An interventional study of Tibial nerve mobilization and Multisensory Excercise in Diabetic Pheripheral Neuropathy, sponsored by Qurat Ul Ain Ashfaq. Completed at 1 site in Pakistan. Open to female participants aged 40 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-11-02.
Sponsored by Qurat Ul Ain Ashfaq · Not applicable, Interventional, and Treatment
Diabetes mellitus is a chronic metabolic condition characterized by high blood glucose levels due to insufficient insulin production or the body's inability to respond properly to insulin. One of its common complications is diabetic peripheral neuropathy (DPN), which develops when prolonged high blood glucose levels damage peripheral nerves, particularly those in the lower limbs and feet. Patients with diabetic peripheral neuropathy may experience burning pain, tingling, numbness, muscle weakness, and loss of sensation. The condition can also affect balance and walking ability, making daily activities difficult. Reduced sensation increases the risk of unnoticed injuries, foot infections, ulcers, and other serious complications.
A randomized controlled trial was conducted involving 38 participants, divided into two groups. Group A received tibial nerve mobilization along with conventional physiotherapy, while Group B received multisensory exercise training along with conventional physiotherapy. According to the abstract, both interventions were delivered for 35 minutes per session, three sessions per week, over four weeks.
The aim of this study is to determine the comparison of multisensory exercise and tibial nerve mobilization in patients with type 2 diabetic peripheral neuropathy.
Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels due to insufficient insulin production or the body's reduced response to insulin. One of its important complications is diabetic peripheral neuropathy (DPN), which involves damage to peripheral nerves, particularly those supplying the lower limbs and feet. Patients with diabetic peripheral neuropathy may experience burning pain, tingling, numbness, muscle weakness, and reduced sensation. The condition can also impair balance and walking ability, increasing the risk of unnoticed injuries, foot ulcers, infections, and functional limitations. Chronic high blood glucose contributes to nerve damage through metabolic, vascular, oxidative stress, and inflammatory processes. These changes may impair nerve function and negatively affect patients' physical, mental, and overall quality of life. Physiotherapy can help address the functional problems associated with diabetic peripheral neuropathy. Two interventions considered in this study are multisensory exercise and tibial nerve mobilization.
Multisensory exercise focuses on activities that challenge sensory integration and postural control. Tibial nerve mobilization focuses on mobilizing the tibial nerve to address neural movement and sensitivity. The study compares these interventions to determine their relative merits. The BBS is a functional assessment tool used to evaluate balance during sitting, standing, and functional movements. It consists of 14 items, each scored on a five-point scale. The scores are added to obtain the overall balance score. A higher score indicates better balance performance. The SF-12 is a 12-item questionnaire used to assess health-related quality of life. Group A-Multisensory exercise: Participants receive multisensory exercise training alongside conventional physiotherapy.
Group B - Tibial nerve mobilization: Participants receive tibial nerve mobilization alongside conventional physiotherapy. Thirty five minutes per session, three sessions per week, for four weeks. Pain, balance, and quality of life are evaluated to compare the outcomes of the two interventions.
10,054 studies on the registry are indexed under Pain; 1,649 are open to participants now.
This study's enrollment of 34 is below the median of 66 across 8,493 interventional studies indexed under Pain.
Browse Pain studies →Qurat Ul Ain Ashfaq is the lead sponsor of 2 studies on the registry; none are open to participants now.
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Inclusion Criteria: Adults aged 40-60 years. Diagnosed cases of type 2 diabetes mellitus by clinical and laboratory tests. Diagnosed case of subclinical diabetic neuropathy by physician. Moderately disturbed balance on BBS from the 21 to 40 range. Both male and female participants. Participants must have poor glycemic control according to ≥ 7.5% or fasting blood glucose ≥ 130 mg/dl or random blood glucose ≥ 200 mg/dl.
No cognitive impairments that would affect participation. (31) Diabetes duration of less than 10 years. Severe diabetic neuropathy with a \<12 score on the Toronto Clinical Neuropathy Score.
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Exclusion Criteria: Presence of other systemic diseases apart from diabetes, such as diseases or rheumatoid arthritis.
Foot ulcers that are classified as Grade 2 or higher using the Wagner Ulcer Classification.
Recent fractures, or trauma leading to nerve injuries in the last year. Patient with any other neurological issue like stroke, multiple sclerosis, Parkinson's, etc.
Visual impairments or cognitive disorders that could affect participation. History of recent vascular complications, surgical procedures for lower limbs in the last 6 months, or amputation above the metatarsophalangeal joint.
