Comparative Effects Of Sensory Reweighting And Proprioceptive Facilitation Training On Balance And Fall Risk In Diabetic Peripheral Neuropathy

Comparative Effects Of Sensory Reweighting And Mechanical Proprioceptive Facilitation Training On Static Balance, Functional Mobility And Fall Risk In Patients With Diabetic Peripheral Neuropathy

This randomized controlled trial aims to compare the effects of Sensory Reweighting and Mechanical Proprioceptive Facilitation Training on static balance, functional mobility, and fall risk in patients with diabetic peripheral neuropathy. Study design will be a randomized clinical trial. Non-probability convenient sampling will be used and the subjects will be allocated to two groups by random allocation. Group A will receive either sensory reweighting exercises and Group B will receive mechanical proprioceptive facilitation training using the Blueidea Deep Muscle Massage Fascial Gun BLD-888 in combination with conventional therapy for six weeks. Outcome measures will include Nintendo Wii Balance Board for Static Balance, Timed Up and Go Test for Functional Mobility, and Fall Efficacy Scale for Fall Risk. Both groups will receive 18 sessions for a period of 6 weeks. Measurements of all the outcome variables will be taken at baseline, and post treatment. Results will be analyzed by using SPSS 25.

Study Overview

• Status: Active, not recruiting
• Conditions: Diabetic Peripheral Neuropathy (DPN)
• Intervention / Treatment: Other: Sensory Reweighting with conventional Physical Therapy; Other: Mechanical Proprioceptive Facilitation Training with conventional Physical Therapy

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • University of Management & Technology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria

• Patients diagnosed with Type 2 Diabetes Mellitus by a medical practioner and confirmed by using MNSI Questionnaire total score ranges from 0 to 13, with higher scores indicating greater neuropathic symptoms. A score of ≥4 indicates an abnormal/positive neuropathy screen. MNSI Physical Examination: Total score ranges from 0 to 10. A score of ≥2.5 indicates an abnormal/positive neuropathy screen.
• Both Male and Female
• Age between 40-75 years
• Duration of diabetes ≥ 5 years
• HbA1c >8%
• Able to walk independently without assistive devices Exclusion Criteria
• History of lower limb fractures, severe deformities (Claw toes / hammer toes with functional limitation, Significant limb length discrepancy, or Musculoskeletal problems (Hip osteoarthritis affecting mobility, Recent ligament injuries in 6 months, Severe plantar fasciitis)
• Active foot ulcer, infection, or gangrene
• History of recent lower limb surgery or trauma (within 6 months), including fractures, dislocations, joint replacement, ligament or tendon repair/injury, or other injuries involving the hip, knee, ankle, or foot
• Amputation of lower limb
• History of deep vein thrombosis (DVT)
• History of severe vestibular and neurological disorders (e.g., stroke, Parkinson's disease), Diabetic Retinopathy and Diabetic Nephropathy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Sensory Reweighting with conventional Physical Therapy; Sensory reweighting will be performed under four different sensory conditions including eyes closed on a firm surface, eyes open on a firm surface, eyes open on a foam surface and eyes closed on a foam surface. The exercise program will include double-leg stance, tandem stance, single leg stance, tandem walking/ forward and backward waling and sit to stand exercises without arm support. Only standing exercises will be performed on foam surface while eyes closed to ensure patient safety. Each exercise trial will be performed for 20-30 seconds under each condition with three repetitions per condition. Rest intervals of 30-60 seconds will be given between trials. The total duration of each session will be 15-20 minutes. Progression of exercise will be introduced gradually initially exercises with eyes open on firm surface during week 1-2, followed by eyes closed condition in 3-4 week and dual task activities will be introduced during week 5-6.	Other: Sensory Reweighting with conventional Physical Therapy; Sensory reweighting will be performed under four different sensory conditions including eyes closed on a firm surface, eyes open on a firm surface, eyes open on a foam surface and eyes closed on a foam surface. The exercise program will include double-leg stance, tandem stance, single leg stance, tandem walking/ forward and backward waling and sit to stand exercises without arm support. Only standing exercises will be performed on foam surface while eyes closed to ensure patient safety. Each exercise trial will be performed for 20-30 seconds under each condition with three repetitions per condition. Rest intervals of 30-60 seconds will be given between trials. The total duration of each session will be 15-20 minutes. Progression of exercise will be introduced gradually initially exercises with eyes open on firm surface during week 1-2, followed by eyes closed condition in 3-4 week and dual task activities will be introduced during week 5-6.
Active Comparator: Mechanical Proprioceptive Facilitation training with conventional Physical Therapy; Mechanical Proprioceptive Facilitation Training using Blueidea Deep Muscle Massage Fascial Gun BLD-888 percussion massage gun. Mechanical stimulation will be applied to the plantar surface of the foot, calf muscles, and anterior and posterior thigh muscles. The device will be applied perpendicular to the tissue at a moderate, patient-tolerable intensity level. Each treatment area will receive percussion stimulation for approximately 1-2 minutes with a total intervention duration of 8-10 minutes per session(38, 39). The intervention program will be conducted for 6 weeks, with 3 sessions per week total 18 treatment sessions.	Other: Mechanical Proprioceptive Facilitation Training with conventional Physical Therapy; Mechanical Proprioceptive Facilitation Training using Blueidea Deep Muscle Massage Fascial Gun BLD-888 percussion massage gun. Mechanical stimulation will be applied to the plantar surface of the foot, calf muscles, and anterior and posterior thigh muscles. The device will be applied perpendicular to the tissue at a moderate, patient-tolerable intensity level. Each treatment area will receive percussion stimulation for approximately 1-2 minutes with a total intervention duration of 8-10 minutes per session. The intervention program will be conducted for 6 weeks, with 3 sessions per week total 18 treatment sessions. Conventional treatment Range of motion exercises (ankle, knee, toes) included knee flexion and extension, ankle dorsiflexion and plantarflexion, ankle inversion and eversion, and toe flexion and extension, Alternate weight shifting (side-to-side) Seated calf raises Heel raises with support (standing) will be given to both groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional mobility through time up go test	Timed Up and Go Test is a standardized test used for the assessment of functional mobility. Procedure of test includes the participant stands up from the chair, walks 03 meters, turns around, returns and sit down while the completion time is recorded in seconds. Lower completion time indicates better mobility while longer completion time indicates impaired functional mobility. Score less than 10 shows Freely Mobile, >10 indicate Mostly independent and score greater than 20 seconds is generally associated impaired mobility. The test has shown excellent intra-rater and inter-rater reliability with interclass correlation coefficient reported around 0.99, along with strong validity in older adults and patients with neurological impairments	baseline and after 6 weeks
Fall risk through Fall Efficacy Scale	Fall Efficacy Scale is a 16 item self-reported questionnaire tool which measures fear of fall and self-confidence when carrying out activities of daily life. Individuals will be asked to rate, on a four-point Likert scale, their concerns about the possibility of falling when performing 16 activities. High scores means more fear of falling and less balance self-confidence. 16-19 low concern, 20-27 moderate concern and 28-64 high concern. The tool has been shown to have very good internal consistency, as evidenced	baseline and after 6 weeks
static balance through	Nintendo Wii Balance Board was used to assess static balance. This device measured postural sway, weight-shifting ability and balance control through force-sensing technology) For the measurement of center of gravity (COG) a patient was asked to stand still on balance board and then the weight distribution over the left and right feet was evaluated (body center of gravity; BCG). As a result, the percentage of weight over each foot was recorded. The result of weight distribution was measured in the percentage on right and left and further analyzed as affected and normal side. The Basic Balance Test involved shifting weight Mediolaterally to direct the center of pressure to target areas on the display. The Wii instructions were "spread your feet apart; lean left and right to keep the red bar in blue area for three seconds". The test had five possible levels with a time limit of 30 seconds to complete all levels.	baseline and after 6 weeks

Collaborators and Investigators

• Sponsor: University of Management and Technology Lahore

Publications and helpful links

Helpful Links

• <p>Sams L, Langdown BL, Simons J, Vseteckova J. The impact of protocol designs for using massage guns on lower body flexibility: A randomised cross-over design study. Journal of Bodywork and Movement Therapies. 2025 Mar 1;41:85-93.</p>
• <p>Naz S, Jamil A, Ashraf S, Tauqeer S, Akram S. Proprioceptive training and conventional physical therapy on balance and quality of life in patients with diabetic peripheral neuropathy: A randomized controlled trial. Asia Pacific Journal of Health Manageme</p>

Study record dates

Study Major Dates

• Study Start (Actual): October 19, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: October 20, 2026
• First Submitted That Met QC Criteria: October 20, 2026
• First Posted (Actual): October 27, 2026

Study Record Updates

• Last Update Posted (Actual): November 5, 2026
• Last Update Submitted That Met QC Criteria: November 2, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: Balance; Functional Mobility; Fall Risk; Diabetic Peripheral Neuropathy; Sensory Reweighting; Mechanical Proprioceptive Facilitation
• Other Study ID Numbers: RE-203-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

The results data collected; de-identified individual participant data will be shared.

IPD Sharing Time Frame

6 months after the publication of the manuscript.

IPD Sharing Access Criteria

The data can be requested from the corresponding author.

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No