Effects of thai foot massage on balance performance in diabetic patients with peripheral neuropathy: a randomized parallel-controlled trial

From inflammatory signaling to neuronal damage: Exploring NLR inflammasomes in ageing neurological disorders

The persistence of neuronal degeneration and damage is a major obstacle in ageing medicine. Nucleotide-binding oligomerization domain (NOD)-like receptors detect environmental stressors and trigger the maturation and secretion of pro-inflammatory cytokines that can cause neuronal damage and accelerate cell death. NLR (NOD-like receptors) inflammasomes are protein complexes that contain NOD-like receptors. Studying the role of NLR inflammasomes in ageing-related neurological disorders can provide valuable insights into the mechanisms of neurodegeneration. This includes investigating their activation of inflammasomes, transcription, and capacity to promote or inhibit inflammatory signaling, as well as exploring strategies to regulate NLR inflammasomes levels. This review summarizes the use of NLR inflammasomes in guiding neuronal degeneration and injury during the ageing process, covering several neurological disorders such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, stroke, and peripheral neuropathies. To improve the quality of life and slow the progression of neurological damage, NLR-based treatment strategies, including inhibitor-related therapies and physical therapy, are presented. Additionally, important connections between age-related neurological disorders and NLR inflammasomes are highlighted to guide future research and facilitate the development of new treatment options.

Effects of exercise using a modified elastic band with a coconut shell on muscle strength and balance in community-dwelling older adults

[Purpose] To investigate the effects of exercise using a modified elastic band with a coconut shell on leg muscle strength and balance in older adults. [Participants and Methods] The study consisted of 30 participants aged 60 years and older. The participants were randomly assigned to either the exercise (n=15) or control groups (n=15). The exercise group used a modified elastic band with a coconut shell three days a week for four weeks. Both groups received a single educational session on fall prevention after a baseline assessment. The Functional Reach Test (FRT) and Timed Up and Go Test (TUG) were used to assess balance, respectively. The 30-second chair stand test (30CST) was also used to measure leg strength. All outcome parameters were measured at the beginning of the study, immediately after a single exercise session, and after four weeks of exercise. [Results] The FRT and 30CST significantly increased in the exercise group after four weeks of exercise. The TUG significantly decreased in the exercise group after completing the program. [Conclusion] This study demonstrated that exercise using a modified elastic band with a coconut shell could effectively improve leg muscle strength and balance in older adults.

A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET

Introduction

Painful diabetic neuropathy (PDN) is a leading cause of pain and disability globally with a lack of consensus on the appropriate treatment of those suffering from this condition. Recent advancements in both pharmacotherapy and interventional approaches have broadened the treatment options for PDN. There exists a need for a comprehensive guideline for the safe and effective treatment of patients suffering from PDN.

Objective

The SWEET Guideline was developed to provide clinicians with the most comprehensive guideline for the safe and appropriate treatment of patients suffering from PDN.

Methods

The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations for PDN. A multidisciplinary group of international experts developed the SWEET guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus to identify and compile the evidence for diabetic neuropathy pain treatments (per section as listed in the manuscript) for the treatment of pain. Manuscripts from 2000-present were included in the search process.

Results

After a comprehensive review and analysis of the available evidence, the ASPN SWEET guideline was able to rate the literature and provide therapy grades for most available treatments for PDN utilizing the United States Preventive Services Task Force criteria.

Conclusion

The ASPN SWEET Guideline represents the most comprehensive review of the available treatments for PDN and their appropriate and safe utilization.

Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson's disease: a randomized non-inferiority trial

Background

ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in falls and reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used to compensate for proprioceptive impairment, increased visual reliance may be affected by disease progression. Emerging evidence suggests that modulation of peripheral sensory processing may alleviate ON-FOG, and therapeutic Thai acupressure (TTA) may be a solution. This study aims to evaluate the effect of TTA in alleviating ON-FOG and compare its effectiveness to LC in patients with PD.

Methods

This open-label, non-inferiority trial randomized 90 PD patients with ON-FOG equally into three arms: TTA for plantar nerve stimulation for 96 s, LC for visual cueing, and sham control (SC). Stride length was the primary non-inferiority endpoint [non-inferiority margin: lower limit of 95% confidence interval (CI) above -10 cm in mean change difference in pre- and immediately post-intervention in TTA versus LC (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up and go (TUG) test, and visual analog scale (VAS) score.

Results

TTA showed non-inferiority to LC in stride length (mean = -0.7 cm; 95% CI: -6.55; 5.15) (one-sided). The improvements with TTA and LC versus SC were comparable between (mean = 13.11 cm; 95% CI: 7.26; 18.96) and (mean = 13.8 cm; 95% CI: 7.96; 19.65) (one-sided). Secondary outcomes favored TTA and LC over SC with improved FOG, velocity, step length, and VAS scores, while only TTA resulted in improved double support time, cadence, and TUG test results. No complications occurred.

