COMPARATIVE EFFECTS OF INTRANEURAL FACILITATION THERAPY AND NERVE FLOSSING TECHNIQUE ON PAIN, BALANCE, GAIT, AND QUALITY OF LIFE IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY: A RANDOMIZED CLINICAL TRIAL

Abstract

Background: Diabetic peripheral neuropathy (DPN) impacts >50% of type 2 diabetes patients, leading to microvascular ischemia, neuropathic pain, and functional impairments in balance and gait. Intraneural Facilitation (INF) therapy is a manual technique that reduces endoneurial hypoxia, while the Nerve Flossing (NF) technique enhances neurodynamics through mechanical mobilization. This study compared the effects of INF therapy and NF techniques on pain, balance, gait, and quality of life in patients with diabetic peripheral neuropathy. Methods: This randomized clinical trial employed a non-probability, convenience sampling technique, in which 44 patients with diabetic peripheral neuropathy were randomly allocated to Group A (INF = 22) and Group B (NFT = 22) using a computer-generated method. Interventions were performed in both groups for 50-60 minutes, three times a week, over 8 weeks, and a follow-up was conducted after 2 months. Pain was measured using the Numeric Pain Rating Scale, Balance using the Berg Balance Scale, Gait with the Dynamic Gait Index, and Quality of life was assessed using the QOL-DN Questionnaire. For the between-group comparison, the Mann-Whitney U test was used, and for the within-group comparison, the Friedman test was used. Results: The trial reported that INF significantly improved pain scores (p = 0.01), quality of life (p = 0.018), and balance (p = 0.02) at 16 weeks compared to NFT. Gait also showed significant enhancement (p=0.001), with INF demonstrating superior efficacy. Conclusion: The study reported that both INF and NFT improve pain, balance, gait, and quality of life in patients with diabetic peripheral neuropathy. However, INF demonstrated superior results, particularly in reducing neuropathic pain, enhancing balance and gait, and improving quality of life.