Neuromuscular electrical stimulation for the management of diabetic neuropathy
File(s)
Author(s)
Smith, Sasha
Type
Thesis
Abstract
Background: Diabetic neuropathy is the most common chronic complication of diabetes. Diabetic sensorimotor polyneuropathy (DSPN) is a prevalent manifestation characterised by pain, numbness, muscle weakness and atrophy in the lower limbs. DSPN increases the risk of falling, ulceration, amputation and mortality, incurring considerable healthcare costs. Neuromuscular electrical stimulation (NMES) is a novel, non-pharmacological, non-invasive adjunctive therapy for DSPN which requires further investigation.
Aims: 1) To gain an understanding into the current management of DSPN and its limitations. 2) To assess a potential efficacy signal, safety and feasibility of a NMES device in people with DSPN.
Methods: For aim 1, a comprehensive literature review of DSPN was undertaken, clinical practice guidelines were identified and appraised, and healthcare professionals in the United Kingdom (UK) were surveyed on their management of DSPN. For aim 2, a systematic review of NMES for the treatment of DSPN was performed, patients were interviewed on the acceptability of a NMES device, a proof-of-concept study investigating NMES in people with DSPN was conducted and an ongoing randomised sham-controlled trial was presented.
Results: Current management of DSPN prioritises pain relief and treatment of modifiable risk factors to slow disease progression, but issues exist with effectiveness, unaddressed symptoms, pharmacotherapy side effects and accessing services. Clinical practice guidelines differ in methodological quality, and limited guidance in the UK is impacting the management of DSPN. NMES may be an acceptable, beneficial adjunctive therapy for people with DSPN by improving symptoms and peripheral nerve conductivity, but most studies investigating its efficacy have not been sham-controlled. Although an ongoing randomised, sham-controlled trial may strengthen the evidence base, participant recruitment remains challenging.
Conclusion: The current management of DSPN is inadequate and there is a need to investigate novel therapies. NMES therapy may be beneficial, but further high-quality research is needed to better understand its effects.
Aims: 1) To gain an understanding into the current management of DSPN and its limitations. 2) To assess a potential efficacy signal, safety and feasibility of a NMES device in people with DSPN.
Methods: For aim 1, a comprehensive literature review of DSPN was undertaken, clinical practice guidelines were identified and appraised, and healthcare professionals in the United Kingdom (UK) were surveyed on their management of DSPN. For aim 2, a systematic review of NMES for the treatment of DSPN was performed, patients were interviewed on the acceptability of a NMES device, a proof-of-concept study investigating NMES in people with DSPN was conducted and an ongoing randomised sham-controlled trial was presented.
Results: Current management of DSPN prioritises pain relief and treatment of modifiable risk factors to slow disease progression, but issues exist with effectiveness, unaddressed symptoms, pharmacotherapy side effects and accessing services. Clinical practice guidelines differ in methodological quality, and limited guidance in the UK is impacting the management of DSPN. NMES may be an acceptable, beneficial adjunctive therapy for people with DSPN by improving symptoms and peripheral nerve conductivity, but most studies investigating its efficacy have not been sham-controlled. Although an ongoing randomised, sham-controlled trial may strengthen the evidence base, participant recruitment remains challenging.
Conclusion: The current management of DSPN is inadequate and there is a need to investigate novel therapies. NMES therapy may be beneficial, but further high-quality research is needed to better understand its effects.
Version
Open Access
Date Issued
2024-05-01
Date Awarded
05/07/2024
License URL
Advisor
Davies, Alun
Normahani, Pasha
Lane, Tristan
Sponsor
Actegy Limited (Firm)
Grant Number
P63190
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)