Adding tibial nerve neurodynamic techniques to a rehabilitative pain management strategy improved neuropathy severity and quality of life in patients with diabetic peripheral neuropathy: a randomized sham-controlled trial.

BACKGROUND

Diabetic Peripheral Neuropathy (DPN), affects 30% of type 2 diabetics, leading to severe foot problems. Existing treatments offer limited efficacy. This randomized controlled trial explores Neurodynamic Techniques (NDTs) for their impact on neuropathy severity, quality of life (QoL), nerve function, range of motion (ROM), and nerve mechanosensitivity in DPN patients.

METHODS

Forty DPN patients, confirmed by electrodiagnostic and laboratory tests, were randomized into real and sham tibial NDT groups. Both groups received a basic complementary treatment plus their respective NDTs. Outcome measurements included Michigan Diabetic Neuropathy Score (MDNS), QoL, tibial nerve conduction velocity, distal latency, amplitude of compound muscle action potential, F-wave latency, plantarflexion straight leg raise (PFSLR) ROM and dorsiflexion SLR (DFSLR) ROM tested to the first onset of symptoms (P1) and maximally tolerated symptoms (P2), and nerve mechanosensitivity.

RESULTS

MDNS demonstrated a significant improvement, with a mean difference (MD) of -4.60, indicating a large effect size (Cohen's d: -0.93) and surpassing the minimal clinically important difference (MCID) of 2.48, with a P-value of 0.001. QoL improved significantly (MD: -13.25, Cohen's d: -0.73, MCID: 9.00, P-value: 0.006). Nerve conduction parameters remained unchanged. Small to medium effects were observed in PFSLRP1 ROM for both limbs (right limb MD: 3.35, Cohen's d: 0.38, MCID: 4.42, P-value: 0.05; left limb MD: 4.40, Cohen's d: 0.56, MCID: 3.88, P-value: 0.06), and both limbs' PFSLRP2 ROM (right limb MD: 2.10, Cohen's d: 0.21, MCID: 4.80, P-value: 0.07; left limb MD: 4.80, Cohen's d: 0.57, MCID: 4.17, P-value: 0.05). Left DFSLRP1 ROM also improved (MD: 2.35, Cohen's d: 0.29, MCID: 4.07, P-value: 0.04). Left tibial mechanosensitivity to P1 improved significantly (MD: 2.05, Cohen's d: 0.64, MCID: 1.57, P-value: 0.04). Other DFSLR ROM outcomes and other mechanosensitivity outcomes remained unchanged throughout this trial.

CONCLUSIONS

While NDTs did not enhance nerve conduction parameters, they significantly reduced neuropathy severity and improved QoL and PFSLR ROM in individuals with DPN.

TRIAL REGISTRATION: This study has been pre-registered at https://www.irct.ir/ , (registration number: IRCT20220401054379N1) on October 13, 2022.