Rehabilitation interventions for upper limb dysfunction in type 2 diabetes mellitus, with or without diabetic peripheral neuropathy: a systematic review and meta-analysis.

Abstract

This systematic review and meta-analysis aimed to evaluate the effectiveness of rehabilitation interventions for upper limb dysfunction in adults with type 2 diabetes mellitus (T2DM), with or without diabetic peripheral neuropathy (DPN). Five databases were searched from inception to June 2025. Randomized controlled trials and quasi-experimental studies evaluating upper limb rehabilitation in adults with T2DM were included. Methodological quality was assessed using the PEDro scale and NIH quality assessment tools. Meta-analyses used random-effects models, with subgroup analyses by DPN status. A structured narrative synthesis summarized intervention types and outcomes. Eighteen studies (<i>n</i> = 835) were included, four involving individuals with DPN. Pooled effects were not statistically significant for hand grip strength (MD = 1.58 kg; 95% CI: -0.06 to 3.22), pinch strength (MD = 0.36 kg; 95% CI: -6.80 to 7.52), or dexterity (SMD = -0.43; 95% CI: -1.61 to 0.75). Overall methodological quality was predominantly moderate, with substantial heterogeneity. Narrative synthesis suggested clinically relevant improvements, particularly with multicomponent programs combining resistance, aerobic, and functional training. Multicomponent rehabilitation programs may provide meaningful benefits for upper limb function among individuals with T2DM and should be considered in practice. High-quality, DPN-specific trials using standardized hand-focused outcomes are needed.