Effects of Perturbation-Based Versus Conventional Balance Training on Reactive Stepping Ability in Patients With Diabetic Peripheral Neuropathy

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.

Inclusion Criteria: * Adults aged 45-65 years of either gender. * Confirmed cases of diabetic peripheral neuropathy with a score ≥2.5 on physical examination using the Michigan Neuropathy Screening Instrument (MNSI). * Able to stand independently on a firm surface and walk independently without a walking aid. Exclusion Criteria: * Patients with active diabetic foot ulcers, gangrene, severe peripheral vascular disease, or severe musculature disorder. * Any neurological condition other than peripheral neuropathy affecting balance or postural control. * Participants with any musculoskeletal condition, such as fracture, joint replacement, recent lower-limb or spinal surgery, or other balance-related musculoskeletal disorders that may affect balance, gait, or functional mobility will be excluded.