Physical Therapy–Based Interventions Improve Balance, Function, Symptoms, and Quality of Life in Patients With Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) involves damage to peripheral nerves. It can cause weakness, loss of dexterity, pain, sensory disturbances, and decreased ankle proprioception. These impairments lead to decreased balance, increased risk of falls, difficulty with activities of daily living, and difficulty walking at home and in the community. These functional limitations also contribute to decreased quality of life (QOL) and participation restrictions. There is a lack of evidence related to physical therapy (PT) interventions and outcomes in patients with CIPN. Objective: To systematically review the evidence to determine whether adults with CIPN benefit from PT interventions to improve balance, function, and QOL. Methods: A database search was performed in January 2017 for articles dated in the last 15 years. Search terms used were as follows: chemotherapy, peripheral, neuropathy, prevalence, management, falling, strength, and balance training. This yielded 300 studies, with another 98 studies found through other methods. Inclusion criteria were as follows: adults with diagnosis of CIPN, balance or functional mobility issues due to CIPN, and studies involving PT interventions. Articles were excluded if they were pharmacological intervention based, if they did not include patients with documented CIPN, and if they did not involve PT interventions. Articles were appraised using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. A total of 5 articles met the criteria, including 3 experimental studies and 2 randomized control trials, and were included in this review. Results: Lower limb closed kinetic chain exercises showed a decrease in tingling sensation, decrease in pain, and improved balance. Interactive sensor-based balance training showed increasing tandem stance balance with eyes open. Studies involving strength and endurance training showed positive effects for balance, lower extremity strength, function, and QOL, as measured using the McGill QOL Questionnaire and the European Organization for Research and Treatment in Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30). Conclusion: PT interventions are beneficial for individuals with CIPN demonstrating improved static and dynamic balance, increased lower extremity strength, and reduction in CIPN symptoms such as pain and paresthesia. This could lead to a decreased risk of falls and has been shown to correlate to an improved QOL. Larger sample sizes, more specific outcome measures and interventions, and better defined inclusion criteria will further inform best practice with this patient population.