Comparative Effects of Reactive Balance Training and Task-Oriented Training on Postural Stability in Patients With Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is a common complication, resulting from prolonged high blood sugar damaging peripheral nerves. It substantially affects patients by increasing their risk of falls, impairing sensory function, and diminishing overall quality of life. Exercise programs that include balance training have demonstrated promising results in enhancing postural stability and reducing fall risk among patients with DPN .By engaging the visual, vestibular, and proprioceptive systems, balance training facilitates central nervous system adaptation, enhancing the integration of sensory inputs critical for maintaining postural control.This randomized controlled trial aims to compare the effects of Reactive Balance Training and Task-Oriented Training on Postural Stability in Patients with Diabetic Peripheral Neuropathy.The study will be a single -blinding randomized controlled trial, consisting of 2 groups and it will be conducted over a period of 1 year at Foundation University and Collage of Physical Therapy. A calculated sample of 36 subjects will be selected via convenience sampling technique followed by randomization into two groups using coin toss method. Ethical approval will be obtained from FUSH ERC. Individuals fulfilling the inclusion criteria will be selected, followed by written informed consent after explaining the study purpose. Postural stability will be assessed using Posture Assessment Checklist Form, MiniBestest, Funtional Reach test and Time Up and Go in both group.

Each group will have 30-40 minutes divided into 5-7 minutes of warm-up and 20-30 minutes of Reactive balance training or task-specific depending on the group the patient is assigned to follow by 5 minutes cool down period. With every 3 sets or 8-10 repetitions patient will take a 60 seconds break. The total intervention duration will last for 6 weeks. The total number of sessions will be 18 with 3 sessions per week. Each session will begin with a 5-7-minute warm-up consisting of marching in place, ankle pumps and circles, and anterior-posterior (AP) and medial-lateral (ML) weight shifts. This will be followed by 20-30 minutes of group-specific training, with the Reactive Balance Training group performing perturbation-based tasks involving unexpected changes in direction, timing, or surface, while the Task-Oriented Training group will perform functional, goal-directed activities with repetitive practice and progressive challenges.

Each session will conclude with a 5-minute cool-down, including slow walking and stretching of the calf, hamstrings, and hip flexors. Group A will receive reactive balance training with Protocol of 6 Weeks.

In Weeks 1-2 - Familiarization: Warm-up (5-7 min), followed by lean-and-release (forward/backward), gentle AP pelvic perturbations, predictable reactive stepping, and elastic-band perturbations in AP/lateral directions. Cool-down (5 min). Dosage: 3 × 10 perturbations, 60-s rest.

In Weeks 3-4 - Adaptation: Multidirectional lean-and-release, eyes-closed perturbations, foam-surface perturbations, foam + elastic-band perturbations, and eyes-closed elastic perturbations. Dosage: 3 × 10 trials, 60-s rest.

In Weeks 5-6 - Functional/Automatic Phase: High-velocity manual perturbations with narrow/tandem stance, reactive stepping during gait, obstacle negotiation with perturbation, and dual-task reactive balance (counting backward while walking). Dosage: 3 × 10 repetitions, 60-s rest.Safety: Gait belt, therapist guarding, stable support, and appropriate elastic-band use throughout.

Group B will receive Task oriented training of 6 weeks protocol with Weeks 1-2 - Basic Functional Task Acquisition: The objective is to improve postural alignment and basic functional mobility. Participants will perform sit-to-stand from a standard chair, static standing with functional reaching, weight shifting while reaching, forward and lateral stepping, and supported heel-to-toe standing. Dosage: 3 sets × 10 repetitions per task, with 60-second rest.

Weeks 3-4 - Intermediate Functional Task Training: The goal is to enhance dynamic balance and functional independence through sit-to-stand from a low chair, reaching beyond arm's length, multidirectional stepping, obstacle crossing during gait, and step-ups. Difficulty will progress by reducing upper-limb support and increasing task speed and repetitions. Dosage: 3 × 10 repetitions, 60-second rest.

Weeks 5-6 - Advanced & Real-Life Task Integration: Activities will include carrying objects during sit-to-stand, dual-task walking, turning/pivoting, obstacle negotiation with load carrying, and simulated ADL tasks. Progression will involve a narrow base of support and increased task complexity and environmental variability. Dosage: 3 × 10 repetitions, 60-second rest.

Baseline assessment will be taken at the time of recruitment using MiniBestest, FRT ,TUG tool and Posture Assessment checklist form. Another assessment at 3rd week will be taken and lastly, post intervention assessment will be done by the end of 6th week using the same tools as mentioned previously. Data will be analyzed using SPSS version 22.