Content and effects of balance training in people with diabetic peripheral neuropathy – a systematic review and meta-analysis

Diabetic Peripheral Neuropathy (DPN) impairs balance due to sensory loss, proprioceptive deficits, muscle weakness, altered gait, and delayed reflexes. Targeted aerobic and balance training seem promising to mitigate these issues. However, the exact content of a recommended training regime is yet to be determined. To delineate and synthesise balance training content and efficacy for people with DPN. The literature search was conducted on PubMed and Embase in accordance with the PRISMA-checklist. Last search was performed on April 29, 2024. Inclusion criteria were established using the PICO-framework. Methodological quality was assessed using the TESTEX Scale. Meta-analyses were exclusively applied to studies featuring a passive control group. A total of 2007 articles were identified. Twelve studies were included in the qualitative synthesis. Seven studies were included in the meta-analyses. Two studies were of high quality. Most studies reported the frequency, session time, duration, and setting of balance training, while none reported the intensity. The meta-analyses showed a standardized mean difference in favor of balance training compared to passive control for One-Legged Stance (openeyes) (0.89[0.5,1.28]), One-Legged Stance (closed eyes) (1.48[0.36, 2.60]), Postural sway (−0.71[−1.04, −0,37]), Timed Up and Go(−0.94[−1.78, −0.10]), and Berg Balance Scale (2.26[0.48, 4.05]), respectively. Studies are few and generally of low methodological quality. The content of balance training interventions is minimally described, especially concerning the applied intensity. However, balance training does seem to improve balance outcomes in people with DPN, but given the methodological limitations, interpretation must be cautious.

糖尿病周围神经病变（Diabetic Peripheral Neuropathy，DPN）可因感觉丧失、本体感觉缺陷、肌肉无力、步态改变及反射延迟损害患者的平衡能力。针对性有氧训练与平衡训练似乎有望改善上述问题，但目前推荐的训练方案的确切内容仍有待明确。为明确并综合针对DPN患者的平衡训练内容与疗效，本研究依照系统评价与元分析首选报告条目清单（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）在PubMed与Embase数据库中开展文献检索，末次检索时间为2024年4月29日。本研究采用PICO框架（PICO-framework）制定纳入标准，使用TESTEX量表（TESTEX Scale）评估研究的方法学质量，元分析（Meta-analysis）仅应用于设置被动对照组的研究。最终共检索到2007篇文献，其中12项研究纳入定性综合分析，7项研究纳入元分析。2项研究的方法学质量较高。多数研究报告了平衡训练的频率、单次时长、总持续时间与实施场景，但未提及训练强度。元分析结果显示，相较于被动对照组，平衡训练在单腿站立（睁眼）（One-Legged Stance (openeyes)）（标准化均数差=0.89[0.5,1.28]）、单腿站立（闭眼）（1.48[0.36,2.60]）、姿势摆动（Postural sway）（-0.71[-1.04,-0.37]）、计时起立行走测试（Timed Up and Go）（-0.94[-1.78,-0.10]）及伯格平衡量表（Berg Balance Scale）（2.26[0.48,4.05]）等指标上均表现出显著优势。现有研究数量较少且整体方法学质量偏低，平衡训练干预的具体内容描述不足，尤其是训练强度相关信息。尽管如此，平衡训练确实可改善DPN患者的平衡相关结局，但鉴于研究存在方法学局限性，对结果的解读需谨慎。