Advancing Type 2 Diabetes as a Condition for Primary Referral to Physiotherapy in Canada
Abstract
Obesity and sedentary lifestyle are increasingly prevalent risk factors for type 2 diabetes (T2D), characterized by high blood glucose levels. Adoption and maintenance of healthy eating, physical activity, and exercise is recommended for lowering blood glucose and weight management. Physiotherapists are experts in prescribing safe, effective exercise to optimize health for people with co-morbid health conditions. However, T2D is not a primary condition for referral to physiotherapy services in Canada. The overall question guiding a series of three related studies was, What is the current education and perspectives of Canadian physiotherapists about their role in managing T2D? Study one surveyed and interviewed Canadian physiotherapy educators (n=10) as content experts of academic training of entry-to-practice physiotherapists. Participants held the opinion that physiotherapists are educated to assess for and manage diabetes complications, including peripheral neuropathy, lower limb amputations, and cardiovascular disease. Educators reported T2D is considered as a co-morbid health condition currently in curriculum. Study two detailed the perspectives of physiotherapists (n=21) through interviews. Physiotherapists agreed they would welcome the primary referral of people with T2D. They advocated physiotherapists can provide effective care for people with T2D, as a condition of primary referral, through education, prescription and supervision of exercise, and supporting healthy lifestyle behaviours. Lastly, study three examined the effectiveness of an 8-week supervised group education and exercise program, ‘Get Fit for Active Living with Diabetes’ (GFAL-D), for 12 people with T2D, exploring motivation at one-, six- and 12-month follow ups through interviews. Clinically significant improvements were observed for waist circumference, systolic blood pressure, six-minute walk test (6MWT), timed up-and-go (TUG), 30-second chair stand test (CST) and arm curls. Follow up with a physiotherapy student was a motivator contributing to physical activity adherence within an episodic pattern of adherence throughout the year post-GFAL-D. In conclusion, entry-to-practice physiotherapists are trained to provide direct care employing exercise prescription and monitoring, behaviour change for living healthy lifestyles, and recognition of uncontrolled disease for referral to medical team members. Promotion of physiotherapy as a resource and partnership for referral from primary health care providers is needed to optimize health for people living with T2D.