1Centre for Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
2Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
3Department of Community Oral Health & Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
4College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
Correspondence: Ahmad Zamir Che Daud Centre for Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam, Selangor 42300, Malaysia. Tel: +60-3-3258-4000 Fax: +60-3-3258-4599 E-mail: zamir5853@uitm.edu.my
• Received: December 11, 2024 • Revised: April 19, 2025 • Accepted: May 7, 2025
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diabetic peripheral neuropathy (DPN), a common complication of type 2 diabetes mellitus, leads to sensory and motor impairments that significantly affect fine motor skills, grip strength, and dexterity, limiting daily functioning. Understanding the impact of DPN on hand-related activities of daily living (ADLs) is crucial for improving patient care and outcomes. This review employed the International Classification of Functioning, Disability, and Health (ICF) framework to assess hand function issues. A systematic search of peer-reviewed studies was conducted across multiple databases to identify research examining the impact of DPN on hand-related ADLs. The findings were categorised using relevant ICF codes linked to hand function issues. The analysis identified four major themes: (1) the impact of DPN on daily activities and participation; (2) sensory impairments affecting hand function; (3) muscle weakness and functional limitations; and (4) unaddressed areas, such as structural changes, driving, assisting others, and preparing meals. DPN was found to significantly hinder hand function, reducing independence in ADLs and overall quality of life. This review highlights the need for comprehensive assessments that address not only impairments, but also activity limitations and participation restrictions, to capture the multifaceted challenges of DPN. Developing targeted assessments tailored to the specific needs of individuals with DPN is essential for improving intervention strategies and overall quality of care.
Type 2 diabetes mellitus (T2DM) is an escalating global public health concern. Once pre-dominantly affecting older adults, it is now increasingly prevalent among younger individuals during their economically productive years. In Malaysia, the National Strategic Plan for Non-Communicable Disease 2016–2025 predicts that by 2025, the prevalence of diabetes mellitus (DM) among adults aged 18 and over will reach 31.3%, impacting approximately 7 million people [1]. Unfortunately, with the rising prevalence of T2DM, the occurrence of diabetes-related complications also escalates. Prolonged duration of DM has been shown to increase the risk of medical complications, leading to a significant reduction in quality of life. Among these complications, diabetic peripheral neuropathy (DPN) is the most common and one of the most debilitating [2-5]. Affecting up to 50% of individuals with T2DM, DPN results from chronic hyperglycemia that damages peripheral nerves, leading to a range of sensory and motor impairments [6].
In diabetes management, DPN of the foot has been extensively researched due to its high susceptibility to ulcers and amputations [7]. While DPN most commonly affects the lower limbs, it could also impact the upper limbs, leading to significant functional limitations [5,8,9]. Although lower limb dysfunction in individuals with DPN is well-documented, there is growing attention being directed toward the challenges related to hand function, which are equally critical [5,10,11]. This imbalance in research attention has resulted in limited tools or guidelines for assessing hand-related functional impairments in this population. Therefore, this shift in focus addresses the increasing recognition of how DPN impacts hand function, marking a significant expansion in research.
Hand function is essential for activities of daily living (ADLs), as both gross and fine motor skills are key to maintaining an individual’s independence and overall quality of life. Recent studies have begun to explore the impacts of DPN on hand function, with early evidence suggests that individuals with DPN experience hand weakness, diminished dexterity, and sensory loss, leading to challenges in performing ADLs [5,12,13]. However, despite this evidence, a critical knowledge gap remains in understanding how DPN specifically impact hand-related ADLs in individuals with T2DM. A survey-based study revealed that 85% of individuals with DPN report that it significantly affects their ability to perform ADLs. These activities, including sleep, walking, and exercise, are particularly impacted as the severity of pain increases [14]. The results demonstrate that DPN significantly disrupts ADLs, contributing to a loss of independence and a decline in quality of life. Although some studies have addressed the broader impacts of DPN on ADLs, many have yet to sufficiently explore the specific sequelas on hand-related ADLs and their functional consequences.