Conclusion

The efficacy of TTA, which improves stride length, is non-inferior to that of LC and consequently alleviates FOG comparable to LC. TTA might enhance proprioceptive function and reduce visual dependence. Therefore, TTA, characterized by its non-invasive, simple, and safe techniques, is a potential non-pharmacological alternative for ON-FOG treatment and might enhance overall quality of life. However, further research into the mechanism, efficacy, and utilization of TTA is essential.

Clinical trial registration

https://www.thaiclinicaltrials.org/show/TCTR20200317001, identifier TCTR20200317001.

Feasibility of therapeutic Chinese massage (tui na) for peripheral neuropathy among people with human immunodeficiency virus: findings of a pilot randomized controlled trial

Background

Peripheral neuropathy (PN) is prevalent in people with human immunodeficiency virus (PHIV) with no Food and Drug Administration-approved treatment. Therapeutic Chinese massage (TCM) is a promising noninvasive and non-harmful intervention for HIV-related PN. However, relevant research is lacking. The purpose of this study is to evaluate the feasibility of TCM for HIV-related PN.

Method

We conducted a pilot, single-centered, two-arm, double-blinded, randomized controlled trial. Twenty eligible PHIV were recruited primarily from the AIDS Foundation Houston, Inc. in Texas and were randomly assigned into two groups. Ten participants in the intervention group received three weekly 25-min TCM sessions by a certified TCM therapist. The remaining ten control group participants received the same therapist's three weekly 25-min placebo massage sessions on their lower extremities. The outcome was the feasibility of this study as measured by recruitment and completion rates, participant safety, and treatment adherence and compliance, as well as the effect size of the intervention.

Results

The study population comprised 20 PHIV (mean age 55.23). This study showed high feasibility as measured by a high rate of recruitment, a 100% rate of completion, and zero serious adverse events. As we inquired 21 respondents for eligibility for the study, all except one had HIV-related PN. All respondents were willing to participate in the study and adhered to the group assignment after they enrolled in the study. The participants' baseline pain was at a medium to a high level (6.30 [2.15] out of 10).

Conclusion

Chinese massage is a feasible intervention in PHIV. Future relevant randomized controlled trials are expected.

Clinical trial registration

https://clinicaltrials.gov/, NCT05379140.

Tui Na for painful peripheral neuropathy in people with human immunodeficiency virus: A randomized, double-blind, placebo-controlled trial protocol

Background

Peripheral neuropathy (PN), including numbness, loss of sensation, paresthesia, a burning sensation, and stabbing pain in extremities, is a common complication in people with human immunodeficiency virus (PHIV). Medications commonly used to treat HIV-related PN are not effective and lead to many side effects. HIV-related PN symptoms may be alleviated or treated with a series of therapeutic Chinese foot massages (TCFM), which are non-invasive and relatively safe. However, relevant studies are lacking.

Study design

This proposed trial is a prospective, two-arm, parallel, double-blinded, randomized controlled trial.

Aim

This proposed trial aims to assess the effectiveness of TCFM on HIV-related PN in people with HIV (PHIV).

Outcomes

The primary outcomes, measured at baseline, end of TCFM/placebo, and twelve weeks after, include (1), lower extremity pain, (2) lower extremity functioning, and (3) health-related quality of life. The secondary outcomes, measured throughout the trial process, include (1) recruitment and completion rate (No. of referred, No. of eligible, No. of enrolled, No. of withdrawals, trial recruitment rate, and trial completion rate), (2) participants' safety (No. and severity of adverse events), (3) treatment adherence (average time of each message session, No. of completed sessions, and No. of missed sessions), and (4) compliance (No. of participants completing the trial following the initial group assignment).

Sample size

An estimated 142 participants in total, or 71 participants in each arm, will be needed for this trial.

Trial status

This trial was registered at ClinicalTrials.gov of the National Institute of Health on Oct 26, 2022 (ClinicalTrials.gov Identifier: NCT05596123). The researchers expect to recruit participants starting in Feb. 2023 and ending in Feb 2025.

Determination of light pressing pressure for improving foot skin blood flow in type 2 diabetic patients

OBJECTIVE

Traditional Thai massage is one of the alternative treatments for diabetic feet. However, the specific amount of pressing pressure applied to the foot during Thai foot massage is unknown. This study aimed to evaluate the effect of light pressing pressure on foot skin blood flow in type 2 diabetic patients.

METHODES

A single-arm repeated measures was conducted. Forty-three participants were recruited via the subjective examination and screening using the Michigan Neuropathy Screening Instrument. To obtain foot skin blood flow by laser doppler blood flowmetry, a probe was pasted on the 1st distal phalange of the big toe. Light pressure at a single point was applied on the plantar skin fold between the bases of the second and third toes by using the digital algometer. The pressure was applied gently, then increased slightly until the participant started to feel some minor discomfort. Patients were asked to rate their pain intensity using the visual analogue scale.

