Type of Article:  Original Research

Volume 7; Issue 5 (October 2019)

Page No.: 3239-3246

DOI: https://dx.doi.org/10.16965/ijpr.2019.172


Paul Daniel V.K 1, Syeda Umme Kulsum *2.

1 Professor, RV College of Physiotherapy, affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India.

*2 RV College of Physiotherapy, affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India.

Address For Correspondence: Syeda Umme Kulsum (MPT pursuing), Student, RV College of Physiotherapy, affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India. E-Mail: syedaummekulsumrazvi@gmail.com


Background and Objectives: Diabetes mellitus (DM) has become the leading chronic disorders in nearly all countries due to urbanization, changing lifestyles and lack of physical activity. Neuropathy is the commonest and most debilitating complications of diabetes. Diabetic Peripheral Neuropathy (DPN) increases balance impairment, increasing fall risk. Consequences include decline in mobility, avoidance of activity, institutionalization and mortality; thus affecting one’s Quality of Life (Quality of Life). Previous studies have focused on balance impairment and fall risk in DPN patients and also on QoL separately. Thus, the aim of this study is to find the effect of balance impairment and fall risk on QoL.

Methods: A correlational study was done on 30 DPN patients, selected by purposive sampling technique. Subjects were screened for neuropathy using Toronto Clinical Neuropathy Scoring System (TCSS) and those fulfilling the inclusion criteria, underwent balance and fall risk assessment by Berg Balance Scale (BBS) and Timed Up and Go (TUG) Test respectively. Following which, neuropathy specific quality of life questionnaire (NeuroQoL) was administered to evaluate their QoL. Results obtained were statistically analysed using SPSS 16.0, MS Word and MS Excel. Pearson’s correlation was used to find the correlation between variables.

Results: The results showed statistically significant correlation between all the variables. Correlation between BBS and reduction in QoL (r=-0.540, p=0.002), TUG and reduction in QoL (r=0.531, p=0.003).

Conclusion: In conclusion, physical limitations such as balance impairment and greater fall risk significantly reduces DPN patient’s QoL.

Key words: Diabetic Peripheral Neuropathy, Balance Impairment, Fall Risk, Quality of Life.