The International Classification of Functioning, Disability, and Health (ICF) framework provides a thorough methodology for comprehending the impact of health conditions on an individual’s functioning and engagement in everyday activities [15]. Several studies have applied the ICF to assess the impact of DM, including the International Classification of Functioning, Disability, and Health Core Set (ICF-CS) of diabetes mellitus [16]; ICF Core Sets for diabetes mellitus [17]; Validation of the comprehensive ICF Core Sets for diabetes mellitus: A Malaysian perspective [18]; and Validation of the International Classification of Functioning, Disability, and Health (ICF) Core Set for diabetes mellitus [19]. Scoping reviews are increasingly used to systematically map the extent, range, and nature of evidence in emerging fields, particularly when research is heterogeneous or conceptually broad. To address the current gap in knowledge, this scoping review was conducted to identify the hand-related ADLs most affected by DPN, using the integration of the ICF framework, providing insight into the specific challenges faced by individuals with T2DM.
METHODS
Study design
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist to ensure methodological rigour and transparency [20]. The review process was structured into four key phases: (1) establishing eligibility criteria; (2) identifying relevant literature; (3) selecting studies; and (4) analysis and data presentation.
Establishing eligibility criteria
The aim of this review was to systematically map existing studies focused on the impacts of DPN on hand-related ADLs in individuals with T2DM. Studies were included based on the following criteria: (1) peer-reviewed studies examining the impacts of DPN on hand-related ADLs in individuals with T2DM; (2) studies were published between January 1, 2004, and August 1, 2024; (3) the population focuses on individuals with T2DM; and (4) reports published in English. To minimize the influence of confounding factors, this study will focus exclusively on individuals with T2DM, as those with type 1 diabetes mellitus (T1DM) have different underlying causes and treatment approaches [21]. Additionally, studies were excluded if they did not focus on DPN, if they were grey literature such as editorial letters, dissertations, reviews, or conference abstracts, and if they focused on T1DM or other conditions.
Identifying relevant literature
The search for studies that fulfilled the eligibility criteria was conducted using several electronic databases, including Scopus, Cochrane, MEDLINE, ProQuest, and Web of Science. Medical Subject Headings were used to guide the development of the search terms. The keywords and Boolean operators utilized in the search strategy included: (“type 2 diabetes mellitus” OR “type 2 DM” OR “T2DM” OR “diabetes mellitus type 2” OR “non-insulin-dependent diabetes mellitus” OR “NIDDM” OR “adult-onset diabetes”) AND (“diabetic peripheral neuropathy” OR “DPN” OR “peripheral neuropathy in diabetes” OR “diabetes-related peripheral neuropathy” OR “diabetic nerve damage” OR “diabetic neuropathy” OR “diabetic neuropathies”) AND (“activit* of daily living” OR “ADL” OR “daily living activit*” OR “function* ability*” OR “function* difficult*” OR “function* impairment*” OR “functional problems” OR “function* limit*” OR “function* disabilit*” OR “functional status” OR “self-care activit*” OR “self-care task*” OR “daily functions*” OR “independent living skill*” OR “instrumental activit* of daily living” OR “IADL” OR “occupation*”) AND (“problem*” OR “difficult*” OR “impairment*” OR “challenge*” OR “limitation*” OR “disabilit*” OR “dysfunction” OR “performance” OR “activity” OR “participation” OR “restriction” OR “hindrance” OR “obstruction” OR “deficiency” OR “complications” OR “decline” OR “issue” OR “adversity”). Fig. 1 illustrates the identification process. Two independent reviewers (NAMN and AZCD) performed the literature search.
Selecting studies
The selection of studies was conducted by NAMN and AZCD. This process involved a comprehensive evaluation of the articles retrieved from the five databases. Initially, articles were identified and retrieved based on the established search criteria and keywords. Data extraction was considered saturated once no additional relevant articles were found beyond those identified through the searches. A total of 300 articles were retrieved (Fig. 1). After eliminating 7 duplicates, 293 articles were subjected to further screening. In cases of disagreement between NAMN and AZCD, a third reviewer (CWC) was consulted to resolve the issue and determine article inclusion. The first step in the screening process involved reviewing article titles to assess their relevance to the research question.
