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Balance Interventions for Diabetic Peripheral Neuropathy: A Systematic Review

Ites, Katherine I. PT, DPT1; Anderson, Elizabeth J. PT, DPT2; Cahill, Megan L. PT, DPT3; Kearney, Jenny A. PT, DPT4; Post, Emily C. PT, DPT4; Gilchrist, Laura S. PT, PhD4

Journal of Geriatric Physical Therapy: July/September 2011 - Volume 34 - Issue 3 - p 109–116
doi: 10.1519/JPT.0b013e318212659a
Systematic Review

Diabetic Peripheral Neuropathy (DPN) is a complication of diabetes experienced by more than 30% of all diabetic patients. It causes decreased sensation, proprioception, reflexes, and strength in the lower extremities, leading to balance dysfunction. The purpose of this study was to assess the effectiveness of interventions used by physical therapists to minimize balance dysfunction in people with DPN. Currently, no systematic review exists that explores the effectiveness of these interventions. When conducting this systematic review, we searched the electronic databases CINAHL, EMBASE, Cochrane Review, and Medline using specific search terms for the period from inception of each database to June 2009. Two independent reviewers analyzed the abstracts obtained to determine whether the article focused on balance interventions that are within the scope of physical therapy practice. All study designs were eligible for review with the exception of case reports and systematic reviews. The Delphi criteria was used to assess methodological quality. This literature search and methods assessment resulted in 2213 titles, 82 abstracts, and 6 articles, including 1 randomized controlled trial eligible for inclusion. The 6 articles contained 4 physical therapy interventions including monochromatic infrared energy therapy, vibrating insoles, lower extremity strengthening exercises, and use of a cane. Upon thorough analysis of outcome measures, statistical significance, and clinical relevance, the intervention of lower extremity strengthening exercises was given a fair recommendation for clinical use in treating balance dysfunction in patients with DPN. All others had insufficient evidence to either support or refute their effect on balance in this population.

1Children's Hospitals and Clinics of Minnesota, Developmental and Rehabilitation Services, Minneapolis, Minnesota.

2Aegis Therapies, Martin Luther Care Center, Bloomington, Minnesota.

3Regions Hospital, St Paul, Minnesota.

4Department of Physical Therapy, St Catherine University, Minneapolis, Minnesota.

Address correspondence to: Katherine Ites, PT, DPT, Children's Hospitals and Clinics of Minnesota, Developmental and Rehabilitation Services, 2530 Chicago Ave South, Minneapolis, MN 55404 (

Copyright © 2011 the Section on Geriatrics of the American Physical Therapy Association
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