Effects of Exercise Through Telerehabilitation on Balance and Walking Speed in Older Adults with Diabetic Peripheral Neuropathy: A Randomized Controlled Trial

Abstract

Objective: Determine the effects of exercise through telerehabilitation (TR) on balance and walking speed in older adults with diabetic peripheral neuropathy (DPN). Materials and Methods: An observer blinded randomized controlled trial was conducted at Sirindhorn School of Prosthetics and Orthotics. Participants age ≥60 years with type 2 diabetes, DPN, and a moderate to high risk of diabetic foot ulcer were randomly assigned to an intervention group who underwent an eight-week TR exercise program (2 x 60 min/week) and a control group who received standard hospital care. Outcome measures were balance (Berg Balance Scale, BBS), walking speed (10-Meter Walk Test, 10MWT), and satisfaction. Differences in change between the groups were analyzed using Mann Whitney U (MWU) test or t-test for independent samples. Results: Forty-four participants were included (intervention: n=22; control: n=22), with 18 and 21 completing the study, respectively. The median age [IQR] was 69.5 [63, 72.8] years in the intervention group and 67 [65, 74] years in the control group. No differences between groups were found in baseline characteristics and initial outcomes. The intervention group demonstrated significantly greater improvements than the control group in BBS scores (median change [IQR]: 6.5 [4.8, 5.2] vs. -1 [-1, -2], P<0.001, MWU test) and 10MWT time (mean change -1.9 seconds [95% CI: -2.5, -1.3] vs. -0.1 seconds [95% CI: -0.5, 0.4], P<0.001, independent t-test). The intervention group was highly satisfied with the program. Conclusion: This exercise through TR improves balance and walking speed in older adults with DPN. High satisfaction supports its feasibility and acceptability.