RESULTS

The average pressing pressure without discomfort was 3.55 ± 1.04 kg/cm². The foot skin blood flow increased significantly immediately after the pressing pressure, and this increase represented about 1.9 times when compared with the baseline (p < 0.001).

CONCLUSION

The application of light pressing pressure could be used as a basic standard criterion for massage to improve the foot skin blood flow in type 2 diabetic patients.

Responsiveness of the Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy

Background

Mini-BESTest is an instrument for assessing the balance impairment; however, the use of the Mini-BESTest in type 2 diabetic patients with peripheral neuropathy is not well documented in the literature. The aim of this study was to examine the responsiveness and the minimal important change (MIC) of the Mini-BESTest after four weeks of the balance exercises.

Methods

A prospective single group pretest-posttest design was applied, and forty-eight type 2 diabetic patients with peripheral neuropathy were participated (mean age of 59.04 ± 7.533 years; 3 males and 45 females). All participants were given an intervention program including foot care and balance exercises (50-minute sessions, three times a week for four weeks). The responsiveness of the Mini-BESTest was determined using two approaches: 1) the distribution-based method evaluating the change scores (pre- and post-intervention), the effect size (ES), the standard response mean (SRM), the standard error of measurement (SEM) and the minimum detectable change (MDC₉₅) and 2) the anchor-based method evaluating the MIC using the Global Rating of Change scale (GRC) as an external criterion.

Results

After the balance exercises treatment, the Mini-BESTest scores significantly improved (p < 0.001) with an ES of 3.9 and SRM of 4.32. SEM was 0.73 and MDC₉₅ was 2.03 points. The area under the receiver operating characteristic (ROC) curve corresponded to 81%. The cutoff point of the Mini-BESTest was ≥5 points corresponding to the GRC ≤3 versus >3 for the discrimination of the Mini-BESTest between improvement and no improvement after exercises.

Conclusion

The Mini-BESTest can be demonstrated as high responsiveness according to the determination of the distribution-based and the anchor-based methods. The MIC of the Mini-BESTest was taken as ≥5 points and could be used as an outcome measure for the discriminated evaluation of type 2 diabetic patients with peripheral neuropathy.

Evidence-Based Treatment of Painful Diabetic Neuropathy: a Systematic Review

PURPOSE OF REVIEW

Painful diabetic neuropathy (PDN) manifests with pain typically in the distal lower extremities and can be challenging to treat. The authors appraised the literature for evidence on conservative, pharmacological, and neuromodulation treatment options for PDN.

RECENT FINDINGS

Intensive glycemic control with insulin in patients with type 1 diabetes may be associated with lower odds of distal symmetric polyneuropathy compared to patients who receive conventional insulin therapy. First-line pharmacologic therapy for PDN includes gabapentinoids (pregabalin and gabapentin) and duloxetine. Additional pharmacologic modalities that are approved by the Food and Drug Administration (FDA) but are considered second-line agents include tapentadol and 8% capsaicin patch, although studies have revealed modest treatment effects from these modalities. There is level I evidence on the use of dorsal column spinal cord stimulation (SCS) for treatment of PDN, delivering either a 10-kHz waveform or tonic waveform. In summary, this review provides an overview of treatment options for PDN. Furthermore, it provides updates on the level of evidence for SCS therapy in cases of PDN refractory to conventional medical therapy.

Reliability and Validity of Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy

Type 2 diabetic peripheral neuropathy is known to cause balance limitations in static, dynamic, and functional activity. The Mini-BESTest, a shortened version of BESTest, was evolved to identify balance disorders within a short duration. No prior studies have yet been conducted to assess the usefulness of Mini-BESTest in the diagnosis of type 2 diabetic peripheral neuropathy. The current study aimed to examine the reliability and discriminant validity by comparing the Mini-BESTest scores between type 2 diabetic patients with peripheral neuropathy, divided into two 2 groups based on reporting scores of <4 and ≥4 in the MNSI questionnaire, respectively. Therefore, a cross-sectional study design was conducted including 44 type 2 diabetic patients (4 males and 40 females; aged 56.61 ± 7.7 years old). Diabetic peripheral neuropathy was diagnosed by physical assessment using the Michigan Neuropathy Screening Instrument (MNSI). Inter-rater (two physiotherapists) and Intra-rater (7−10 days) reliability of the Mini-BESTest were explored with intraclass correlation coefficients (ICC2,1) and (ICC3,1). The Mini-BESTest presented an excellent inter-rater reliability (ICC2,1= 0.95, 95% CI = 0.91−0.97, SEM = 0.61) and an excellent intra-rater reliability (ICC3,1 = 0.93, 95% CI = 0.87−0.96, SEM = 0.66), with confirmation by a good agreement presented by the Bland−Altman plots. The internal consistency measured with the overall Cronbach’s alpha showed an acceptable agreement (0.73). The MDC was 2.16. In addition, the Mini-BESTest scores in the type 2 diabetic neuropathy patients reporting MNSI questionnaire scores <4 was found to be significantly higher when compared with those reporting scores ≥4. The Mini-BESTest can be used as a highly reliable and valid clinical application in the population with type 2 diabetic peripheral neuropathy.