Subsequently, a more comprehensive screening of titles and abstracts was conducted to assess the articles based on their abstracts. This stage allowed for a more thorough assessment of each article’s relevance to the research, considering both the title and a brief overview of the content. Out of the initial 293 articles, only 25 were suitable for an extensive full-text review. At this stage, 268 articles were excluded because they are not focused on impacts on ADLs, not studying DPN and articles published as dissertations and the studies published before 2004. This process involved an evaluation of the entire content of each article, including the introduction, methodology, results, and conclusion sections. The full-text screening enabled a comprehensive evaluation of the articles’ relevance and alignment with the research objectives. After reviewing the full-text articles, three additional articles were excluded because they focused on conditions other than DPN. Finally, a set of 22 articles was selected for inclusion in this study.
Analysis and data presentation
An extraction matrix was used to systematically compile information on study objectives, methods, and findings. The extracted data were then analyzed thematically, guided by the ICF framework, to identify patterns and categorize findings. The thematic analysis involved three main steps. First, two reviewers, NAMN and AZCD independently coded the data from the selected articles to identify patterns and themes. Next, the identified codes were grouped into broader categories aligned with relevant ICF codes. Finally, these categories were further refined and condensed into key themes through discussion and consensus among the reviewers. The resulting themes, supported by the extracted data, were summarized in Table 1 and discussed within the context of the ICF framework to provide comprehensive insights into the impacts of DPN on hand-related ADLs.
RESULTS
ICF categories related to hand function
The relevant ICF codes and components related to hand-related activities were derived from the data of the four key studies that explored the link between the ICF and DM [16-19]. ICF categories that were unrelated to hand function were excluded to ensure the focus remained specifically on the functional issues affecting hand-related ADLs. Table 1 outlines the set of relevant ICF codes and their corresponding categories. The body functions (b codes) include b260 (proprioceptive functions), b265 (touch functions), b270 (sensory functions related to temperature and other stimuli), b280 (sensation of pain), and b730 (muscle power functions), all of which are critical in assessing hand function. Additionally, b820 (repair functions of the skin) and b840 (sensation related to skin) further highlight the physiological functions relevant to hand health in the context of DPN. Furthermore, body structure (s codes) categories such as s730 (structure of upper extremity), s810 (structure of area of skin), and s830 (structures of nails) address the physical structures of the hand affected by DPN. The activities and participation (d codes), such as d440 (fine hand use), d445 (hand and arm use), and d630 (preparing meals), relate to the specific activities where hand function is essential, and where individuals with DPN often encounter limitations. Additionally, codes like d430 (lifting and carrying objects), d520 (caring for body parts), d540 (dressing), and d640 (doing housework) reflect broader activity restrictions that affect independence and quality of life. Other related codes, including d660 (assisting others), d230 (carrying out daily routine), and d475 (driving), emphasize the social and functional roles impacted by impaired hand function in DPN, further reflecting the significant consequences of this condition on daily living.
Based on these ICF codes, the data extracted from the selected studies were organized accordingly into their respective categories. From this structured analysis, four major themes were developed that reflect the various impacts of DPN on hand-related complications in daily life. To provide a clearer overview of the findings, a frequency summary was compiled to show how many studies reported each hand-related issue based on the aligned ICF codes (Table 2). This summary highlights the most affected functional domains in individuals with DPN, particularly those involving fine motor skills, lifting and carrying, and sensory impairments. These themes include: (1) impact on daily activities and participation; (2) sensory impairments and their impact on hand function; (3) muscle weakness and functional limitations; and (4) unaddressed areas such as structural changes, driving, assisting others, and preparing meals. Each theme corresponds to specific ICF categories, ensuring a comprehensive understanding of the functional challenges identified in the research.
The included studies, conducted between 2007 and 2021 across countries such as India, the USA, China, Turkey, Taiwan, and Germany, employed various methodologies, including cross-sectional, case-control, randomized controlled trials, and systematic reviews. Sample sizes ranged from fewer than 50 participants to over 900, focusing on adults with T2DM, with or without DPN. The primary outcomes assessed included sensory impairments, motor function, and functional limitations in daily activities. Several studies also evaluated quality of life and psychosocial impacts, aligning findings with the ICF codes to highlight the challenges faced by individuals with DPN. Table 3 outlines the characteristics of the studies included in this review.
