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Effects of Perturbation-Based Versus Conventional Balance Training on Reactive Stepping Ability in Patients With Diabetic Peripheral Neuropathy
Sponsor: Lahore University of Biological and Applied Sciences
Summary
This study will compare perturbation-based balance training (PBBT) with conventional balance training in patients with diabetic peripheral neuropathy to assess reactive stepping ability, dynamic balance, and functional balance. Diabetic peripheral neuropathy is a prevalent complication of type 2 diabetes, affecting nearly 43% of diabetic patients in Pakistan. As a progressive condition, it leads to peripheral sensory loss, proprioceptive deficits, and delayed neuromuscular responses, all of which compromise balance and postural control and place this population at significantly elevated risk of falls. In this study, a total of 40 adults with DPN will be randomly allocated into two groups: PBBT and CBT. Both groups will receive a total of 24 sessions with 3 supervised sessions per week for 8 weeks. The PBBT group will receive manually delivered, repeated, unexpected perturbations by a physical therapist. The CBT group will receive conventional balance training without perturbations. Outcome measures will include reactive stepping (Lean-and-Release Test), dynamic balance (Mini-BESTest), and functional balance (Berg Balance Scale). The assessment will be done at baseline, post-intervention (Week 8), and follow-up (Week 12). The study aims to determine which intervention provides superior improvement in reactive stepping and balance in patients with diabetic peripheral neuropathy.
Key Details
Gender
All
Age Range
45 Years - 65 Years
Study Type
INTERVENTIONAL
Enrollment
40
Start Date
2026-10-12
Completion Date
2027-01
Last Updated
2026-10-28
Healthy Volunteers
No
Conditions
Interventions
Perturbation-Based Balance Training (PBBT)
Participants will receive routine physical therapy (7 minutes of warm-up, 6 minutes of rest, and 7 minutes of cool-down) along with perturbation-based balance training for 8 weeks, with 3 supervised sessions per week (24 sessions, 60 minutes each). After a 2-week shared familiarization phase (weeks 1-2), participants will receive manually delivered, repeated exposure to unexpected and externally imposed postural perturbations by a physical therapist in standing position on stable and unstable surfaces (weeks 3-8). Perturbations will progress from anterior and posterior to multi-directional and randomized, and from standing tasks to walking, uneven surfaces, and dual-task conditions, increasing from 10 to 15 perturbations per session. A support bar and pre-session blood glucose monitoring will be used for safety.
Conventional Balance Training (CBT)
Participants will receive routine physical therapy (7 minutes of warm-up, 6 minutes of rest, and 7 minutes of cool-down) along with conventional balance training for 8 weeks, with 3 supervised sessions per week (24 sessions, 60 minutes each). After a 2-week shared familiarization phase (weeks 1-2), participants will be trained for balance with eyes open and eyes closed in various conditions on stable and unstable surfaces, with no manual perturbations (weeks 3-8). Training will progress from foam-pad standing and weight shifting to functional gait tasks, obstacle negotiation, stair negotiation, and dual-task walking. A support bar and pre-session blood glucose monitoring will be used for safety.
Locations (1)
Gillani Physio & Joint Care
Lahore, Punjab Province, Pakistan