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The effect of exercise therapy combined with psychological therapy on physical activity and quality of life in patients with painful diabetic neuropathy: a systematic review.

Scandinavian journal of pain
January 1, 1970
Charlotte C M van Laake-Geelen et al. (5 authors)
Journal ArticleResearch Support, Non-U.S. Gov'tSystematic ReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the effects of integrated rehabilitation treatments combining exercise and psychological therapies, including mindfulness, on physical activity and quality of life in patients with painful diabetic neuropathy (PDN).

Results Summary

The study found moderate effects of mindfulness meditation on quality of life and mindfulness-based stress reduction on function, health-related quality of life, pain catastrophizing, and depression in PDN patients. However, no studies directly combined exercise and psychological interventions, and overall evidence was limited.

Population

Patients with painful diabetic neuropathy (PDN), aged >18 years.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (11)
InterventionDirectionEndpointPopulationDosageImpactClaim #
mindfulness meditation
increase
QoL
patients with PDN
-
moderate effects
#1
CBT
decrease
pain severity
patients with PDN
-
moderate effects
#2
mindfulness-based stress reduction intervention
increase
function
patients with PDN
-
moderate effects
#3
mindfulness-based stress reduction intervention
increase
health-related QoL
patients with PDN
-
moderate effects
#4
mindfulness-based stress reduction intervention
decrease
pain catastrophizing
patients with PDN
-
moderate effects
#5
mindfulness-based stress reduction intervention
decrease
depression
patients with PDN
-
moderate effects
#6
aerobic exercise
increase
QoL
patients with PDN
-
moderate effects
#7
Tai Chi
increase
glucose control
patients with PDN
-
moderate effects
#8
Tai Chi
increase
balance
patients with PDN
-
moderate effects
#9
Tai Chi
decrease
neuropathic symptoms
patients with PDN
-
moderate effects
#10
Tai Chi
increase
some dimensions of QoL
patients with PDN
-
moderate effects
#11
Abstract

Background and aims Approximately 25% of patients with diabetes mellitus type 2 (DMII) develop painful diabetic neuropathy (PDN). PDN is known to affect both mental and physical wellbeing, resulting in anxiety, depression, low quality of life and physical disability. Pharmacological treatment of PDN aims at pain relief and is often ineffective and/or has many side effects. Rehabilitation treatment modalities that are designed to help the patient deal with PDN related complaints, are mostly focussed on either physical (e.g. exercise therapy) or psychological aspects (e.g. cognitive behavioural therapy, CBT). There is emerging evidence that PDN can be approached from a biopsychosocial perspective, in which physical and psychosocial aspects are integrated. From this biopsychosocial approach it is plausible that integrated treatment modalities such as acceptance commitment therapy (ACT) or exposure in vivo (EXP) could be effective in patients with PDN. The objective of this review was to provide an overview of the current evidence on the effects of rehabilitation treatments that combine exercise therapies with psychological therapies in order to improve physical activity (PA) and quality of life (QoL) in patients with PDN. Methods Systematic review of the current literature. EMBASE, MEDLINE, Medline In-Process citations and e-Pubs ahead-of-print, Pedro, Web of Science, PsycINFO, CENTRAL, PubMed and Google Scholar were searched. All studies on interventions combining exercise therapy with psychological interventions in patients with PDN, aged >18 years, were included. Outcome measures were PA, QoL. Results The search resulted in 1603 records after removing duplicates. After screening on titles and abstracts, 100 records remained. From these, not one study reported on interventions that combined exercise therapy with psychological interventions. Through a secondary hand search, a total of three reviews were identified that described a total of five studies regarding either physical or psychological interventions in patients with PDN. These studies reported moderate effects of (1) mindfulness meditation on QoL, (2) CBT on pain severity, (3) mindfulness-based stress reduction intervention on function, health-related QoL, pain catastrophizing and depression, (4) aerobic exercise on QoL and (5) Tai Chi on glucose control, balance, neuropathic symptoms, and some dimensions of QoL in patients with PDN. All studies were of a moderate quality, and results should be interpreted with caution. Conclusions Based on increasing knowledge in the domain of chronic pain, it could be assumed that integrated rehabilitation treatments for patients with PDN are beneficial. There is no literature to support this and more research should be done on integrated biopsychosocial interventions in patients with PDN. Implications This empty review highlights the importance that more research should be done on integrated biopsychosocial interventions in patients with PDN. Currently, our research group is performing a study on the effects of EXP treatment in patients with PDN.

Medical Subject Headings (MeSH)
Chronic PainCognitive Behavioral TherapyDiabetic NeuropathiesExerciseExercise TherapyHumansMind-Body TherapiesQuality of Life
Study Links
Quality Scores
SafetyNot Assessed
Efficacy65/10
Quality70/10
Citation Metrics
Total Citations27
Citations/Year4.5
Relative Citation Ratio2.00
NIH Percentile74.5%
Research Impact Scores
APT Score0.75
Weight Score1.64
Normalized Score0.60
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