Theme 1: Impact on daily activities and participation
DPN significantly impact daily activities and participation, as shown across several studies. Fine hand use (ICF code: d440) was impaired in 16 of 22 studies, with difficulty handling small items, buttoning, using tools, and writing [2,5,8,11,12,22-32]. Hand and arm use (ICF code: d445) was affected in 20 out of 22 studies, particularly in tasks requiring reaching, grasping, and manipulating objects [2-5,8,11,12,22-34]. Problems with lifting and carrying objects (ICF code: d430) were reported in 21 out of 22 studies, limiting the ability to perform basic tasks [2-5,8,11,12,14,22-31,33-35]. Additionally, challenges in caring for body parts (ICF code: d520) and dressing (ICF code: d540) were reported in nine out of 22 studies and seven out of 22 studies, respectively, indicating complications in personal hygiene and grooming [2,4,12,23-27,35]. While three out of 22 studies reported difficulties with house-work (ICF code: d640), all studies indicated problems in managing daily routines (ICF code: d230), highlighting the significant impact of DPN on everyday functioning [2,5,26].
Theme 2: Sensory impairments and their impact on hand function
Sensory impairments were frequently reported in studies examining the impacts of DPN on hand function. Proprioceptive deficits (ICF code: b260), identified in one study, impacted fine motor tasks such as pinching and grasping small objects [9]. Loss of touch sensation (ICF code: b265) was reported in ten of 22 studies, significantly affecting the ability to manipulate objects, use tools, and perform tasks like buttoning [2,3,5,8,13,25,28,29,31,32]. Additionally, altered sensory functions related to temperature (ICF code: b270) and sensation related to skin (ICF code: b840) were found in nine of 22 studies and all studies, respectively, increasing the risk of burns and injuries [2-5,8,11,12,14,22-35]. Pain sensation (ICF code: b280), reported in one study, contributed to reduced grip strength and task avoidance, further limiting hand function [14].
Theme 3: Muscle weakness and functional limitations
Muscle weakness, particularly in grip and pinch strength, was highlighted in eight of 22 studies, with reduced muscle power (ICF code: b730) significantly affecting the ability to lift, carry, and handle objects [3,5,8,11,22,26,31,32]. This weakness restricts daily activities such as opening containers and performing household chores, further limiting functional independence.
None of the studies reviewed assessed the impacts of hand impairments in areas such as structural changes, driving, assisting others, and preparing meals. It remains unclear whether these areas are unaffected by DPN or simply underexplored. Further research is necessary to determine their relevance and potential impacts on individuals with DPN.
DISCUSSION
This scoping review aims to provide a comprehensive overview of the hand-related functional issues in individuals with DPN through the lens of the ICF. This integration of the ICF allowed for a structured approach to understanding the impacts of DPN on hand function, with key themes derived from the selected studies highlighting the breadth of challenges individuals with DPN face in performing daily activities. Although the ICF framework was applied retrospectively in this review, it served as a useful tool to organise and interpret the findings across heterogeneous studies. The assignment of ICF codes after data extraction reflects a common practice in scoping reviews aimed at thematic synthesis rather than hypothesis testing. Nonetheless, this approach may introduce interpretive subjectivity, and efforts were made to mitigate this through independent coding and consensus discussions.
In the past, medical outcome evaluation focused solely on the physiological effects of DM. However, societal expectations have shifted, with an increasing emphasis on leading a life free from disabilities, especially considering the hand’s significant role in daily activities [36]. The findings highlight the significant limitations in daily activities and participation caused by DPN, as noted in theme 1. The high prevalence of fine hand use issues and difficulties in hand and arm use reflects the profound impacts of DPN in performing ADLs and quality of life [2,30]. Basic tasks such as buttoning, using tools, and handling small items are often challenged, leading to reduced functionality and an inability to maintain self-care or household activities. These issues are not only detrimental to physical functioning but also affect the social and emotional well-being of individuals, who may experience frustration or reduced confidence in their ability to perform daily tasks [37]. The studies consistently indicate challenges in managing daily routines, highlights the significant influence that DPN has on tasks that are performed on a daily basis.
The sensory impairments identified in theme 2 suggest the intricate details of hand function issues in DPN. Loss of touch sensation and proprioceptive deficits significantly affect the ability to manipulate objects and perform tasks requiring fine motor control, such as writing or buttoning clothes [12]. The finding that altered sensory functions, particularly in relation to temperature and skin sensation, could increase the risk of burns and injuries during activities like cooking, implies the importance of addressing sensory deficits in clinical assessments and interventions [25]. Moreover, pain sensation (ICF code: b280) was reported in 1 out of 22 studies, contributing to task avoidance and further limiting hand function, indicating the need for pain management strategies in DPN rehabilitation [14,38].
