Comparative Effect of Buerger-Allen Exercise and Intraneural Facilitation on Lower Extremity Perfusion and Peripheral Neuropathy Symptoms Among Patients with Type II Diabetes Mellitus

Background: Diabetes mellitus is a complex metabolic disorder characterized by chronic hyperglycemia, which can lead to severe microvascular and macrovascular complications. Peripheral neuropathy and impaired lower extremity perfusion are common among diabetic patients, significantly affecting their quality of life. Buerger-Allen Exercise (BAE) and Intraneural Facilitation (INF) are therapeutic interventions aimed at improving blood flow and reducing neuropathy symptoms in diabetic patients. This study aimed to compare the effectiveness of these two interventions in enhancing lower extremity perfusion and alleviating peripheral neuropathy symptoms. Objective: To assess and compare the effects of Buerger-Allen Exercise and Intraneural Facilitation on lower extremity perfusion and peripheral neuropathy symptoms in patients with type II diabetes mellitus. Methods: This quasi-experimental study was conducted at Al-Raheem Clinic and Skin Laser Center in Faisalabad over three months. A purposive sampling technique was used to recruit 12 patients with type II diabetes mellitus and peripheral neuropathy symptoms restricted to the lower limbs. Patients were divided into two groups: one received Buerger-Allen Exercise and the other Intraneural Facilitation. Assessments included the Ankle-Brachial Index (ABI) to measure lower extremity perfusion, the Michigan Neuropathy Screening Instrument (MNSI) for neuropathy symptoms, and monofilament testing for sensory function. Ethical approval was obtained, and informed consent was collected from all participants. Data were analyzed using SPSS version 25, employing paired and independent t-tests to evaluate pre- and post-intervention outcomes. Results: The ABI scores showed significant improvement in both groups post-intervention (BAE: pre 0.6883 ± 0.10980, post 1.0250 ± 0.10968, p < 0.001; INF: pre 0.6467 ± 0.06919, post 0.9617 ± 0.08909, p < 0.001). MNSI scores also decreased significantly (BAE: pre 7.5000 ± 1.04881, post 4.5000 ± 1.37840, p = 0.003; INF: pre 7.3333 ± 1.21106, post 4.1667 ± 1.16905, p < 0.001). Monofilament testing scores improved notably in both groups (BAE: pre 3.3333 ± 2.33809, post 6.3333 ± 1.86190, p = 0.002; INF: pre 3.1667 ± 2.31661, post 6.0000 ± 2.44949, p < 0.001). Conclusion: Both Buerger-Allen Exercise and Intraneural Facilitation effectively improved lower extremity perfusion and reduced peripheral neuropathy symptoms in patients with type II diabetes mellitus. Buerger-Allen Exercise demonstrated better patient compliance and ease of administration. Further research with larger sample sizes and longer follow-up periods is recommended to validate these findings and explore the long-term benefits of these interventions. Keywords: Diabetes mellitus, Buerger-Allen Exercise, Intraneural Facilitation, lower extremity perfusion, peripheral neuropathy, Ankle-Brachial Index