Abstract

Diabetic neuropathy often harms postural control, making patients more prone to fall. Proprioceptive exercise is thought to improve neuromuscular coordination and balance; however, past findings with diabetic neuropathy patients have been mixed. To evaluate whether proprioceptive exercise, alone or combined with other interventions, improves balance among adults with diabetic neuropathy, a systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide lines. Searches were performed in PubMed, Google Scholar, and ScienceDirect up to September 2024. Eligible studies were randomized controlled trials involving adults with diabetic neuropathy who received proprioceptive exercise compared with control groups. Standardized mean differences (SMDs) were calculated using random-effects models to estimate pooled effects. Twelve randomized controlled trials (n = 515) were included, published between 2010 and 2024, originating mainly from India, Iran, South Korea, Pakistan, and the USA. Pooled analysis showed a statistically significant moderate-to-large improvement in balance with proprioceptive training (SMD = 0.76; 95% CI: 0.13-1.38; p = 0.021). Substantial heterogeneity was observed (I² = 82.3%), and Egger’s test indicated possible publication bias (t = 2.93, p = 0.0127). Proprioceptive exercise significantly enhances balance in adults with diabetic neuropathy, although heterogeneity and potential publication bias warrant cautious interpretation. Standardized protocols and larger multicenter trials are needed to confirm these findings.

Key words: Proprioceptive exercise, diabetic neuropathy, balance.