Foot-ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial

This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN.

Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).

The efficacy and safety of massage adjuvant therapy in the treatment of diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The incidence of diabetic peripheral neuropathy (DPN) is increasing year by year. If patients cannot receive timely and effective treatment, DPN may lead to diabetic foot ulcers or even amputation. This risk factor has been widely concerned around the world. Massage, as a non-invasive physical therapy method, is gradually being applied in the adjuvant treatment of DPN. However, there is no systematic review of the adjuvant treatment of DPN by massage. Our study will explore the effectiveness and safety of massage applied in DPN.

METHODS

Eight electronic databases (PubMed, Cochrane, Web of Science, Sinomed, Embase, China National Knowledge Infrastructure, WanFang Data, Chongqing VIP Information) will be searched by our computer on February 9, 2022. A randomized controlled trial (RCT) of adjuvant massage therapy for DPN was screened. Primary outcome measures: efficiency, nerve conduction velocity. Secondary outcome measures: pain, blood glucose, and incidence of adverse reactions. The quality of the study was evaluated by two researchers using the RCT bias risk assessment tool in the Cochrane review manual Handbook5.4, and meta-analysis was performed by RevMan5.4 software.

RESULTS

RCTs will be used to evaluate the clinical efficacy of massage adjuvant therapy in DPN.

CONCLUSION

This study will provide evidence-based evidence for the safety and effectiveness of massage adjuvant therapy in DPN.

PROTOCOL REGISTRATION NUMBER

INPLASY202220025.

The Effectiveness of Massage Therapy on Healing of Diabetic Neuropathy in Diabetes Mellitus Patients

BACKGROUND: Diabetic neuropathy reduces the patient’s quality of life and the quality of diabetes management itself and, as a result, worsens the prognosis of other diabetic complications. Various complaints that are often felt by diabetes mellitus (DM) patients due to neuropathy include pain in the legs, numbness, and weakness in the affected leg, paresthesia, or numbness, and the absence of tendon reflexes in the affected leg. AIM: This study aimed to determine the effectiveness of electric massage therapy on neuropathy healing in DM patients. METHODS: The pre-test and post-test experimental design without a control group was employed. Patients with neuropathy diabetic were recruited as the subject of the study. The total number of participants in the study was 30 people. All the subjects were assessed for neuropathy using the neuropathy assessment instrument and the monofilament test. The Kolmogorov–Smirnov test was employed to analyze the normality of the data. The Wilcoxon signed-rank test was employed for non-normally distributed data. The study used a 95% confidence interval, and significance was assessed at alpha <0.05. RESULTS: Mean difference test resulted that the Z value was −4.791; (p < 0.01). These results indicate that there was a statistically significant difference in the level of neuropathy before and after the massage therapy intervention. CONCLUSIONS: Foot massage therapy has a significant effect in reducing the complaints of diabetic peripheral neuropathy (DPN). It is recommended for the DPN patients to conduct foot massage independently regularly as an alternative treatment in-home care treatment.

Effects of myofascial release of the ankle plantar flexors on static postural balance of young men: A randomized clinical trial

BACKGROUND

Myofascial release (MR) has been widely used in sports and clinical environment. There are studies that have already evaluated the effect of MR on postural control, however, the data found are inconclusive.

OBJECTIVES

Investigate the effect of MR on ankle plantar flexor muscles over static postural balance.

METHOD

Sixty-five young men were randomized allocated into one of three groups: 1) MR group (n = 25, Myofascial Release); 2) Sham (n = 25, fake intervention); or 3) Control group (n = 15). Both MR and Sham techniques were applied during 5 min in the ankle flexors of each leg. The bipodal static postural balance test was performed before and 2 min post each intervention on a force plate with eyes closed during the test. All subjects performed 3 sets of 30-s with 1 min of rest. Mean values to the center of pressure velocity (COPvel) was used for analysis.

RESULTS

The bipodal balance test showed that there was no significant difference between groups (p > 0.05), but there was a significant time effect (p < 0.05). A significant decrease (p < 0.05) in post-test COPvel (cm.s^-1) values (sham 4.9 ± 1.2; MR 4.5 ± 0.6; CON 4.22 ± 0.8) was found when compared to values of pre-test (sham 5.3 ± 1.0; MR 5.0 ± 0.8; CON 4.94 ± 1.3) for all groups.