Leprosy or any skin disease.
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Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A blood test of average blood sugar over the past two to three months, given as a percentage or in mmol/mol. 6.5% (48 mmol/mol) or more is the usual threshold for diabetes, normally confirmed by a second test.
A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.
Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.
HbA1c
A blood test of average blood sugar over the past two to three months, given as a percentage or in mmol/mol. 6.5% (48 mmol/mol) or more is the usual threshold for diabetes, normally confirmed by a second test.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Autoimmune disease
A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.
Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants in the multisensory exercise group received multisensory exercise training in addition to conventional physiotherapy. The session duration was 35 minutes, 3 sessions per week, and for 4 weeks. Warm-up: ankle dorsiflexion and plantarflexion, inversion and eversion, walking at a normal pace, and calf and hamstring stretching. Visual-system exercises: visual-motor coordination, including focusing on a moving target while moving the head from side to side and up and down. The intervention was intended to improve balance, functional performance, and quality of life, while reducing pain associated with diabetic peripheral neuropathy.
Other: Multisensory Excercise
Tibial nerve mobilization will be administered for 20 minutes as part of a 35-minute treatment session. The intervention included three techniques: remote sliders, local sliders, and tensioners. For remote sliders, the patient was positioned in supine lying with the hip flexed to approximately 90° and the knee extended. Ankle dorsiflexion with eversion was combined with cervical flexion and extension to facilitate proximal and distal neural excursion. For local sliders, the patient remained supine with the hip and cervical spine in neutral and the knee fully extended and stabilized. The therapist supported the heel and forefoot while alternating ankle dorsiflexion with eversion and plantarflexion with inversion. For tensioners, the patient lay supine with the hip flexed and knee fully extended; the therapist progressively elevated the limb to increase hip flexion while applying ankle dorsiflexion with eversion and simultaneous cervical flexion to increase neural tension.
Other: Tibial nerve mobilization
Tibial nerve mobilization will be administered for 20 minutes as part of a 35-minute treatment session. The intervention included three techniques: remote sliders, local sliders, and tensioners. For remote sliders, the patient was positioned in supine lying with the hip flexed to approximately 90° and the knee extended. Ankle dorsiflexion with eversion was combined with cervical flexion and extension to facilitate proximal and distal neural excursion. For local sliders, the patient remained supine with the hip and cervical spine in neutral and the knee fully extended and stabilized. The therapist supported the heel and forefoot while alternating ankle dorsiflexion with eversion and plantarflexion with inversion. For tensioners, the patient lay supine with the hip flexed and knee fully extended; the therapist progressively elevated the limb to increase hip flexion while applying ankle dorsiflexion with eversion and simultaneous cervical flexion to increase neural tension.
Participants in the multisensory exercise group received multisensory exercise training in addition to conventional physiotherapy. The session duration was 35 minutes, 3 sessions per week, and for 4 weeks. Warm-up: ankle dorsiflexion and plantarflexion, inversion and eversion, walking at a normal pace, and calf and hamstring stretching. Visual-system exercises: visual-motor coordination, including focusing on a moving target while moving the head from side to side and up and down. The intervention was intended to improve balance, functional performance, and quality of life, while reducing pain associated with diabetic peripheral neuropathy. In conventional treatment, TENS will apply for 5 minutes, with a pulse duration of 150 µs and a frequency of 80 Hz. Ankle range-of-motion exercises: 5 minutes, including dorsiflexion, plantarflexion, inversion, and eversion, with 10 repetitions of the movements.
Visual Analogue Scale
The scoring range is from 0 to 10, where 0 shows no pain, 5 shows moderate pain, and 10 shows the worst pain.
Time frame: 4 weeks
Quality of life (SF-12 Health Survey)
It will be used to evaluate the quality of life. It is a health-related quality of life questionnaire including 12 questions. (28) It has eight main ones, which are some up to see physical and mental health. It has a scoring range from 0 to 100 for both physical and mental health.
Time frame: 4 weeks
Berg Balance Scale (BBS)
The Berg balance scale consists of 14 dynamic and static activities that were applicable to everyday life. Through direct observation of the participant's performance by medical professionals in a variety of contexts, the BBS evaluates balance and fall risk. A 5-point ordinal scale was used for scoring, with 0 denoting incompetence to execute the job and 4 denoting independence. The best possible score of 56 indicates good balance.
Time frame: 4 weeks
Plan to share: No
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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Qurat Ul Ain Ashfaq