Muscle weakness, as discussed in theme 3, further intensifies the functional limitations experienced by individuals with DPN. Grip and pinch strength are critical for performing basic tasks, and their reduction significantly impacts daily activities such as lifting, carrying, and handling objects [3,5,8,11,22,26,31,32]. Muscle weakness restricts mobility and leads to increased dependence on others, diminishing overall independence. The role of muscle power in hand function highlights the need for interventions to improve or maintain muscle strength in patients with DPN.
Interestingly, theme 4 reveals noticeable gaps in the current literature regarding the impacts of DPN on activities such as driving, food preparation, and assisting others. The lack of research in these areas suggests that they may be underexplored, despite their relevance to ADLs [16-19].
None of the studies reviewed directly assessed these domains, leaving it unclear whether these activities are genuinely unaffected by DPN or simply underreported. One possible explanation for this gap is that traditional assessments of hand function often prioritize physical evaluations (e.g., grip strength, pinch strength, sensory thresholds), which may not capture the complexity of real-world tasks that require multi-step coordination, judgment, and context-specific motor control. Additionally, many of the commonly used instruments in the included studies may not include items that reflect instrumental ADLs (IADLs), such as preparing meals or helping others, despite their importance to independent living.
Functionally, impairments in sensory discrimination, strength, or dexterity may plausibly affect these tasks, even if not explicitly measured. For instance, diminished fine motor control or delayed tactile feedback could compromise safety while cooking or driving, while reduced grip endurance may limit one’s ability to assist others in physical or household activities. These underexplored areas may reflect a methodological blind spot in current research rather than an absence of impact. Future studies should consider expanding assessment domains to better capture these complex but essential aspects of daily living, especially as they relate to daily living activities and quality of life.
The insights gained from this scoping review might guide the development of new instruments tailored specifically for individuals with DPN. By identifying the specific hand-related challenges, including fine motor impairments, sensory deficits, and muscle weakness, this review provides a foundation for developing a comprehensive, patient-centered instrument. This instrument would be designed to capture the full spectrum of functional issues and daily activity limitations unique to this population, ensuring more precise evaluation, targeted interventions, and efficient monitoring of treatment outcomes.
In this context, a scoping review conducted in 2024 revealed that most existing evaluations primarily address the physical components of hand function, such as grip and pinch strength [10]. While these aspects are important, they do not fully capture the entire spectrum of functional issues caused by DM. The Duruöz Hand Index, which was originally developed for arthritis patients, has been identified as the only validated instrument for assessing hand function in individuals with DM [39]. Although useful, its design for a non-diabetic population limits its ability to detect diabetes-specific impairments, particularly those associated with neuropathy-induced sensory loss, sensorimotor dysfunction, and participation restrictions.
One plausible explanation for the absence of a widely recognised DPN-specific assessment tool is the historical focus on lower limb complications in diabetes care and research. Given the more visible clinical risks of foot ulcers and gait instability, upper limb and hand function has often been overlooked. Additionally, the complexity and variability of hand-related symptoms in DPN, ranging from sensory and motor deficits to fine motor dysfunction, make it challenging to develop a concise yet comprehensive instrument.
This review lays the groundwork for addressing the existing gap in hand function assessment for individuals with DPN. By systematically mapping hand-related challenges, such as fine motor impairments, sensory deficits, muscle weakness, and activity limitations, this scoping review supports the development of a more comprehensive and patient-centered assessment tool. Such a tool should be firmly grounded in the ICF framework and reflect real-world activities of ADLs to ensure its clinical relevance for rehabilitation planning and outcomes.
Future development should begin with input from experts and individuals with DPN to ensure content validity, followed by iterative testing using robust psychometric methods, such as Rasch analysis and principal component analysis. Implementation in clinical settings should prioritize simplicity, time-efficiency, and integration with existing diabetes care workflows. This foundational guidance may support future research and clinical application by providing a structured path toward developing practical, evidence-based assessment tools.
