title: The clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people: A systematic review.
abstract: BACKGROUND
  Central nervous system receives information from foot mechanoreceptors in order to control balance and perform movement tasks. Subthreshold random noise seems to improve sensitivity of the cutaneous mechanoreceptor.
  
  
  OBJECTIVE
  The purpose of this study was to systematically review published evidence conducted to evaluate the clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A literature search was performed in PubMed, Scopus, ScienceDirect, Web of Knowledge, CINAHL, and EMBASE databases based on population, intervention, comparison, outcomes, and study method. Quality of studies was assessed using the methodological quality assessment tool, using Physiotherapy Evidence Database scale.
  
  
  RESULTS
  In all, 11 studies were selected for final evaluation based on inclusion criteria. Five studies evaluated the effects of subthreshold random noise in diabetic patients and six in elder people. In seven studies, biomechanical (balance and gait parameters) effects and in four studies clinical (pressure and vibration sensations) effects of subthreshold random noise were investigated. All reviewed studies were scored fair (2) to good (9) quality in terms of methodological quality assessment using Physiotherapy Evidence Database scale.
  
  
  CONCLUSIONS
  The results indicated that subthreshold random noise improves balance and sensation in diabetic patients and elder people. Also gait variables can be improved in elder people with subthreshold random noise. However, further well-designed studies are needed.
  
  
  CONCLUSIONS
  The previous studies reported that subthreshold random noise may improve gait, balance, and sensation, but more studies are needed to evaluate the long-term effect of subthreshold random noise in shoe or insole for daily living tasks in diabetic patients and elder people.
authors.affiliation: Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Masumeh
authors.initials: M
authors.lastname: Bagherzadeh Cham
authors.affiliation: Iranian Research Center on Aging, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Mohseni_Bandpei@yahoo.com.|University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Mohseni-Bandpei
authors.affiliation: Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Bahramizadeh
authors.affiliation: Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Kalbasi
authors.affiliation: Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Akbar
authors.initials: A
authors.lastname: Biglarian
mesh_terms: D000367:Age Factors; D000368:Aged; D001696:Biomechanical Phenomena; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008465:Mechanoreceptors / Q000502:physiology; D012684:Sensory Thresholds; D013269:Stochastic Processes; D014110:Touch / Q000502:physiology*
keywords: Diabetes mellitus; elder people; random noise; stochastic resonance