Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Diabetic peripheral neuropathy (DPN) is a common complication of long-term diabetes, affecting approximately 50 percent of patients. It causes tingling, numbness, and burning pain primarily in the feet, which reduces quality of life. Photobiomodulation therapy (PBMT), also known as low-level laser therapy, is a non-invasive treatment that may improve nerve function by reducing inflammation and promoting cellular repair. This randomized controlled trial aims to evaluate the effectiveness of PBMT in improving nerve function and quality of life in patients with DPN. A total of 36 participants with type 2 diabetes and DPN will be randomly assigned to either a treatment group receiving PBMT (900 nm wavelength, 25W, 1000 Hz frequency) or a control group receiving sham laser therapy. The intervention will be applied to the dorsum and plantar surface of the foot every other day for 6 weeks. Outcomes include pain intensity measured by the Numeric Pain Rating Scale, Neuropathic pain measured by Leeds Assessment of Neuropathic symptoms and signs scale, Nerve function measured by Michigan Neuropathy Screening Instrument and quality of life measured by the NORFOLK QOL DN questionnaire, assessed at baseline and after the intervention period.
This study is a randomized, double-blind, sham-controlled clinical trial. Participants will be enrolled from Move Better Clinic and Madinah Teaching Hospital in Faisalabad, Pakistan.
Randomization and allocation concealment: Eligible participants will be randomly assigned in a 1:1 ratio to either the photobiomodulation therapy group or the sham laser group. Randomization will be performed using a computer-generated random number table. Allocation will be concealed in sequentially numbered, opaque, sealed envelopes that will be opened only after baseline assessment.
Blinding: Participants will be blinded to their group assignment because both groups will undergo the same procedure with the same device; only the experimental group will receive active laser. Outcome assessments will be performed by a physiotherapist who remains blinded to group assignment. The therapist delivering the intervention cannot be blinded, but all data entry and statistical analysis will be performed using coded group identifiers.
Sample size calculation: Sample size of 36 participants (18 per group) was calculated using Rao Software based on a previous study by Suganthirababu et al. (2018), assuming a power of 80% and alpha of 0.05.
Statistical analysis: Data will be analyzed using IBM SPSS software. Normality of data distribution will be tested using the Shapiro-Wilk test. For normally distributed data, within-group differences will be analyzed using paired t-tests, and between-group differences will be analyzed using independent t-tests. For non-normally distributed data, appropriate non-parametric tests (Wilcoxon signed-rank and Mann-Whitney U) will be used. A p-value less than 0.05 will be considered statistically significant.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Photobiomodulation Therapy Group | Experimental | Photobiomodulation therapy (PBMT) was delivered using a device with wavelength of 900 nm, power of 25W, and frequency of 1000 Hz in pulse mode. The therapy was applied to the dorsum and plantar surface of the foot for 9 minutes per session. Treatment was administered every other day for 2 weeks, resulting in a total of 7 sessions per participant. The intervention was delivered by a trained physiotherapist in a clinical setting at Aziz Fatima Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. Participants remained in a comfortable seated position with the foot exposed during treatment. Safety goggles were provided to both the participant and the therapist. |
|
| Sham Laser Therapy Group | Sham Comparator | Sham laser therapy was delivered using the same device as the experimental group, with the laser deactivated. The same procedure was followed: application to the dorsum and plantar surface of the foot for 9 minutes per session, every other day for 2 weeks (total of 7 sessions). The device was positioned and handled identically to the active treatment, and the same auditory signals were produced to maintain blinding of participants. Participants were unaware of their group assignment throughout the study period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Photobiomodulation Therapy | Device | Photobiomodulation therapy (PBMT) was delivered using an infrared light therapy device with 3 x 808 nm and 12 x 650 nm multi-speed modes with pulse function. The device parameters were: wavelength of 900 nm, power of 25W, and frequency of 1000 Hz in pulse mode. The therapy was applied to the dorsum and plantar surface of the foot for 9 minutes per session. Treatment was administered every other day for 2 weeks, resulting in a total of 7 sessions per participant. The intervention was delivered by a trained physiotherapist in a clinical setting at MoveBetter Clinic, Faisalabad, Pakistan. Participants remained in a comfortable seated position with the foot exposed during treatment. Safety goggles were provided to both the participant and the therapist. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Pain Intensity | Pain intensity was measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst possible pain). Participants were asked to rate their current level of foot pain at each assessment point. Higher scores indicate greater pain intensity. The change from baseline to post-intervention was calculated for each participant. | Baseline and Week 2 (post-intervention) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Quality of Life | Quality of life was measured using the SF-36 questionnaire, a 36-item validated instrument assessing physical and mental health across eight domains: physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health. Domain scores range from 0 to 100, with higher scores indicating better quality of life. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Neuropathy Screening Status | Neuropathy status was assessed using the Michigan Neuropathy Screening Instrument (MNSI), which includes a 15-item questionnaire and a brief physical examination of the feet. This measure was used for screening and descriptive purposes rather than as a primary or secondary efficacy outcome. | Baseline only (screening) |
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The University of Faisalabad | Faisalābad | Punjab Province | 3800 | Pakistan |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
Not provided
Not provided
| ID | Term |
|---|---|
| D028022 | Low-Level Light Therapy |
| ID | Term |
|---|---|
| D053685 | Laser Therapy |
| D013812 | Therapeutics |
| D010789 | Phototherapy |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
| Sham Laser Therapy | Device | Sham laser therapy was delivered using the same infrared light therapy device as the active treatment, with the laser deactivated. The device was positioned and handled identically to the active treatment, and the same auditory signals were produced to maintain blinding of participants. The same procedure was followed: application to the dorsum and plantar surface of the foot for 9 minutes per session, every other day for 2 weeks (total of 7 sessions). Participants were unaware of their group assignment throughout the study period. The sham intervention was delivered by the same trained physiotherapist in the same clinical setting at MoveBetter Clinic, Faisalabad, Pakistan. |
|
| Baseline and Week 2 (post-intervention) |
| Change in Neuropathic Pain Characteristics | Neuropathic pain characteristics were assessed using the LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) scale. The LANSS scale includes sensory descriptions and bedside sensory testing (allodynia and altered pin-prick threshold). Total scores range from 0 to 24. Scores of 12 or greater indicate that neuropathic mechanisms are likely contributing to the patient's pain. | Baseline and Week 2 (post-intervention) |
| D004700 | Endocrine System Diseases |