  1. Habtamu Wondifraw Baynest. Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. J Diabetes Metab. 2015; 6(5).
  2. Thomas Paul, Nihal Thomas. Peripheral neuropathy. In: Nihal Thomas, Kanakamani Jeyaraman, HS Asha, Jachin Velavan, K Senthilvasan. A Practical Guide to DIABETES MELLITUS, 2012, 6/e. Jaypee Brothers Medical Publishers, India.
  3. Bogdan Timar, Romulus Timar, Laura Gaita, Cristian Oancea, Codrina Levai, Diana Lungeanu. The Impact of Diabetic Neuropathy on Balance and on the Risk of Fall in Patients with Type 2 Diabetes Mellitus: A cross-sectional study. PLoS ONE. 2016; 11(4).
  4. David R Whiting, Leonor Guariguata, Clara Weil, Jonathan Shaw. Global Estimates of the Prevalence of Diabetes for 2011 and 2030. IDF Diabetes Atlas. 2011. Elsevier
  5. World Health Organisation Diabetes fact sheet (2017). http://www.who.int/mediacentre/factsheets/fs312/en/. ( seen on 16.03.2018)
  6. India – International Diabetes Federation. https://www.idf.org>members>94-india. (seen on 16.03.2018)
  7. Type 2 diabetes- symptoms and causes Mayo clinic. (seen on 16.03.2018)
  8. NCD Alliance- Diabetes. 2014 hungary. https://ncdalliance.org/diabetes. (seen on 16.03.2018)
  9. Amirah Mustapa, Maria Justine, Nadia Mohd Mustafa, Nursuriati Jamil, Haidzir Manaf. Postural control and gait performance in the diabetic peripheral neuropathy: a systematic review. BioMed Research International. 2016.
  10. I.Vinik. Advances in diabetes for the millennium: new treatments for diabetic neuropathies. Medscape General Medicine. 2004; 6(3): 13.
  11. D Udayashankar, Sarah S Premraj, K Mayilananthi, Vishwanath Naragond. Applicability of Toronto Clinical Neuropathy Scoring and its Correlation with Diabetic Peripheral Neuropathy- A Prospective Cross Sectional Study. Journal of Clinical and Diagnostic Research. 2017; 11(2).
  12. Robert J Tanenberg. Diabetic Neuropathy: Painful or Painless. Hospital Physician. 2009 (seen on 18.03.2018)
  13. Jong Chul Won,Yong-Jin Im, Ji-Hyun Lee, Chong Hwa Kim, Hyuk Sang Kwon, Bong-Yun Cha et al. Clinical Phenotype of Diabetic Peripheral Neuropathy and Relation to Symptom Patterns: Cluster and Factor Analysis in Patients with Type 2 Diabetes in Korea. Journal of Diabetes Research. 2017.
  14. Stephen D. Jernigan, Patricia S. Pohl, Jonathan D. Mahnken, Patricia M. Kluding. Diagnostic Accuracy of Fall Risk Assessment Tools in People with Diabetic Peripheral Neuropathy. American Physical Therapy Association. 2012; 92: 1461-1470.
  15. Carmella Wint, Joann Jovinelly. Everything you should know about diabetic neuropathy. Health line. 2017. https://www.healthline.com/health/type-2-diabetes/diabetic-neuropathy. (seen on 18.03.2018)
  16. Brown SJ, Handsaker JC, Bowling FL, Boulton AJ, Reeves ND. Diabetic Peripheral Neuropathy Compromise Balance during Daily Activities. Diabetes care. 2015; 38(6):1116-22.
  17. http://www.strokecenter.org\trials\scales\berg.pdf (seen on 16.11.2018).
  18. Pijnappels M, Reeves ND, Maganaris CN, van Dieen JH. Tripping Without Falling; Lower Limb Strength, a Limitation for Balance Recovery and Target for Training in the Elderly. J Electromyography kinesiology. 2008; 18(2): 188-196.
  19. Mark W. Powell, Dale H. Carnegie, Thomas J. Burke. Reversal of diabetic peripheral neuropathy with phototherapy (MIRE™) decreases falls and the fear of falling and improves activities of daily living in seniors. Age and Ageing. 2006; 35: 11–16.
  20. http://www.Timed-Up-and-Go-Test scoring sheet (seen on 16.11.2018)
  21. Hewston P, Deshpande N. Falls and Balance Impairments in Older Adults with Type 2 Diabetes: Thinking Beyond Diabetic Peripheral Neuropathy. Can J Diabetes. 2016; 40(1):6–9.
  22. Amal Samir Ahmed. Assessment of Quality of Life of Patients with Diabetic Peripheral Neuropathy. IOSR Journal of Nursing and Health Science. 2017; 6(5): 37-46.
  23. Loretta Vileikyte et al. The Development and Validation of a Neuropathy-and Foot Ulcer-Specific Quality of Life Instrument. Diabetes Care. 2003; 26(9): 2549-2555.
  24. Mamta Jaiswal et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth with Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care. 2017; 40: 1226–1232.
  25. Vera Bril, Bruce A Perkins. Validation of the Toronto Clinical Scoring System for Diabetic Polyneuropathy. Diabetes Care. 2002; 25(11): 2048-2052.
  26. Neuls Patrick D et al. Usefulness of Berg Balance Scale to Predict Falls in the Elderly. Journal of Geriatric Physiotherapy. 2011; 34(1): 3-10.
  27. Mark A Davis, Sinead Brophy, Rhys Williams, Ann Taylor. The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus. Diabetes care. 2006; 29(7): 1518-1522.
  28. Shumway-Cook A, Brauer S, Woollacott M. Predicting the Probability for Falls In Community-Dwelling Older Adults Using the Timed Up & Go Test. Phys Ther. 2000; 80: 896–903.
  29. Aaron Charles Lobo, Peter George, Kavina Marian Fernandes. An assessment of the Patterns and severity of diabetic neuropathy using the modified – Toronto Clinical Neuropathy Score in recently detected diabetics. International Journal of Biomedical Research. 2017; 8(05): 266-270.
  30. J.Tuttle et al. Early Onset Physical Frailty in Adults with Diabesity and Peripheral Neuropathy. Canadian Journal of Diabetes. 2018; 42(5):478-483.
  31. T et al. Effect of Diabetes on Peripheral Neuropathy in an Adult US Population. American Diabetes Association. 2018; 67(1).
  32. Amy Muchna et al. Association with Incident Falls, Frailty, Syndrome and Sensor-derived Gait, Balance and Physical Activity Measures. Journal of the American Podiatric Medical Association. 2018; 108(2).
  33. Ilania Zivi et al. Effectiveness of Aquatic versus Land Physiotherapy in the Treatment of Peripheral Neuropathies: A Randomized Controlled Trial. 2017.
  34. HB Menz Et Al. Walking Stability And Sensory Motor Function In Older People With Diabetic Peripheral Neuropathy. Archieves Of Physical Medicine And Rehabilitation. 2004; 85(2).
  35. Irshad Et Al. Balance Training In Diabetic Peripheral Neuropathy: A Narrative Review. JSM Diabetology And Management. 2017; 2(1): 1002.
  36. Vileikyte, L. Et Al. Predictors Of Depressive Symptoms In Persons With Diabetic Peripheral Neuropathy: A Longitudinal Study. Diabetologia. 2009; 52(7):1265-1273.

Cite this article: Paul Daniel V.K, Syeda Umme Kulsum. THE EFFECT OF IMPAIRED BALANCE AND FALL RISK ON QUALITY OF LIFE IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY. Int J Physiother Res 2019;7(5):3239-3246. DOI: 10.16965/ijpr.2019.172