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A Randomized Sham-controlled Trial of Sciatic Nerve Neurodynamic Mobilization in Painful Diabetic Peripheral Neuropathy

Senthil P Kumar, , Mohd Javed Iqbal1 , Ahmad Merajul Hasan Inam2 , Senthil P Kumar

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Physiotherapy and Occupational Therapy Journal 14(4):p 143-151, October-December 2021. | DOI: http://dx.doi.org/10.21088/potj.0974.5777.14421.1

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Mohd Javed Iqbal, Ahmad Merajul Hasan Inam, Senthil P Kumar/A Randomized Sham-controlled Trial of Sciatic Nerve Neurodynamic Mobilization in Painful Diabetic Peripheral Neuropathy/Physiotherapy and Occupational Therapy Journal.
2021;14(4):143-151.
 

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Abstract

Objective: To study the efficacy of sciatic nerve neurodynamic mobilization as compared to control intervention on vibration thresholds, neuropathic pain severity, sciatic nerve neurodynamic test range of motion and neuropathy specific quality of life (NeuroQoL) in painful diabetic peripheral neuropathy patients. Design: Observer-blinded randomized sham-controlled trial. Methods: The study conduct was approved by Institutional Ethics Committee and was registered at Clinical Trials Registry- India. Thirty two patients of age (60.12 ± 11.41years), both gender (13 male, 19 female) were selected on convenient sampling. Subjects were selected based on following: Physician diagnosed type-II DM of atleast eight years duration; complaint of neuropathic pain (screened using neuropathic pain questionnaire NPQ) in the legs and feet; mechanical behavior of neuropathic pain (aggravated and/or relieved by movements); ability to understand and co-operate for instructions of tester. The twenty one excluded subjects had either of the following: progressive worsening neurological deficit, irritable pain, allodynia/ hyperalgesia, musculoskeletal problems, cognitive maladaptation syndrome. The independent blinded observer then recorded neuropathic pain intensity on NPQ, sciatic nerve neurodynamic test range of motion at initial resistance R1, vibration thresholds by Biothesiometry and NeuroQoL. The subjects then were randomized to receive either of two interventionscontrol and experimental. The control group received sham treatment, drugs for glycemic control, Gabapentin for neuropathic pain, diet-lifestyle modification and walking exercise prescription. The experimental group received in addition, sciatic nerve neurodynamic mobilization consisting of nerve massage and nerve sliders. The treatment session was of 45 min duration on five sessions (one session per week) for total study duration of five weeks. Patients were instructed to perform self-mobilization once daily and were given patient log to ensure compliance. Data was collected twice- pre and post intervention. Results: The groups were comparable in age, gender, chronicity and severity of neuropathic pain. Both groups showed significant improvements. The experimental group showed significant improvements post treatment in all the four study outcomes. The between-group mean differences were NPQ (18.89 ± 2.46), neurodynamic range of motion (4.00 ± 3.85 degrees), vibration threshold (5.94 ± 1.12 volts) and NeuroQoL (15.93 ± 2.85) in favour of experimental group. All differences were statistically significant at p<.05 when analyzed using students’ t-test at 95% confidence interval using SPSS 12.0.1 for Windows. Conclusion: Sciatic nerve neurodynamic mobilization comprising of nerve massage and nerve sliders was shown to be an effective treatment adjunct for painful diabetic peripheral neuropathy. Implications for practice: Neurodynamic assessment and intervention should be considered as an effective therapeutic option for painful diabetic peripheral neuropathy patients who complain of pain in the sciatic nerve distribution.

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Mohd Javed Iqbal, Ahmad Merajul Hasan Inam, Senthil P Kumar/A Randomized Sham-controlled Trial of Sciatic Nerve Neurodynamic Mobilization in Painful Diabetic Peripheral Neuropathy/Physiotherapy and Occupational Therapy Journal.
2021;14(4):143-151.
 

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DOI: http://dx.doi.org/10.21088/potj.0974.5777.14421.1

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