Neurology · Medical Literature
Effectiveness of Sensorimotor and Balance Training Compared to Conventional Physiotherapy on Balance and Quality of Life in Chemotherapy-Induced Peripheral Neuropathy: A Randomised Controlled Trial.
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side effect that leads to sensory deficits, impaired balance, and a reduced quality of life (QoL). This study evaluates the effectiveness of sensorimotor and balance training compared with conventional physiotherapy. Determine whether integrating sensorimotor and balance training results in greater improvements in balance, neuropathic symptoms, and QoL among patients with CIPN. A single-blinded randomised controlled trial was conducted with 86 participants undergoing neurotoxic chemotherapy. Outcomes, measured at baseline, Week 4, and follow-up at Week 6, included the Michigan Neuropathy Screening Instrument (MNSI), Berg Balance Scale (BBS), and Functional Assessment of Cancer Therapy-General (FACT-G). Linear mixed-effects modelling revealed significant group × time interactions for balance, physical well-being, emotional well-being, and functional well-being, favouring the experimental group (all p < 0.001). Large effect sizes were observed for balance (d = 0.70-0.82), physical well-being (d = 0.76-0.80), and functional well-being (d = 0.56-0.75). Social well-being showed a small, transient improvement at Week 4 (d = 0.32) that was not sustained at Week 6. Sensorimotor and balance training significantly enhance balance, reduce neuropathic symptoms, and improve QoL in patients with CIPN.
Clinical relevance
In patients with chemotherapy-induced peripheral neuropathy (CIPN) undergoing active neurotoxic chemotherapy, does a structured sensorimotor and balance training program produce greater improvements in balance, neuropathic symptoms, and quality of life compared with conventional physiotherapy? __SNAPSHOT__ {"studyDesign":"Single-blinded randomised controlled trial","setting":"Not reported (India, based on author affiliations; specific institution type not reported in abstract)","sampleSize":"n = 86 (allocation ratio between experimental and control arms not reported in abstract)","population":"Adults undergoing neurotoxic chemotherapy with chemotherapy-induced peripheral neuropathy (CIPN); detailed inclusion/exclusion criteria not reported in abstract","intervention":"Sensorimotor and balance training program (specific components, frequency, intensity, and duration beyond the 4-week active intervention window not reported in abstract)","comparator":"Conventional physiotherapy","primaryOutcome":"Not explicitly designated as a single primary outcome in the abstract; outcomes assessed included balance (Berg Balance Scale, BBS), neuropathic symptom severity (Michigan Neuropathy Screening Instrument, MNSI), and quality of life (Functional Assessment of Cancer Therapy–General, FACT-G)","followUp":"6 weeks total: active intervention assessed at Week 4, with follow-up measurement at Week 6","fundingSource":"Not reported"}
Key findings
Using linear mixed-effects modelling, the study found significant group × time interactions favouring the sensorimotor and balance training group for balance (BBS), physical well-being, emotional well-being, and functional well-being (all p < 0.001). Large Cohen's d effect sizes were reported for balance (d = 0.70–0.82), physical well-being (d = 0.76–0.80), and functional well-being (d = 0.56–0.75). Social well-being demonstrated only a small, transient improvement at Week 4 (d = 0.32) that was not sustained at the Week 6 follow-up assessment. Absolute between-group mean differences, 95% confidence intervals, and NNT/NNH values were not reported in the abstract. Whether neuropathic symptom severity on the MNSI achieved a statistically significant group × time interaction is not clearly delineated in the abstract excerpt provided. No adverse events or safety data are reported in the abstract.
Practice implications
This RCT provides evidence that a structured sensorimotor and balance training program produces statistically significant and large-magnitude improvements in functional balance and several quality-of-life domains compared to conventional physiotherapy in patients with CIPN during active chemotherapy. The large effect sizes for balance and physical and functional well-being, if confirmed in larger and more diverse cohorts, would represent clinically meaningful differences in a population with limited effective non-pharmacological treatment options. However, several important constraints must be acknowledged: (1) Only an abstract is available for review; full methodology, CONSORT flow, blinding procedures, allocation concealment, the specific content of both interventions, and complete numerical results cannot be independently verified. (2) The primary outcome is not clearly pre-specified in the abstract, raising concern for outcome reporting flexibility. (3) The follow-up window of 6 weeks is short; durability of benefit beyond this period is unknown. (4) The sample (n = 86, single site) limits generalizability across cancer types, chemotherapy regimens, severity of CIPN, and healthcare settings. (5) Social well-being did not sustain improvement, suggesting domain-specific limits of the intervention. (6) Single-blinding (assessor only, presumably) introduces risk of participant and therapist performance bias. (7) The absence of reported funding source limits assessment of conflict of interest. Findings should not yet be used to alter institutional protocols without corroboration from adequately powered, multi-centre trials. __LIMITATIONS__ Only an abstract is available; full-text review is required before drawing firm methodological conclusions.,Primary outcome not clearly pre-specified; multiple co-equal endpoints inflate type I error risk without explicit correction.,Small single-centre sample (n = 86) limits statistical power for subgroup analyses and generalizability across cancer diagnoses and chemotherapy regimens.,Short follow-up (6 weeks) precludes any conclusion about durability of benefit, fall risk reduction, or long-term QoL impact.,Single-blinding design: participants and treating therapists were unblinded, introducing substantial performance and detection bias risk.,Absolute between-group differences, confidence intervals, and minimal clinically important differences (MCIDs) for BBS and FACT-G are not reported, making it impossible to assess clinical magnitude independently.,Conventional physiotherapy comparator is not defined in the abstract; heterogeneity of the control arm is a meaningful confound.,Patients were assessed during active chemotherapy; symptom fluctuation concurrent with chemotherapy cycles may have confounded results.,Funding source not reported; potential conflicts of interest cannot be assessed.,Generalizability is uncertain: cancer type mix, CIPN severity distribution, and demographic characteristics of the sample are not described in the abstract. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This single-blinded RCT (n = 86) reports that sensorimotor and balance training produces statistically significant improvements over conventional physiotherapy in functional balance and several QoL domains in CIPN patients during active chemotherapy, with large Cohen's d effect sizes (0.56–0.82) across key domains. Given the short follow-up, undisclosed primary outcome hierarchy, single-centre design, and abstract-only availability, these findings are promising but require replication in larger, adequately powered, multi-centre trials before informing changes to standard rehabilitation practice. Clinicians may cautiously consider incorporating structured balance and sensorimotor exercises into CIPN rehabilitation, given the low harm potential and convergent support from prior sensorimotor training literature, while awaiting confirmatory evidence.