Effects of Computer-based Balance Exercises on Balance, Pain, Clinical Presentation and Nerve Function in Patients With Diabetic Peripheral Neuropathy: A Randomized Controlled Study

Abstract

Objective: To evaluate the use of a computer-based biodex balance exercise system (BBS) on balance, neuropathic pain, clinical presentation and nerve function in patients with diabetic peripheral neuropathy (DPN).

Methods: A total of 32 participants with DPN were randomly assigned in a 1:1 ratio to an intervention group (IG) or control group (CG). The IG performed exercises using the BBS twice weekly for 8 weeks, while CG were informed regarding diabetes self-management. At baseline and after study completion, participants underwent balance (postural stability and fall risk) and neuropathic pain assessment (DN4 questionnaire) and were screened using the Michigan Neuropathy Screening Instrument and nerve conduction test.

Results: Among the baseline participants, 14 in the IG and 13 in the CG completed the study. Balance training improved postural stability (overall, p<0.001), fall risk (p<0.001), neuropathic pain (p=0.01) and symptoms (p<0.001), and clinical presentation (p=0.02), but not nerve function, within the IG. At follow-up, IG displayed significantly improved stability (p<0.001) and fall risk (p=0.02) and decreased neuropathic symptoms (p=0.01) compared to the CG.

Conclusion: Computer-based balance exercises improve balance, pain, and clinical presentation of DPN, but not nerve function, in patients with DPN.

Clinicaltrials: gov ID: NCT05255497.

Keywords: Balance; Diabetes Complications; Diabetic Neuropathy; Exercise; Nerve Conduction Test.

Figure 1

Study Flow Diagram. Study participation and loss to follow-up or discontinued intervention. DPN denotes diabetic peripheral neuropathy.

Figure 2

Biodex Balance System exercise protocol. A) Intervention group (IG) and control group participants underwent balance, neuropathic pain (Douleur Neuropathique 4, DN4), clinical presentation (Michigan Neuropathy Screening Instrument, MNSI), and nerve function (nerve conduction test, NCT) assessments and examinations prior to start of intervention. Participants in the IG performed exercises using the computerized Biodex Balance System (BBS) twice a week for 8 weeks. Participants in the CG received education regarding diabetes self-management. After 8 weeks of intervention, participants were again assessed and examined for balance, neuropathic pain, clinical presentation, and nerve function. B) Postural stability was the first training and asked participants keep the cursor at the midpoint at that time, in second exercise requested from participants to turn the target randomly illuminated. Participants stayed in while the ring moving on the screen random training as third, and participants followed circularly located targets at the last.