Limitations
While this scoping review was conducted following established guidelines, certain limitations need to be considered when interpreting the study’s results. First, there is a possibility that relevant research may have been missed during the search process, particularly studies published in languages other than English, as this review only included English-language publications. This language restriction introduces a potential bias, particularly given that DPN is prevalent in many non-English-speaking regions. As a result, valuable research from these regions may have been excluded, which could have narrowed the scope and limited the generalizability of our findings across global contexts. Moreover, there was variability in the reviewers’ interpretation of the data. Although the reviewers came from diverse clinical backgrounds and experiences, incorporating additional reviewers could have provided different perspectives and further enriched the analysis.
The scoping review methodology aligned well with the study’s objective to map existing knowledge and identify research gaps, enabling structured mapping of diverse evidence in an underexplored area. However, it also has inherent limitations. Scoping reviews do not involve critical appraisal of individual studies, nor do they quantify effect sizes or compare relative risks. Thus, the findings are descriptive in nature and should be interpreted as exploratory, serving as a foundation for future targeted research and tool development.
Additionally, while this review highlights the lack of standardized tools for assessing hand function in individuals with DPN, it did not systematically examine or compare the psychometric properties (e.g., validity, reliability, sensitivity) of the tools used in the included studies. This limits the review’s ability to inform the refinement or development of improved tools. Future research should prioritize psychometric evaluations of existing instruments to guide evidence-based tool development.
CONCLUSION
This study highlights the critical need for comprehensive assessments that go beyond the physical aspects of the hand. Incorporating impairments, activity limitations, and participation restrictions is essential. Such assessments are essential to accurately capture the breadth of functional limitations experienced by individuals with DPN and to guide the intervention plan. Additionally, these results highlight the necessity for multidisciplinary approaches to care, integrating occupational therapy, physical therapy and patient education to optimise hand function and improve the overall quality of life for individuals living with DPN. To build on this foundation, future research should focus on designing condition-specific, psychometrically sound tools that reflect the complexities of DPN-related impairments and support meaningful, targeted rehabilitation strategies.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING INFORMATION
This study was funded by the Fundamental Research Grant Scheme (FRGS), Ministry of Higher Education, Malaysia, Reference number: FRGS/1/2023/SS10/UITM/02/1.
AUTHOR CONTRIBUTION
Conceptualization: Mohd Nayan NA, Chien CW, Alrashdi M, Che Daud AZ. Formal analysis: Chien CW, Lokman N. Methodology: Mohd Nayan NA, Chien CW, Alrashdi M, Che Daud AZ. Funding acquisition: Che Daud AZ. Visualization: Mohd Nayan NA. Supervision: Chien CW, Lokman N, Che Daud AZ. Writing – original draft: Mohd Nayan NA, Chien CW, Lokman N, Alrashdi M, Che Daud AZ. Writing – review & editing: Mohd Nayan NA, Chien CW, Lokman N, Alrashdi M, Che Daud AZ. Approval of final manuscript: all authors.
ACKNOWLEDGMENTS
The authors would like to thank all the staff from Faculty of Health Sciences, UiTM, for their support and encouragement.
Fig. 1.
Flow diagram of the search strategy. ADLs, activities of daily living; DPN, diabetic peripheral neuropathy.
Table 1.
Relevant hand-related ICF component
Theme
ICF component
ICF code & category
Details of hand-related issue aligning with ICF code
Theme 1: The impact of upper limb DPN on daily activities and participation
AP
d440-Fine hand use
DPN reduces the ability to perform tasks that require precise finger movements, such as buttoning, using utensils, and handling small objects. Challenges are primarily related to limited finger coordination, decreased control over fine movements, and impaired finger strength, all of which are crucial for activities requiring delicate hand use [2,5,8,11,12,22-32].
d445-Hand and arm use
DPN impairs hand and arm function, restricting tasks such as reaching, grasping, and manipulating objects, which are essential for daily activities [2-5,8,11,12,22-34].
d430-Lifting and carrying objects
DPN impairs lifting and carrying, affecting daily tasks [2-5,8,11,12,14,22-31,33-35].
d520-Caring for body parts
DPN impacts self-care tasks such as washing, drying, and grooming, affect personal hygiene routines, contributing to reduced independence [2,4,12,23-27,35].
d540-Dressing
DPN complicates dressing tasks, including buttoning, zipping, and tying. The challenges primarily focus on actions that require sustained hand function and precision [2,4,23-26,35].
d640-Housework
DPN reduces hand function, impacting the ability to perform household tasks [2,5,26].
d230-Carrying out daily routine
DPN limits the ability to maintain daily routines, making everyday tasks and schedules challenging and reducing participation in routine activities [2-5,8,11,12,14,22-35].
