PICOS Elements

Eligibility Criteria (Concepts of Interest)

Population/ Problem/ Phenomenon

REQUIRED:

Ÿ Humans with clinically-diagnosed T2D and DSPN

○ DSPN is analogous to diabetic peripheral neuropathy and diabetic polyneuropathy

○ Articles fulfilling all criteria—but not specifying the type of clinically-diagnosed diabetes—will be included, since the odds are that most of those patients had T2D

NOT REQUIRED (but provides greater accuracy or reliability):

Ÿ DSPN diagnosed using recognized criteria, such as those provided by the ADA [8] or IDF [26]

Intervention/ Treatment

REQUIRED:

Ÿ Physical exercise (with information on the type, amount, and duration of exercise performed)

NOT REQUIRED (but provides greater accuracy or reliability):

Ÿ Physical exercise sessions supervised by the researchers to ensure conformity of performance and adherence

Ÿ Exercise protocols standardized for all subjects (i.e., precludes personalization that could vary relative exertion)

Comparison/ Control

REQUIRED:

Ÿ Includes at least one of the following:

○ No intervention or treatment

○ Planned crossover

○ Other treatment (e.g., dietary modifications, lifestyle counseling, pharmacotherapy, electrical stimulation, etc.)

○ Physical exercise combined with other treatment

NOT REQUIRED (but provides greater accuracy or reliability):

Ÿ Control group baseline characteristics highly similar to (i.e., not significantly different from) those of the experimental group

Outcome

REQUIRED:

Ÿ Evaluates changes in quantitative measurements of DSPN signs or symptoms (i.e., neuropathic severity)

○ QST to measure decreases in

§ Vibration perception threshold

§ Touch sensation (e.g., 10g monofilament, SWM)

§ Temperature threshold

§ Pinprick pain sensation

§ Ankle reflexes

○ Posturography to measure abnormalities in proprioception

NOT REQUIRED (but provides greater accuracy or reliability):

Ÿ DSPN signs or neuropathic severity measured using validated clinical instruments or accessory methods recommended by the ADA [8] :

○ Clinical instruments:

§ Michigan Neuropathy Screening Instrument

§ Modified Toronto Clinical Neuropathy Scale

§ Utah Early Neuropathy Scale

§ Neuropathy Disability Score

○ Accessory methods:

§ Nerve Conduction Study

§ Corneal Confocal Microscopy

§ Skin Biopsy (for Nerve Fiber Density)

Study Type

REQUIRED:

Ÿ Randomized and controlled

NOT REQUIRED (but provides greater accuracy or reliability):

Ÿ Randomization single- or double-blinded

(Report)

Ÿ Published within the last 8 years(January 1, 2012-April 20, 2020)

Ÿ English language only

Ÿ Snowballing references prohibited

Ÿ Must obtain ≥10 eligible articles for thematic synthesis