EFFECTS OF TASK-ORIENTED TRAINING WITH OR WITHOUT TEXTURED INSOLES ON BALANCE IN PATIENTS WITH PERIPHERAL DIABETIC NEUROPATHY: A RANDOMIZED CONTROLLED TRIAL
Keywords:
Diabetic peripheral neuropathy; Task-oriented training; Textured insoles; Balance; Functional mo-bility.Abstract
Background: Peripheral diabetic neuropathy (DPN) is associated with reduced plantar sensation, proprioception, muscle function, balance and functional mobility, and with pain, functional limitation and falls. Task-oriented training improves task performance, but reduced sensory input from neuropathy may impair postural control. Textured insoles may improve plantar sensory feedback and enhance the benefits of rehabilitation.
Objective: To evaluate the effects of task-oriented training with and without textured insoles on balance, functional mobility and foot pain in patients with DPN.
Methods: A single-blind randomized controlled trial was conducted in adults with DPN. Twenty-eight participants were analyzed (14 per group): the Control group (Group A) received task-oriented training and the Experimental group (Group B) received the same training with textured insoles, for six weeks. Balance, functional mobility and foot pain were assessed at baseline and six weeks with the Berg Balance Scale (BBS), Timed Up and Go test (TUG) and Visual Analogue Scale (VAS), respectively. Within-group changes were tested with paired-samples t-tests (BBS, TUG) and the Wilcoxon signed-rank test (VAS); a two-way mixed ANOVA tested differences between groups over time.
Results: Both groups improved in BBS and TUG. BBS rose from 39.07 ± 3.65 to 44.00 ± 3.04 in Group A and from 37.93 ± 2.67 to 46.21 ± 2.94 in Group B, with a significant Time × Group interaction, F(1,26) = 54.285, p < 0.001. TUG fell from 13.03 ± 1.95 to 11.30 ± 1.65 s in Group A and from 13.79 ± 2.64 to 10.86 ± 2.54 s in Group B; the interaction was not significant, F(1,26) = 2.396, p = 0.134, partial η² = 0.084. VAS pain decreased significantly in both groups, with a lower post-intervention score in Group B (p < 0.001).
Conclusion: Task-oriented training improved balance, functional mobility and pain in people with DPN. Adding textured insoles gave an additional benefit for balance and pain, but not for functional mobility, and may be a useful supplement to task-oriented rehabilitation.