Theme 2: Upper limb sensory impairments and their impact on hand function
BF
b260-Proprioceptive functions
DPN reduces proprioceptive accuracy and precision in hand movements [8].
b265-Touch functions
DPN reduces touch sensitivity, compromising the ability to perceive fine tactile stimuli, which affects precision tasks and increases the risk of hand injuries [2,3,5,8,13,25,28,29,31,32].
b270-Sensory functions related to temperature and other stimuli
DPN impairs the detection of temperature and vibration, affecting hand safety and dexterity. Challenges include decreased ability to perceive temperature changes and vibrations and increased risk of burns, injuries, and object slippage during fine motor tasks [3,5,8,25,28,30,31,34].
b280-Sensation of pain
Neuropathic pain in the hands due DPN significantly impairs daily hand functions, limiting the ability to perform tasks because of pain and discomfort [14].
b840-Sensation related to skin
DPN results in sensory impairments related to skin, including loss of tactile and thermal sensation, numbness, tingling, and reduced touch sensitivity [2-5,8,11,12,14,22-35].
Theme 3: Upper limb muscle weakness and functional limitations
BF
b730-Muscle power
DPN leads to significantly reduced grip and pinch strength in individuals with T2DM. This decrease in muscle power impacts hand function and increases the risk of hand disability, affecting the ability to perform daily tasks [3,5,8,11,22,26,31,32].
ICF, International Classification of Functioning, Disability, and Health; DPN, diabetic peripheral neuropathy; AP, activities and participation; BF, body function; T2DM, type 2 diabetes mellitus; BS, body structure.
Table 2.
Frequency of ICF categories reported across studies
ICF code
ICF category
Number (%) of studies reporting
d440
Fine hand use
16 (72.7)
d445
Hand and arm use
20 (90.9)
d430
Lifting and carrying objects
21 (95.5)
d520
Caring for body parts
9 (40.9)
d540
Dressing
7 (31.8)
d640
Housework
3 (13.6)
d230
Carrying out daily routine
22 (100)
b260
Proprioceptive functions
1 (4.5)
b265
Touch functions
10 (45.5)
b270
Sensory functions related to temperature
9 (40.9)
b280
Sensation of pain
1 (4.5)
b840
Sensation related to skin
22 (100)
ICF, International Classification of Functioning, Disability, and Health.
214 Participants: 141 with T2DM (30.5% with upper limb neuropathy, 49.6% with lower limb neuropathy) and 73 controls
Quantitative Sensory Testing, Purdue Pegboard Test, hand grip strength, SF-12 for quality of life, Patient Health Questionnaire for psychosocial health
161 Participants with T2DM; 36 with both CTS and DPN, 42 with neither, mean age 58.4 years
Semmes-Weinstein Monofilament Test, Purdue Pegboard Test, grip and pinch strength, electrophysiological testing for DPN
/
/
/
/
/
/
/
/
ICF, International Classification of Functioning, Disability, and Health; T2DM, type 2 diabetes mellitus; DPN, diabetic peripheral neuropathy; T1DM, type 1 diabetes mellitus; DASH, Disabilities of the Arm, Shoulder, and Hand; QOL-DN, Quality of Life-Diabetic Neuropathy; ROM, range of motion; SF-12, 12-item Short Form Survey; ADL, activities of daily living; DHI, Duruöz Hand Index; /, Indicates it was reported in the study.
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Hand-Related Activities of Daily Living Challenges Among Individuals With Diabetic Peripheral Neuropathy: A Scoping Review
Fig. 1. Flow diagram of the search strategy. ADLs, activities of daily living; DPN, diabetic peripheral neuropathy.
Graphical abstract
Fig. 1.