CONCLUSIONS

The results demonstrated that MR performed on ankle flexors did not affect static postural balance in young man. This study is a clinical trial (Register Number: RBR-48k5jm).

Immediate effects of myofascial release maneuver applied in different lower limb muscle chains on postural sway

BACKGROUND

There is little evidence about the myofascial release maneuver (MLM) targeting the fascial tissue and its effect on postural balance. This study investigated the immediate effects of the MLM in different lower limb muscle chains on the postural sway of healthy men.

METHODS

Sixty-three healthy men (27.2 ± 4.7 years) were randomly assigned to 7 groups (n = 9 each) to receive MLM applied to the lower limb muscle chains (anterior, posterior, medial, lateral, anterior/posterior, and medial/lateral) or placebo intervention. Skin pressure during the 3-min MLM was determined by the visual analog scale between 5 and 7 as previously assessed on participants. Posturography analysis of the elliptical area (Area) and average velocity (Vavg) of the center-of-pressure displacement was performed before and immediately after the MLM in single-leg support and with eyes closed.

RESULTS

A two-way repeated measures analysis of variance showed no interaction effect of factors group and time (Area: p = 0.210, ω² = 0.004; Vavg: p = 0.358, ω² < 0.001). Within-factor main effect of time was observed for both Area (p < 0.001, ω² = 0.038) and Vavg (p < 0.001, ω² = 0.028), with decreased Area and Vavg after all interventions. No between-factor main effect of group was observed for Area or Vavg (MLM or placebo, p = 0.188 or higher).

CONCLUSION

MLM applied to the lower limb muscle chains showed no immediate specific effects on postural sway in healthy men. Pre-post effects of MLM were not different from those elicited by a superficial massage. MLM in lower limb muscle chains is not advocated for an immediate improvement of postural balance in this population.

A Systematic Review and Meta-analysis on Efficacy of Exercise on Posture and Balance in Patients Suffering from Diabetic Neuropathy

BACKGROUND

Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% patients suffering from diabetes. There is the involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability.

OBJECTIVE

The aim of this study is to assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus.

METHODS

Mean changes in Timed Up and Go test (TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on the PEDro Rating scale. The risk of bias was assessed by the Cochrane collaboration tool of risk of bias. Included studies had a low risk of bias. Sixteen RCT's were included for the meta-analysis.

RESULTS

Results of meta-analysis showed that there was a statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I2 = 84%, p < 0.00001) in the experimental group as compared to control group. There was a statistically significant difference in Berg Balance Scale scores and heterogeneity of I2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I2 = 100%, p =0.01 and eyes closed, heteogeneity I2 = 0%, p =0.01). Sensitivity analysis causes a change in heterogeneity.

CONCLUSION

It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training, etc. have a significant effect on improving balance and posture in diabetic neuropathy.

The efficacy of physiotherapy interventions in mitigating the symptoms and complications of diabetic peripheral neuropathy: A systematic review

PURPOSE

Diabetic peripheral neuropathy (DPN) leads to decreased sole sensation and balance disorder, all of which increase the risk of falls and socioeconomic costs. Since the physiotherapists do not use the same manner to lessen the complications of this problem. Therefore, this review study was directed to appraise physiotherapy intervention efficiencies in diminishing DPN's symptoms and complications.

METHOD

A database search of Pubmed, Elsevier, Google Scholar, and Embase was performed to determine DPN's published documents. Finally, studies of DPN and treatments available in this field, particularly physiotherapy that included electrotherapy, exercise therapy, and other therapies, were identified.

RESULT

According to a database search on August 1, 2019, from 1989 to 2019, in the last 30 years, about 968 articles were found, 345 of which were free full text available, and finally, 19 articles were approved. These articles examined the effects of physiotherapy interventions, including exercise therapy, electrotherapy, and other treatment techniques on DPN patients.

CONCLUSIONS

The results showed that most diabetic peripheral neuropathy patients suffer from muscle weakness, pain, loss of balance, and lower limb dysfunction. As a result, their daily activity and Life satisfaction are gradually impaired. Exercise therapy, electrotherapy, and other physiotherapy methods have been used to reduce the mentioned cases. Among these interventions, exercise therapy has been the most effective. Although there was little evidence of aerobic exercise in these patients, further studies should be done on other therapies' effects.

Effect of Acupressure on Dynamic Balance in Elderly Women: A Randomized Controlled Trial

BACKGROUND

Balance disorders are common in the elderly and are a major cause of falls. This study aimed to determine the effect of acupressure on dynamic balance in elderly women.

