paired comparisons revealed, no significant improvement in proprioceptive deficits at 6 weeks (p > 0.05), but significant improvement was achieved at 12-weeks (p < 0.05) in the intervention group. Mean errors in P position re-position (R: p < 0.001, L: p < 0.001) and lower limb matching (R: p < 0.001, L: p < 0.001) tests reduced by 5 degrees and 10 degrees respectively, indicating a 70% improvement in the intervention group. Error of detecting speed reduced only on right side by 0.041 ms accounting for a 42% improvement. No improvements were observed in the control group. CONCLUSIONS: Novel 12-week PRP may yield a significant reduction in LL proprioceptive deficits among DPN patients. Future RCTs with larger samples should compare the effectiveness of this PRP compared with conventional rehabilitation programs.

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