Slider Versus Tensioner Neural Mobilization in Diabetic Peripheral Neuropathy

Study Overview
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Brief Summary
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Neurodynamics, i.e., the mobilization of the peripheral nervous system, is a physical approach to the treatment of pain; the method relies on influencing pain physiology via mechanical treatment of neural tissues and the non-neural structures surrounding the nervous system. Neural mobilization (NM) is used to treat various disorders of the nervous system concerning the length and mobility of peripheral nerves, as the nerve mobilizing refers to techniques that help to reestablish motion between a nerve and its surrounding soft tissues, thus to treat the nerves that have become entangled within the soft tissue, as it leads to tension release on a nerve by stretching and pulling one end of the nerve during keeping the other end in a relaxed state.

Detailed Description
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The neurodynamic technique both sliders and tensioners results in changes of the mechanical or physiological function of nerve tissues along with the interface; restoring pressure gradients, relieving hypoxia and pain resulting in reducing associated symptoms. Through clinical reasoning the nervous system seems to be the logical place for treatment and explanations and previous descriptions of this method have clarified the overall impact on quality of life in diabetic peripheral neuropathy but it doesn't discuss which technique of neural mobilization is more effective and its effects on diabetic peripheral neuropathic population. Within this reasoning it is important to determine which neurodynamic technique is more effective in improving quality of life and reduce pain in patients with diabetic peripheral neuropathy.

Official Title
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Compare the Effects of Sliding With Tensioner Technique of Neural Mobilization in Diabetic Peripheral Neuropathy Patients

Conditions
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Diabetic Peripheral Neuropathic Pain

Intervention / Treatment
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* Other: Sliding Neural mobilization
* Other: Tensioner Neural mobilization
* Other: Stretching exercises
* Device: TENS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient having≥12score on Self report Leads Assessment of Neuropathic Symptoms and Sign Patients with lower limb pain ≥4 to ≤7 on NPRS Exclusion Criteria: Diabetic foot ulcer Complex regional pain syndrome Infection in lower limb Lower extremity amputation Discogenic pain Restricted joint deformity Dependency on chemical or drugs Pregnancy

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A<br>TENS, Stretching exercises, ROM exercises Sliding neural mobilization to femoral, sciatic, tibial nerve | Other: Sliding Neural mobilization<br>* Sliding neural mobilization to femoral, sciatic and tibial nerve<br>Other: Stretching exercises<br>* Stretching exercises<br>Device: TENS<br>* TENS<br>|
| Active Comparator: Group B<br>TENS, Stretching exercises, ROM exercises Tensioner neural mobilization to femoral, sciatic, tibial nerve | Other: Tensioner Neural mobilization<br>* Tensioner neural mobilization to femoral, sciatic and tibial nerve<br>Other: Stretching exercises<br>* Stretching exercises<br>Device: TENS<br>* TENS<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Michigan neuropathy screening instrument | For screening the neuropathy; The MNSI questionnaire is self-administered. Responses are added to obtain a total score. 'Yes' responses to questions 1-3, 5-6, 8-9, 11-12, 14-15 are each counted as one point. 'No' responses to questions 7 and 13 each count as one point. Question 4 was considered to be a measure of impaired circulation and question 10 a measure of general asthenia and were not included in the published scoring algorithm. A score of ≥ 7 was considered abnormal. All 15 questions were included in the new scoring algorithms. | 3 weeks | 
| Numerical Pain Rating Scale | Quantify the pain ranging from 0 to 10 in which zero means no pain and 10 severe pain | 3 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Life SF-36 | to assess the quality of life, SF-36 ; Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | 3 weeks |