tSCS and AR Training on QoL and Physical Activity in Diabetic Neuropathy Patients
Combined Effects of Transcutaneous Spinal Cord Stimulation (tSCS) and Augmented Reality (AR) Training on Quality of Life (QoL) and Physical Activity in Diabetic Neuropathy Patients
Existing evidence of tSCS emphasizes pain relief and overlooks other functional parameters such as sensory enhancement, lower limb flexibility, and sustained improvements in physical activity and QoL.
Combined effects of tSCS and AR training on lower limb flexibility, vibration sense, QoL, and physical activity in patients with diabetic neuropathy. This dual approach has the potential to deliver a comprehensive strategy for managing DPN, which is low-cost, safe, and a more accessible solution for diabetic patients in Pakistan and around the world.
Tutkimuksen yleiskatsaus
Tila
Ehdot
Interventio / Hoito
Yksityiskohtainen kuvaus
Pakistan has seen a rise in diabetes prevalence, 26.7% among adults, with 43.16% developing neuropathy. This high prevalence is associated with significant complications. Approximately 15% of these cases can progress to limb amputation, which severely impacts QoL, increases dependence on caregivers, and imposes long-term psychosocial and economic stress on patients and their families.
Transcutaneous spinal cord stimulation (tSCS) is a noninvasive neuromodulation technique that involves the application of electrical stimuli over the thoracic or lumbar spinal cord regions. Studies suggest that tSCS may influence afferent sensory pathways, potentially improving vibration perception and proprioceptive feedback, particularly at 30Hz, resulting in enhanced QoL.
Augmented reality (AR)-based rehabilitation has also emerged as a non-invasive tool to enhance balance, postural control, and motor learning in patients with diabetic neuropathy. Recent studies support the use of immersive AR environments in improving lower limb flexibility, gait, and functional performance in neuropathy patients, thus increasing their QoL.
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Mirza Obaid Baig, MSPT
- Puhelinnumero: 00923332238706
- Sähköposti: obaid.baig@riphah.edu.pk
Tutki yhteystietojen varmuuskopiointi
- Nimi: Fatima Zahra, DPT
- Puhelinnumero: 0092 333 4133592
- Sähköposti: fatimazahra905@gmail.com
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- More than or equals to 4 scores on Douleur Neuropathique 4 Questionnaire (DN4)
- More than or equals to 6 Hz at Neurothesiometer
Exclusion Criteria:
- Cognitively compromised (MOCA score ≤ 26/30)
- Metallic implants at skull
- Shunting
- Skin allergy
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Active Comparator: Transcutaneous spinal cord stimulation Group
|
Transcutaneous spinal cord stimulation will be administered non-invasively using surface electrodes placed over the D12-L1 spinal segment.
Stimulation will be delivered using the Soterix 1×1 Transcutaneous Electrical Stimulation (TES) unit.
Stimulation will be applied at a frequency range of 30 Hz.
The pulse duration is 1 ms, and the intensity will be set at 2 mA.
A ramp-up and ramp-down time of 30 seconds will be used to enhance participant comfort during the start and end of each stimulation session, following standardized electrode placement and safety protocols.
The stimulation will be delivered in a comfortable sitting or lying position
|
|
Kokeellinen: Transcutaneous spinal cord stimulation + Augmented reality Group
|
Transcutaneous spinal cord stimulation will be administered non-invasively using surface electrodes placed over the D12-L1 spinal segment.
Stimulation will be delivered using the Soterix 1×1 Transcutaneous Electrical Stimulation (TES) unit.
Stimulation will be applied at a frequency range of 30 Hz.
The pulse duration is 1 ms, and the intensity will be set at 2 mA.
A ramp-up and ramp-down time of 30 seconds will be used to enhance participant comfort during the start and end of each stimulation session, following standardized electrode placement and safety protocols.
The stimulation will be delivered in a comfortable sitting or lying position
AR-based rehabilitation will involve interactive balance and coordination tasks performed in a virtual environment all while receiving real-time visual feedback to guide movement accuracy and postural control.
The main training block will comprise exercises focusing on hip flexion, hip abduction, knee flexion, and lateral weight shifting.
Each module will be performed for 5-8 minutes, with short rest intervals between tasks.
|
|
Active Comparator: Augmented reality Group
|
AR-based rehabilitation will involve interactive balance and coordination tasks performed in a virtual environment all while receiving real-time visual feedback to guide movement accuracy and postural control.