METHODS

This randomized controlled clinical trial was conducted on 72 elderly women in Qazvin, Iran. The intervention group received rotary massage using the thumb at the pressure points for 4 weeks, 3 times a week for 20 minutes each session. Dynamic balance in both groups was measured before, 2 and 4 weeks after the intervention using timed up and go test and the step test. Data were analyzed using two way repeated measures ANOVA.

RESULTS

The mean age of participants was 67.34 ± 6.30 with a range of 60 to 80 years old. The results showed statistically significant improvement in the dynamic balance quantified by timed up and go test (%Δ = 26.53) and step test for the right (%Δ = 35.22) and left (Δ% = 32.62) legs (p < .001). However, in the control group, no significant change was observed in the dynamic balance after completion of the program.

CONCLUSION

The results support that acupressure therapy can be an effective, safe, and inexpensive method to improve the dynamic balance and maintain maximum autonomy of the elderly.

Immediate Effects of Self-Thai Foot Massage on Skin Blood Flow, Skin Temperature, and Range of Motion of the Foot and Ankle in Type 2 Diabetic Patients

Objectives: The purpose of this study was to investigate the immediate effects of self-Thai foot massages (STFMs) on the foot skin blood flow, the foot skin temperature, and range of motion (ROM) of the foot and ankle in type 2 diabetic patients with peripheral neuropathy. Design: A randomized crossover study. Subjects: Twenty five diabetic patients with peripheral neuropathy were recruited. Interventions: Participants were randomly assigned to either STFM or Thai foot massage (TFM) performed by a massage therapist; then, they were switched to the other group after a 1-week washout period. In both groups, the foot massage was performed in a seated position on the dominant lower leg and foot for 25 min. Outcome measures: Before and immediately after treatment, foot skin blood flow, foot skin temperature, and ROM of the foot and ankle were evaluated. Heart rate was measured throughout the treatment. Results: After a single treatment of the massage, foot skin blood flow and ROM of the foot and ankle significantly improved in both groups (p < 0.05). Foot skin temperature did not change in STFM, whereas it significantly increased in TFM. Heart rate significantly increased in STFM, whereas it tended to decrease in TFM. Conclusions: Both STFM and TFM by a massage therapist could improve foot skin blood flow and ROM of the foot and ankle in diabetic patients with peripheral neuropathy. An STFM could be a promising alternative treatment that patients can perform at home.

Predicting Lower Quarter Y-Balance Test Performance From Foot Characteristics

CONTEXT

The lower quarter Y-Balance Test (YBT-LQ) is associated with injury risk; however, ankle range of motion impacts YBT-LQ. Arch height and foot sensation impact static balance, but these characteristics have not yet been evaluated relative to YBT-LQ.

OBJECTIVE

Determine if arch height index (AHI), forefoot sensation (SEN), and ankle dorsiflexion predict YBT-LQ composite score (CS).

DESIGN

Descriptive cohort.

SETTING

Athletic training laboratory.

PARTICIPANTS

Twenty general population (14 females and 6 males; mean [SD]: age 35 [18] y, weight 70.02 [16.76] kg, height 1.68 [0.12] m) participated in this study.

INTERVENTIONS

AHI measurement system assessed arch height in 10% (AHI10) and 90% (AHI90) weight-bearing. Two-point discrim-a-gon discs assessed sensation (SEN) at the plantar great toe, third and fifth metatarsal heads. Biplane goniometer and weight-bearing lunge tests were used to measure static and weight-bearing dorsiflexion, respectively. The YBT-LQ assessed dynamic single-leg balance.

RESULTS

For right-limb dynamic single-leg balance, AHI90 and SEN were included in the final sequential prediction equation; however, neither model significantly (P = .052 and .074) predicted variance in YBT-LQ CS. For left-limb dynamic single-leg balance, both SEN and weight-bearing lunge test were included in the final sequential prediction equation. The regression model (SEN and weight-bearing lunge test) significantly (P = .047) predicted 22% of the variance in YBT-LQ CS.

CONCLUSIONS

This study demonstrates that foot characteristics may play a role in YBT-LQ CS. The authors did not assess limb dominance in this study; therefore, the authors are unable to determine which limb would be the stance versus kicking limb. However, altered SEN and weight-bearing dorsiflexion appear to be contributing factors to YBT-LQ CS.

Effect of Adding Proprioceptive Exercise to Balance Training in Older Adults with Diabetes: A Systematic Review

INTRODUCTION

Accidental fall is a serious problem in older adults. The incidence of accidental fall increases by any dysfunction in the proprioceptive system. The function of the proprioceptive system usually is much affected in people with Diabetes Mellitus (DM), particularly in older ages. However, proprioceptive exercise significantly improves the balance control in older adults, no systematic review demonstrated its effectiveness in improving the balance control in older adults with DM. Thus, this systematic review was conducted to examine the effectiveness of adding proprioceptive exercise to any balance training in older adults with DM.

