Original Research

A Treatment Protocol for Patients With Diabetic Peripheral Neuropathy

Fed Pract. 2015 September;32(9):68-73

References

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Analysis of VAS scores revealed a significant decrease at the 6-month time frame compared with the initial score for the left foot ( P < .05). Further VAS analysis revealed no significant difference between the initial and 6-month right foot VAS score. When both feet were compared together, there was no significant difference in VAS ratings between any 2 points in time.

Analysis of Tinetti Total Score, Tinetti Balance Score, and Tinetti Gait Score revealed a significant difference between the initial vs 3-month visit for all 3 scores ( P < .001, P < .001, and P < .05, respectively). In addition, Tinetti Total ( P < .001) and Tinetti Balance ( P < .01) scores were significantly improved from initial to the final 6-month visit. There were no significant findings between interim scores of the initial and 12th visits, the 12th and 3-month visits, or the 3-month and 6-month scores (Figure 2).

Analysis of SWM testing indicated a significant decrease in the total number of insensate sites (> 5.07) when both feet were grouped together between the initial and 3-month visits ( P < .05) as well as the initial and 6-month ( P < .01) visits. When the left and right feet were compared independently of each other, there was a significant decrease in the number of insensate sites between the initial and 6-month visits ( P < .01 for both) (Figure 3).

Discussion

This study investigated whether or not a multimodal physical therapy approach would reduce several of the debilitating symptoms of DPN experienced by many veterans at WJBDVAMC. The results support the idea that a combined treatment protocol of MIRE and a standardized exercise program can lead to decreased POQ-VA pain levels, improved balance, and improved protective sensation in veterans with DPN. Alleviation of these DPN complications may ultimately decrease an individual’s risk of injury and improve overall QOL.

Because the POQ-VA is a reliable, valid self-reported measure for veterans, it was chosen to quantify the impact of pain. Overall, veterans who participated in this study perceived decreased pain interference in multiple areas of their lives. The most significant findings were in overall QOL, household and community mobility, and pain ratings. This suggests that the combined treatment protocol will help veterans maintain an active lifestyle despite poorly controlled diabetes and neuropathic pain.

Along with decreased pain interference with QOL, participants demonstrated a decrease in fall risk as quantified by the Tinetti Gait and Balance Assessment. The SWM testing showed improved protective sensation as early as 3 months and continued through the 6-month visit. As protective sensation improves and fall risk decreases, the risk of injury is lessened, fear of falling is decreased, and individuals are less likely to self-impose limitations on daily activity levels, which improves QOL. In addition, decreased fall risk and improved protective sensation can reduce the financial burden on both the patient and the health care system. Many individuals are hospitalized secondary to fall injury, nonhealing wounds, resulting infections, and/or secondary complications from prolonged immobility. This treatment protocol demonstrates how a standardized physical therapy protocol, including MIRE and balance exercises, can be used preventively to reduce both the personal and financial impact of DPN.