The main training block will comprise exercises focusing on hip flexion, hip abduction, knee flexion, and lateral weight shifting.
Each module will be performed for 5-8 minutes, with short rest intervals between tasks.
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
International Physical Activity Questionnaire
Aikaikkuna: Up to week 5
|
The IPAQ assesses physical activity across four domains: work, transport, domestic, and recreation time. It includes 27 items and collects data on frequency and duration of physical activity at three intensity levels; high, moderate, and low. The IPAQ has Test-retest reliability ICC = 0.80. the score is calculated by converting activity into MET-minutes/week. Low activity: < 600 MET-min/week, Moderate activity: 600-3000 MET-min/week and High activity: > 3000 MET-min/week. Outcome will be measured at Baseline then Week 1 and then week 5 |
Up to week 5
|
|
Diabetes Quality of Life Questionnaire
Aikaikkuna: Up to week 5
|
The Diabetes Quality of Life (D-QoL) questionnaire is a disease-specific instrument originally developed for the diabetes control and complications trial (DCCT) to assess the quality of life in individuals with diabetes mellitus.
It has 46 items divided into three main domains: satisfaction, impact, and worry.
Each item is rated on a likert scale, with higher scores indicating greater impact, or concern.
The tool assesses the individual's perception of how diabetes affects various aspects of life, including daily activities, social functioning, and emotional well-being.
The D-QoL has demonstrated strong reliability and validity, with internal consistency ranging from 0.73 to 0.94 for its subscales.
Outcome will be measured at Baseline then Week 1 and then week 5
|
Up to week 5
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Neurothesiometer
Aikaikkuna: Up to week 5
|
The neurothesiometer is a non-invasive and reliable device for assessing vibration perception threshold (VPT).
The neurothesiometer demonstrated excellent intra-class correlation coefficients (ICCs) exceeding 0.90, highlighting its consistency.
The cut off value of ≥ 6hz indicates presence of neuropathy.
This tool is beneficial in clinical settings due to its ease of use, objective quantification, and ability to detect subclinical neuropathy.
The neurothesiometer offers superior standardization, making it a preferred method for evaluating protective sensation and vibration loss in diabetic populations.
Outcome will be measured at Baseline then Week 1 and then week 5
|
Up to week 5
|
|
Sit and reach test
Aikaikkuna: Up to week 5
|
The sit-and-reach test is a widely used tool for assessing lower limb flexibility.
The test demonstrates excellent reliability, with intra-class correlation coefficients (ICCs) ranging from 0.92 to 0.99, indicating strong consistency in repeated measures.
Scoring is based on distances recorded in inches or centimeters, higher values indicate better flexibility.
It is simple to administer, cost-effective, making it a reliable method for flexibility assessment in healthy adult populations.
Outcome will be measured at Baseline then Week 1 and then week 5
|
Up to week 5
|
Yhteistyökumppanit ja tutkijat
Sponsori
Tutkijat
- Päätutkija: Mirza Obaid Baig, MSPT, Riphah International University
Julkaisuja ja hyödyllisiä linkkejä
Yleiset julkaisut
- Barss TS, Parhizi B, Porter J, Mushahwar VK. Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord. J Clin Med. 2022 Jan 27;11(3):639. doi: 10.3390/jcm11030639.
- Stanica IC, Moldoveanu F, Portelli GP, Dascalu MI, Moldoveanu A, Ristea MG. Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement. Sensors (Basel). 2020 Oct 23;20(21):6045. doi: 10.3390/s20216045.
- Mekhail NA, Argoff CE, Taylor RS, Nasr C, Caraway DL, Gliner BE, Subbaroyan J, Brooks ES. High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN). Trials. 2020 Jan 15;21(1):87. doi: 10.1186/s13063-019-4007-y.
- Alonso-Enriquez L, Gomez-Cuaresma L, Billot M, Garcia-Bernal MI, Benitez-Lugo ML, Casuso-Holgado MJ, Luque-Moreno C. Effectiveness of Virtual Reality and Feedback to Improve Gait and Balance in Patients with Diabetic Peripheral Neuropathies: Systematic Review and Meta-Analysis. Healthcare (Basel). 2023 Nov 24;11(23):3037. doi: 10.3390/healthcare11233037.
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
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