A Systematic Review of the Effect of Physical Rehabilitation on Balance in People with Diabetic Peripheral Neuropathy Who are at Risk of Falling

IF 3.6 3区 医学 Clinical Interventions in Aging Pub Date : 2024-07-19 DOI:10.2147/cia.s459492
Nesreen Alissa, Andrea Goldstein Shipper, Lindsay Zilliox, Kelly P Westlake
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Abstract

Background: Falls are a significant issue in people with diabetic peripheral neuropathy. Balance interventions have been broadly administered in individuals with diabetic peripheral neuropathy, but the effects on static and dynamic balance in those who are at risk of falling have not yet been comprehensively reviewed.
Objective: To provide a synthesis of the literature regarding the effectiveness of physical rehabilitation interventions to improve balance in people with diabetic peripheral neuropathy who are at risk of falling.
Methods: Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Cumulated Index in Nursing and Allied Health Literature) were systematically searched from inception to July 2022. Articles meeting the eligibility criteria (ie, participants with diabetic peripheral neuropathy and at risk of falling based on validated fall balance outcome risk cut off scores; inclusion of physical rehabilitation intervention) underwent a quality assessment using the Physiotherapy Evidence Database scale. Data regarding fall risk was extracted.
Results: Sixteen studies met the eligibility criteria. Participants in six studies improved balance such that their fall risk was reduced from a moderate-high risk of falls to no or low risk of falls from pre- to post-intervention. Interventions within these six studies were variable and included balance exercise, gait training, endurance, tai-chi with mental imagery, proprioceptive training, aerobic training, and yoga. Participants in seven of the remaining studies showed no improvement and participants in three studies showed mixed results regarding improved balance and reduced fall risk status by post-intervention.
Conclusion: While physical rehabilitation is sufficient to improve balance in individuals with diabetic peripheral neuropathy who are at risk of falling, few interventions led to improved balance and reduced fall risk. Interventions involving intentional weight shifting, manipulation of the base of support, and displacement of the center of mass such as tai-chi and yoga appear to provide the most consistent results in terms of decreasing fall risk. To better understand the effectiveness of rehabilitation on balance and fall risk, future studies should examine the impact of physical interventions on prospective fall rates.

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物理康复对有跌倒风险的糖尿病周围神经病变患者平衡能力影响的系统性综述
背景:跌倒是糖尿病周围神经病变患者的一个重要问题。平衡干预已在糖尿病周围神经病变患者中广泛实施,但对有跌倒风险的患者的静态和动态平衡的影响尚未进行全面审查:综述有关物理康复干预对改善有跌倒风险的糖尿病周围神经病变患者平衡能力的有效性的文献:方法:系统检索了从开始到 2022 年 7 月的四个数据库(PubMed、Embase、Cochrane Central Register of Controlled Trials、Cumulated Index in Nursing and Allied Health Literature)。符合资格标准的文章(即参与者患有糖尿病周围神经病变,且根据经验证的跌倒平衡结果风险截断分数有跌倒风险;包含物理康复干预措施)均使用物理治疗证据数据库量表进行了质量评估。提取了有关跌倒风险的数据:结果:16 项研究符合资格标准。有六项研究的参与者平衡能力得到改善,因此从干预前到干预后,他们的跌倒风险从中度-高度跌倒风险降至无跌倒风险或低跌倒风险。这六项研究的干预措施各不相同,包括平衡锻炼、步态训练、耐力训练、太极拳与心理想象、本体感觉训练、有氧训练和瑜伽。其余七项研究的参与者在干预后的平衡能力改善和跌倒风险降低方面没有任何改善,三项研究的参与者在改善平衡能力和降低跌倒风险方面的结果不一:结论:虽然物理康复足以改善有跌倒风险的糖尿病周围神经病变患者的平衡能力,但很少有干预措施能改善平衡能力并降低跌倒风险。在降低跌倒风险方面,太极拳和瑜伽等涉及有意转移重心、操纵支撑基础和移动质心的干预措施似乎能提供最一致的效果。为了更好地了解康复治疗对平衡和跌倒风险的效果,未来的研究应考察物理干预对预期跌倒率的影响。
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来源期刊
Clinical Interventions in Aging
Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-
CiteScore
6.20
自引率
2.80%
发文量
193
期刊介绍: Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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