Effect of Manual Therapy on Tibiotarsal Joint Mobility in Diabetic Individuals
Condition: Diabetes Complications
MeSH terms: Diabetes Complications
Study type: Interventional

Summary: 
      The study aimed to evaluate the acute effect of manual therapy on ankle joint mobility in
      diabetic patients. Forty volunteers, with a mean age of 59.35±7.85, with type 2 DM and
      neurological symptoms of Diabetic Distal Polyneuropathy according to a Diabetic
      Polyneuropathy Diagnostic Scale (EDPNDD) protocol with the amplitude were performed. Were
      divided into two groups: Sham group (GS), and intervention group (GI), which underwent manual
      manipulation intervention and seven-day follow-up. Joint range of motion analysis was
      performed using digital goniometry and static discharge of weights assessed by computerized
      baropodometry with open and closed eyes, and the Shapiro-Wilk normality test evaluated data
      distribution and relative, Tukey post hoc set ANOVA tests were used for non-normal variables.
      The Kruskal- Wallis test followed by Dunn&#39;s post-hoc test. SAS statistical software was
      used and the significance level of 5%. Results: The results showed an increased joint range
      of motion, plantar flexion, and dorsiflexion, between the moments and moments after
      manipulation and follow-up. It was still possible to make a significant difference between GI
      when it was with GS at poster and follow-up. No intragroup analysis was performed by GS, for
      analysis over time. Regarding intragroup comparisons over time (pre, post-intervention, and
      follow-up), a significant difference was made for Front and back displacement amplitude (PAD)
      with open eyes of the GI, with an increase after intervention and reduction without follow
      up. Conclusion: Based on the results obtained, the work performed with manual therapy
      increased the ankle joint amplitude in diabetic individuals.
    

Detailed description: 
      Diabetes Melittus (DM) is a disease of great incidence, and one of the main public health
      problems worldwide, having as complications the deficit in the functional performance of the
      lower limbs, which can interfere in the maintenance of the balance, besides being a Strong
      predictor of functional limitations. Individuals affected by diabetes are predisposed to
      reduce the mobility of the tibial-tarsal joint. Manual therapy is often used for the purpose
      of improving range of motion. The objective of this study is to evaluate the acute effect of
      manual therapy on ankle joint mobility in diabetic patients. 40 volunteers, aged 59,35±7,85
      years, DM type 2 and tibial-tarsal joint amplitude limitation, of both genders were
      recruited, divided into two groups: group 1 (Sham: submitted to evaluations and follow up of
      seven days), and group 2 (intervention: submitted to the evaluations, manipulative manual
      intervention, with follow up of seven days). The analysis of joint range of motion was
      acessed by digital goniometry and the static discharge of weight was evaluated by
      baropodometry computed with open and closed eyes. After tabulation of variables, the
      Shapiro-Wilk normality test was applied to analyze the distribution. Before a normal and
      related distribution, ANOVA followed by Tukey post-hoc tests were used. For the variables
      that presented a non-normal distribution, the Kruskal-Wallis test was used, followed by the
      Dunn post-hoc test. For the variables that presented a non-normal distribution, the
      Kruskal-Wallis test was used, followed by the Dunn post-hoc test. The SAS software was used
      and a significance level of 5% was considered. The results showed an increase in joint range
      of motion, in the right and left dorsiflexions of the GI between the initial moment and the
      post-manipulation moments, as well as after seven days of the follow-up. There was also a
      significant difference between GI when compared to GS in the post and follow-up moments.
      Regarding the clinical effect of the intervention over time, the intragroup analysis showed
      that in GS there was no difference between the amplitude of movement registers comparing the
      pre-intervention moment with the subsequent records (post and follow-up), even for plantar
      and dorsiflexion flexion movements on both sides. In relation to static plantar weight
      discharge, there was a change in recorded values for the peak of total foot pressure, on the
      right and left sides of the GI, between the moments after the immediate intervention and in
      the measurement 7 days after the manipulative intervention (follow -up), for registration
      with open eyes. Regarding intra-group comparisons over time (pre, post-intervention and
      follow-up), a significant difference was observed for the condition amplitude of
      anteroposterior displacement (DAP) with open eyes of the GI, observing an increase after
      intervention and reduction in the follow-up. In view of the obtained results, it can be
      inferred that the acute intervention with manual therapy produces an increase in the joint
      amplitude of the ankle of diabetic individuals.
    

Intervention name(s): High Velocity Low Amplitude manipulation (HVLA); Care assessment and guidance
Intervention type(s): Procedure; Procedure
Intervention description(s): The thrust manipulation technique was used, which consists of high speed and small amplitude manipulation. The therapeutic intervention was performed through decompressive maneuvers for the tibiotarsal joints. The choice of the place of application of the manipulation technique was delimited by the identification of the area or areas with compressive compartmental impairment and joint restriction. The use of the method depended directly on the identification of one or more regions of joint restraint.; Evaluation and care guidelines on glycemic control and diabetic foot care.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The volunteers were randomized by means of sealed matte envelopes in the following groups: sham group (GS), evaluated on day 1 and day 7, and received preventive diabetes guidance at the end of the experiment (follow-up) and intervention group (GI), assessed on day 1, then underwent manual manipulation intervention and were reevaluated post-intervention. They were again evaluated on the 7th post-treatment day and received preventive guidance at the end of the experiment (follow-up).
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Physiotherapy; Diabetes Melittus; Manual Therapy; Ankle Joint