title: Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taveggia
authors.affiliation: Researcher, IRCCS Don Gnocchi Foundation, Milan, Italy.
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Villafañe
authors.affiliation: Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vavassori
authors.affiliation: Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lecchi
authors.affiliation: Researcher, Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy. Electronic address: alberto.borboni@ing.unibs.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Borboni
authors.affiliation: Researcher, IRCCS Don Gnocchi Foundation, Milan, Italy; Professor/Physician, Director, Physical and Rehabilitation Medicine, University of Brescia, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Negrini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003929:Diabetic Neuropathies / Q000503:physiopathology / Q000534:rehabilitation*; D004185:Disability Evaluation; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005246:Feedback; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D053581:Muscle Strength Dynamometer; D010807:Physical Endurance / Q000502:physiology; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology
keywords: Gait Disorders; Muscle Strength; Neuropathy; Walking