Effectiveness of exposure in vivo for patients with painful diabetic neuropathy: a pilot study of effects on physical activity and quality of life

Objective: To evaluate the effects of personalized exposure in vivo on level of physical activity and quality of life in patients with painful diabetic neuro-pathy. Design: Randomized, single-case, ABC design. Subjects: Twelve patients with painful diabetic neuropathy, age >18 years, diabetes mellitus type II, Clinical Neurological Examination score >5, Diabetic Neuropathy Symptom Score ≥1 and Douleur Neuropathique 4 Questions score ≥3. Methods: The treatment consists of an Intensive screening, followed by an 8-week exposure in vivo intervention specifically adapted to the needs/risks of patients with painful diabetic neuropathy, and 6-months follow-up. Outcome measures included daily and non-daily measures of physical activity, quality of life, meta-bolic parameters, disability, depression, general and painful diabetic neuropathy-related anxiety, pain intensity and pain catastrophizing. Results: Due to high drop-out rates (n=6 during screening, n=2 during treatment, n=1 after treatment), only 3 participants complet-ed the study. Slight, but non-significant, changes in physical activity and disability were observed. In quality of life, no changes were observed. Conclusion: Analysis of the reasons for the high drop-out rate indicate that exposure in vivo may have added value in patients with painful diabetic neuropathy only for those patients: (i) whose daily life functioning is impaired mainly by the painful diabetic neuropathy; (ii) in whom painful diabet-ic neuropathy-related fears are exaggerated and irrational; (iii) in whom specific activities evoke the painful diabetic neuropathy-related fears; (iv) whose spouse and healthcare providers are in-volved in the treatment; and (v) who are willing to change their daily behaviour. Further research is needed into this subject.