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J Manipulative Physiol Ther. 2014 May;37(4):242-52. doi: 10.1016/j.jmpt.2013.09.007. Epub 2014 Mar 20.

Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial.

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Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy.
Researcher, IRCCS Don Gnocchi Foundation, Milan, Italy.
Researcher, Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy. Electronic address:
Researcher, IRCCS Don Gnocchi Foundation, Milan, Italy; Professor/Physician, Director, Physical and Rehabilitation Medicine, University of Brescia, Brescia, Italy.



The purpose of this study was to evaluate the effectiveness of the application of analyzing treadmill, muscle strengthening, and balance training compared with a standard care intervention in patients with diabetic neuropathy.


Twenty-seven patients, 63% female (mean ± standard deviations age, 72 ±9 years), with diabetic neuropathy randomly assigned to receive a multimodal manual treatment approach including analyzing treadmill with feedback focused, isokinetic dynamometric muscle strengthening, and balance retraining on dynamic balance platform or a standard care intervention for activities targeted to improve endurance, manual exercises of muscle strengthening, stretching exercises, gait, and balance exercises (5 weekly over 4 weeks). This study was designed as a double-blind, randomized clinical trial. Measures were assessed at pretreatment, 4 weeks posttreatment, and 2-month follow-up.


No important baseline differences were observed between groups. At the end of the treatment period, the experimental group showed a significant increase in gait endurance in a 6-minute walk test, 65.6 m (F[2.0] = 9.636; P = .001). In addition, the 6-minute walk test increased after the intervention, and an even greater difference was found at follow-up (P = .005) for the standard care group. The Functional Independence Measure in both groups increased (P < .01) and continued until the follow-up in the standard care group (P = .003).


The results suggest that the experimental rehabilitation program showed positive effects on the gait endurance after 4 weeks of treatment, whereas it did not produce significant improvements of the gait speed. Both the treatments produced significant improvement of functionalities of the patient.


Gait Disorders; Muscle Strength; Neuropathy; Walking

[Indexed for MEDLINE]

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