Effect of Educational Booklet for Foot-related Exercises for Prevention and Treatment in People With Diabetic Neuropathy
Condition: Diabetic Neuropathies
MeSH terms: Diabetic Neuropathies
Study type: Interventional

Summary: 
      The main objective of this trial is to investigate the effect of an educational booklet
      foot-related exercise in diabetic neuropathy status, functional outcomes and gait
      biomechanics in people with diabetic neuropathy.
    

Detailed description: 
      A randomized controlled trial will be performed with 48 patients with diabetic neuropathy.
      The participants will be randomly assigned into either a control group (recommended foot care
      by international consensus with no foot exercises) or an intervention group that will perform
      exercises at home, three times a week, through the booklet for 8-weeks.

      The subjects will be evaluated in 3 different times to access the effect of the intervention:
      baseline and 8weeks, for all outcomes; and 16 weeks, for follow-up reasons for all outcomes.

      The following outcomes will be assessed in all times: (1) diabetic neuropathy symptoms by
      Michigan Neuropathy Screening Instrument, (2) fuzzy score of the neuropathy severity, (3)
      tactile and vibration sensititivity (10-g monofilament and tuning fork), (4) foot-ankle
      kinematics and ankle kinetics during gait (infrared cameras and inverse dynamics,
      respectively), (5) foot isometric strength (by a pressure plate measurement), (6) functional
      balance reach test, (7) foot health and functionality by the Foot Health Status
      Questionnaire, (8) plantar pressure distribution during gait.

      The hypothesis of this study is that the intervention will increase the perception of the
      tactile and vibratory sensitivity of the foot, reduce the symptoms of diabetic neuropathy,
      increase the strength of the foot muscles, increase the functional balance score, decrease
      the severity of the diabetic neuropathy (fuzzy score), decrease the number of neuropathy
      symptoms, promote a more physiological foot rollover with a redistribution of plantar
      pressure during gait, as well as increase foot-ankle mobility after 08-weeks of intervention.
      There will be also beneficial biomechanical changes during gait, such as: (1) increase in the
      ankle extensor moment and ankle concentric power in the propulsion phase and (3) increase in
      the ankle flexor moment and ankle eccentric power in the load phase.
    

Intervention name(s): Educational and home-based physical therapy by foot-related exercises
Intervention type(s): Other
Intervention description(s): The booklet is divided in 2: educational and exercise protocol. The aim of the first part is to guide the individual for a change in his/her health behavior, and comprises info about diabetic neuropathy, foot care, shoes, and benefits of exercising. The second part is the foot protocol, composed by 6 exercises. The maximum duration of a session is 20min and should be performed 3 times/week. The subject should warm-up the foot-ankle and then start exercising in the order suggested by the booklet, filling a table with the effort perceived (effort likert scale). The foot exercises progresses from one set with 30 repetitions in a sitting position, to exercising standing, then performing the exercise on one foot only. Other progression criterion is to increase the number of sets performed. The effort scale regulates the individual effort for his/her progression, which is also registered by the participant in the monthly table at the booklet.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: exercise therapy; diabetic foot; preventive care; foot-related exercise; self-management; musculoskeletal function; Booklet; Primary Health Care