Graphical abstract
Hand-Related Activities of Daily Living Challenges Among Individuals With Diabetic Peripheral Neuropathy: A Scoping Review
Theme
ICF component
ICF code & category
Details of hand-related issue aligning with ICF code
Theme 1: The impact of upper limb DPN on daily activities and participation
AP
d440-Fine hand use
DPN reduces the ability to perform tasks that require precise finger movements, such as buttoning, using utensils, and handling small objects. Challenges are primarily related to limited finger coordination, decreased control over fine movements, and impaired finger strength, all of which are crucial for activities requiring delicate hand use [2,5,8,11,12,22-32].
d445-Hand and arm use
DPN impairs hand and arm function, restricting tasks such as reaching, grasping, and manipulating objects, which are essential for daily activities [2-5,8,11,12,22-34].
d430-Lifting and carrying objects
DPN impairs lifting and carrying, affecting daily tasks [2-5,8,11,12,14,22-31,33-35].
d520-Caring for body parts
DPN impacts self-care tasks such as washing, drying, and grooming, affect personal hygiene routines, contributing to reduced independence [2,4,12,23-27,35].
d540-Dressing
DPN complicates dressing tasks, including buttoning, zipping, and tying. The challenges primarily focus on actions that require sustained hand function and precision [2,4,23-26,35].
d640-Housework
DPN reduces hand function, impacting the ability to perform household tasks [2,5,26].
d230-Carrying out daily routine
DPN limits the ability to maintain daily routines, making everyday tasks and schedules challenging and reducing participation in routine activities [2-5,8,11,12,14,22-35].
Theme 2: Upper limb sensory impairments and their impact on hand function
BF
b260-Proprioceptive functions
DPN reduces proprioceptive accuracy and precision in hand movements [8].
b265-Touch functions
DPN reduces touch sensitivity, compromising the ability to perceive fine tactile stimuli, which affects precision tasks and increases the risk of hand injuries [2,3,5,8,13,25,28,29,31,32].
b270-Sensory functions related to temperature and other stimuli
DPN impairs the detection of temperature and vibration, affecting hand safety and dexterity. Challenges include decreased ability to perceive temperature changes and vibrations and increased risk of burns, injuries, and object slippage during fine motor tasks [3,5,8,25,28,30,31,34].
b280-Sensation of pain
Neuropathic pain in the hands due DPN significantly impairs daily hand functions, limiting the ability to perform tasks because of pain and discomfort [14].
b840-Sensation related to skin
DPN results in sensory impairments related to skin, including loss of tactile and thermal sensation, numbness, tingling, and reduced touch sensitivity [2-5,8,11,12,14,22-35].
Theme 3: Upper limb muscle weakness and functional limitations
BF
b730-Muscle power
DPN leads to significantly reduced grip and pinch strength in individuals with T2DM. This decrease in muscle power impacts hand function and increases the risk of hand disability, affecting the ability to perform daily tasks [3,5,8,11,22,26,31,32].
214 Participants: 141 with T2DM (30.5% with upper limb neuropathy, 49.6% with lower limb neuropathy) and 73 controls
Quantitative Sensory Testing, Purdue Pegboard Test, hand grip strength, SF-12 for quality of life, Patient Health Questionnaire for psychosocial health
161 Participants with T2DM; 36 with both CTS and DPN, 42 with neither, mean age 58.4 years
Semmes-Weinstein Monofilament Test, Purdue Pegboard Test, grip and pinch strength, electrophysiological testing for DPN
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Table 1. Relevant hand-related ICF component
ICF, International Classification of Functioning, Disability, and Health; DPN, diabetic peripheral neuropathy; AP, activities and participation; BF, body function; T2DM, type 2 diabetes mellitus; BS, body structure.
Table 2. Frequency of ICF categories reported across studies
ICF, International Classification of Functioning, Disability, and Health.
Table 3. Summary of reviewed studies
ICF, International Classification of Functioning, Disability, and Health; T2DM, type 2 diabetes mellitus; DPN, diabetic peripheral neuropathy; T1DM, type 1 diabetes mellitus; DASH, Disabilities of the Arm, Shoulder, and Hand; QOL-DN, Quality of Life-Diabetic Neuropathy; ROM, range of motion; SF-12, 12-item Short Form Survey; ADL, activities of daily living; DHI, Duruöz Hand Index; /, Indicates it was reported in the study.
, Chi-Wen Chien, PhD2
