Comparison of the Effects of Cold Application and Exercise With Virtual Reality Interventions on Pain, Kinesiophobia, and Fragility Levels in Patients With Diabetic Peripheral Neuropathy
Comparison of the Effects of Cold Application and Exercise With Virtual Reality Interventions on Pain, Kinesiophobia, and Fragility Levels in Patients With Diabetic Peripheral Neuropathy
The study will be conducted to determine the effect of cold application and virtual reality (VR) or combined hand and foot exercises on pain intensity, kinesiophobia, and fragility levels in patients with diabetic peripheral neuropathy.
Diabetic neuropathy is associated with high morbidity and mortality rates in both Type 1 and Type 2 diabetes patients, increasing the risk of foot ulcers and amputations, hospital admission rates, and healthcare costs. It also causes a decline in individuals' quality of life, functional capacity, and physical activity levels. Especially at night, increased pain disrupts individuals' sleep patterns; psychological problems such as stress, anxiety, and depression are common. Diabetic neuropathy is a complication that affects individuals physically, psychologically, and socially. It is known that neuropathic pain accompanies the clinical picture in 25-50% of patients with diabetic neuropathy. One of the exercise programs used by healthcare professionals to alleviate symptoms in patients with peripheral neuropathy is hand and foot exercises. Studies in the literature show that hand and foot exercises performed by patients with peripheral neuropathy reduce pain levels, improve quality of life, and increase physical activity levels.Another alternative method used in the treatment of neuropathic pain is cold application. Cold application causes vasoconstriction in the blood vessels in the area where it is applied, slowing down tissue metabolism. In diabetic peripheral neuropathy, patients often describe a burning sensation in their hands and feet. Virtual reality technology has been used in the treatment and care of many diseases in the healthcare sector in recent years. VR is known to be quite effective in reducing pain, managing symptoms, and continuing care and rehabilitation outside of the hospital. VR applied to patients with diabetic peripheral neuropathy generally involves exercise interventions.
The study population will consist of patients with diabetic peripheral neuropathy who visit the Diabetes Clinic of the Department of Internal Medicine at Sakarya University Education and Research Hospital. All patients who meet the inclusion criteria will be included in the study population. The G*Power 3.1.9.2 program was used to calculate the number of individuals to be sampled. In this regard, a power level of 90% and a significance level of 0.05 were accepted in calculating the research sample. The power analysis is based on a previously published article that addressed a similar topic and provided mean and standard deviation values (Elshinnawy et al., 2024). According to the calculations, 42 patients (14 individuals in each group) are planned to be included in the study sample.The study will use a socio-demographic form, a neuropathic pain assessment questionnaire (DN4), the Tampa Kinesiophobia Scale, and the Tilburg Frailty Scale.
The study will consist of two intervention groups and one control group. The Cold Application group will perform the hand and foot exercises in the exercise video three days a week, then apply cold compress bags to their hands and feet for 5-10 minutes. Patients in the virtual reality group will exercise for 15 minutes with a hand and foot exercise video in a virtual environment accompanied by cold-themed sounds and the sound of snow.Patients in the control group will be allocated time similar to the intervention flow applied to the intervention groups, and diabetic peripheral neuropathy will be explained. The explanation will cover the treatment and management of diabetic neuropathy. Patients will perform this exercise for eight weeks, and at the end of eight weeks, individuals' pain, kinesiophobia, and fragility will be assessed.
No studies have been found in the literature where hand and foot exercises were applied to patients with diabetic neuropathy in combination with VR or cold application. In our study, hand and foot exercises are planned to be applied to patients in both the cold application and virtual reality intervention groups. This will ensure that patients feel relaxed after exercise and that multiple non-pharmacological methods are used simultaneously. As a result of all these interventions, patients' pain levels and kinesiophobia will be assessed.
Inclusion Criteria:
Those who volunteer to participate in the study
Exclusion Criteria: