Effectiveness of Physiotherapy Interventions in Improving Quality of Life, Pain, and Nerve Conduction in Patients with Chronic Distal Symmetric Lower Extremity Sensorimotor Diabetic Peripheral Nerve Disease: A Systematic Review with Meta-Analysis of

Abstract Diabetic peripheral neuropathy (DPN) is the most common complication resulting from type 2 diabetes mellitus (T2DM), with a prevalence rate of 42% in rural north India. The clinical manifestations include progressive weakness, numbness, dysesthesia, and burning pains in DPN patients. This study evaluates the effectiveness of physiotherapy interventions, including physical exercises and electrotherapy, on managing pain, quality of life, and nerve conduction velocity in patients with painful DPN associated with T2DM. A systematic review and meta-analysis were conducted by searching PubMed, Scopus, and PEDro databases up to March 23, 2020, and analyzing the data using RevMan software. The analysis included ten randomized controlled trials, with nine studies undergoing meta-analysis. The results indicate that a combination of exercises and electrotherapy is more effective than control interventions (details are discussed in the methodology) in reducing pain, with an odds ratio (OR) of 0.59, although the improvement was not statistically significant ( P = 0.56). The effectiveness of exercise therapy alone on nerve conduction velocity and quality of life was not significant compared to the control group (OR = 1.21, P = 0.63). Electrotherapy also did not show a statistically significant effect on pain and quality of life when compared to the controls (OR = 0.80, P = 0.70). The study concludes that a combination of exercise and electrotherapy (transcutaneous electrical nerve stimulation and micro-currents) can alleviate pain in DPN patients more effectively when compared to controls, but the overall effectiveness on the other outcomes remains inconclusive. The presence of heterogeneity in the included studies suggests the need for further clinical trials to better understand the benefits of physiotherapy interventions in managing DPN symptoms.