METHODS

A systematic search was performed in five major databases. The inclusion criteria of this search included older adults with DM, peripheral neuropathy, randomized control trial, and proprioceptive dysfunction. The exclusion criterion of this search included any study where participants had a history of a disease that might affect the balance control such as ataxia, stroke, and Parkinsonism. The outcome of interest was the importance of including proprioceptive exercise in increasing the effectiveness of balance training in older adults with DM.

RESULTS

Nine RCTs met the inclusion criteria for this systematic review. Seven studies of these nine studies included randomization details. Only two studies included the blindness, and only one of them included double blindness. The description of the withdrawal of participants was shown in eight studies. All the included studies used a control group and accomplished the homogeny between subjects in the both groups.

CONCLUSION

This systematic review showed that proprioceptive exercise is a vital component that should be included in any balance training to gain short-term improvement in the balance control in older adults with DM.

Hand and foot exercises for diabetic peripheral neuropathy: A randomized controlled trial

Exercises for diabetic peripheral neuropathy remain controversial, especially with regard to recommended precautions and weightbearing exercises for individuals. We aimed to investigate the effect of 8 weeks of simple hand, finger, and foot exercises in patients with diabetic peripheral neuropathy. After randomization, exercise (n = 51) and control (n = 53) groups received usual care and diabetic foot care education; only the exercise group performed exercises. Primary outcomes, including activities of daily living (assessed using the Patient Neurotoxicity Questionnaire), neuropathy severity (monofilament and vibration test), and pain (behavioral rating scale and Visual Analog Scale), and secondary outcomes, including physical function of the hand and foot (grip, pinch, finger counting time, and Timed Up and Go tests), were assessed at baseline, after the 8-week intervention, and at the 16-week follow-up. The exercise group showed significantly stronger improvements in motor score and specific activities of daily living, such as climbing stairs and performing work or chores. Our exercises can be used to improve limb function in patients with diabetic neuropathy.

Toe flexor strength is not related to postural stability during static upright standing in healthy young individuals

BACKGROUND

The human foot has adapted specifically to support body weight when standing upright. At the base of the postural control system, the unique arch structure of the foot still has an uncertain role in human upright standing. Because the toe flexor muscles help to support the foot arches, they might be an important contributor to postural stability. However, no research has identified the influence of the toe flexor strength or the foot arch height on postural stability in static upright standing.

RESEARCH QUESTION

The aim of this study was to examine whether the toe flexor strength and the foot arch height were related to postural stability in static standing in healthy young individuals.

METHODS

Fifty healthy young individuals were recruited into this cross-sectional study. Toe flexor strength was measured using a toe grip dynamometer, and it was normalised by body mass (rTFS). Foot arch height was assessed as the distance between the navicular tuberosity of the foot and the floor, and it was normalised by height (rFAH). Postural stability was evaluated using the path of the centre of pressure (COP) during double-leg standing with eyes open and single-leg standing with eyes open.

RESULTS

rTFS and rFAH were 2.6 ± 0.8 N/kg and 2.8 ± 0.4%, respectively, and they were not significantly correlated (r = 0.094), indicating that they were independent variables. The results of Pearson's correlation analysis revealed that any body size related variables (height, body mass, BMI) were not significantly correlated with COP variables under either double-leg or single-leg standing, rTFS was not significantly correlated with COP variables under either double-leg or single-leg standing and rFAH was not significantly correlated with COP variables under double-leg standing.

SIGNIFICANCE

Toe flexor strength has no significant role in maintaining postural stability during static upright standing.

Therapeutic effects of moxibustion simultaneously targeting Nrf2 and NF-κB in diabetic peripheral neuropathy

Moxibustion is the main alternative medicine treatment that has been beneficial to diabetic peripheral neuropathy (DPN), a common complication secondary to diabetic microvascular injury. However, the underlying protective mechanism of moxibustion against neuroinflammation remains unclear. We hypothesized that moxibustion treats DPN by regulating the balance of nuclear factor-2 erythroid-related factor-2 (Nrf2)-nuclear factor-kappa light chain enhancer of B cells (NF-кB). In vivo, diabetes was induced in rats by injecting streptozotocin (STZ; 60 mg/kg; i.p.). Moxibustion was then applied to “Zusanli” (ST 36), “Guanyuan” (BL 26), and “Yishu” (EX-B 3) acupuncture points. Nerve conduction was detected. Serum interleukin (IL)-1β, IL-6, and IL-8 levels were determined through enzyme-linked immunosorbent assay. NF-κB and Nrf2 proteins were examined through immunoblot analysis. The mRNA of NF-κB and Nrf2 was evaluated through RT-PCR. We found that the conduction velocity and amplitude of the action potentials of sciatic nerve conduction were reduced in the DPN model group but were rescued by moxibustion treatment. Moxibustion also improved the effect of DPN on other parameters, including ultrastructural changes, NF-κB and Nrf2 expression in the sciatic nerve, and serum IL-1β, IL-6, and IL-8 levels. Our data suggested that moxibustion may alleviate neuroinflammation by inhibiting NF-κB and by activating Nrf2. Moxibustion may also provide therapeutic effects for patients with DPN by simultaneously targeting Nrf2 and NF-κB.

An exploration of the relationship between foot skin temperature and blood flow in type 2 diabetes mellitus patients: a cross-sectional study

[Purpose] The current study aimed to investigate the reliability of infrared thermography as a method of determining foot skin temperature, and to determine the relationship between foot skin temperature and blood flow in type 2 diabetes mellitus (DM) patients. [Participants and Methods] Eighty-five patients were recruited and their foot skin temperature and the ankle brachial index (ABI) were measured using infrared thermography and an automated oscillometry, respectively. A correlation between foot skin temperature and blood flow was performed. The patients were screened and classified according to two groups; diabetic peripheral neuropathy (DPN) and non-DPN. Discriminant validity was determined by comparing the foot skin temperature between the two groups. [Results] The test-retest reliability of foot skin temperature was high. A positive correlation was found between foot skin temperature and ABI in both feet. The foot skin temperatures in the DPN group were found to be significant lower when compared with those in the non-DPN group. [Conclusion] Foot skin temperature is an indirect method of evaluating blood flow in the feet of diabetic patients and can be used as a clinical outcome measurement of treatments used to improve blood flow in type 2 DM patients.

The effects of unilateral Swedish massage on the neural activities measured by quantitative electroencephalography (EEG)

Purpose

It is generally accepted that massage can provide a lot of benefits to human health, especially for the brain functions. Little is known about the effect of unilateral massage on the brain activities. Nowadays, Swedish massage is a modern massage technique that is popular in both treatment and research fields. The purpose of this paper is to investigate the effect of unilateral Swedish massage on brain activities with electroencephalography (EEG) recording.

Design/methodology/approach

In total, 18 healthy adult participants (5 men, 13 women) aged between 22 and 36 years were massaged over one side of arm, forearm, hand, neck and face. Then the same procedures were repeated to another side of the body. EEG was recorded before (baseline) and during each massage condition. The absolute power of four common brain waves consisting of δ (0.5-4 Hz), θ (4-8 Hz), α (8-13 Hz), and β activities (13-30 Hz) from the quantitative EEG analysis between baseline and each massage condition were used to compare with the paired t-test.

Findings

The study found the reduction of δ and θ powers over bilateral frontal, fronto-central, and central areas. The increments of α power over the similar brain areas were also observed. These findings indicated the generalized effect of unilateral Swedish massage for inducing relaxation. Moreover, the significant reduction of β power was also found over right central area when left-arm massage was applied. This finding revealed the initial inhibitory effect of Swedish massage over right somatosensory cortex that received sensory stimulation through massage from left side of the body.

Originality/value

Unilateral Swedish massage induced the inhibitory effect at the contralateral somatosensory cortex and then produced the generalized effect which is compatible with relaxation.

Systematic review of treatments for diabetic peripheral neuropathy

AIM

To evaluate treatment options for neuropathic pain and sensory symptoms resulting from diabetic peripheral neuropathy of the feet.

METHODS

The databases PubMed, Embase and Web-of-Science were searched for randomized controlled trials, published in the period from database inception to 2 July 2015, that evaluated treatments for diabetic peripheral neuropathy of the feet with placebo or standard treatment as comparators. Participants in these trials included people with diabetes mellitus and diabetic peripheral neuropathy who were given any treatment for diabetic peripheral neuropathy. Risk of bias was assessed using the Delphi list of criteria. Data from the trials were extracted using standardized data extraction sheets by two authors independently. All analyses were performed using RevMan 5.2. In case of clinical homogeneity, statistical pooling was performed using a random effects model.

RESULTS

This review included 27 trials on pharmacological, non-pharmacological and alternative treatments. In the meta-analysis of trials of α-lipoic acid versus placebo, total symptom score was reduced by -2.45 (95% CI -4.52; -0.39) with 600 mg i.v. α-lipoic acid (three trials), and was reduced by -1.95 (95% CI -2.89; -1.01) with 600 mg oral α-lipoic acid (two trials). Significant improvements in diabetic peripheral neuropathy symptoms were found with opioids, botulinum toxin A, mexidol, reflexology and Thai foot massage, but not with micronutrients, neurotrophic peptide ORG 2677 and photon stimulation therapy.

CONCLUSION

In this review, we found that α-lipoic acid, opioids, botulinum toxin A, mexidol, reflexology and Thai foot massage had significant beneficial results.