Effects of multi-segmental therapeutic exercises on gait spatiotemporal parameters and lower-limb kinematics in individuals with diabetic peripheral neuropathy: A randomized clinical trial protocol.

BACKGROUND

Diabetic peripheral neuropathy (DPN) impairs gait and increases fall risk. Current exercise programs mainly target distal segments, potentially neglecting proximal contributions to locomotor control.

OBJECTIVE

To compare the effects of a multi-segmental therapeutic exercise program versus an ankle-foot focused program on gait biomechanics in individuals with DPN.

DESIGN

Assessor-blinded randomized controlled trial.

METHODS

Sixty-four adults with DPN will be randomized to either a multi-segmental group (trunk, hip, knee and ankle exercises) or an ankle-foot group. Both groups will train twice weekly for 12 weeks. The primary outcome will be self-selected gait speed. Secondary outcomes include kinematic gait parameters, step and stride length, lower-limb muscle strength, 30-s sit-to-stand test and the quality of life. Assessments will occur at baseline, post-intervention and 4-week follow-up. Data will be analyzed using linear mixed models according to the intention-to-treat principle.

HYPOTHESIS: The multi-segmental program will produce greater improvements in gait speed and functional performance.

ETHICS: Approved by ethics committee and registered at ClinicalTrials.gov. Expected impact: Findings may support a shift from segmental to kinetic-chain-based rehabilitation in DPN.