The Role of the Physical Therapist in Managing Type 2 Diabetes: Systematic and Qualitative Perspectives

Introduction: Physical activity (PA) is an effective tool in the management of Type 2 Diabetes (T2D). PA recommendations for people with T2D are to achieve at least 150 minutes per week of moderate intensity PA. This assists to maintain blood glucose control and reduce cardiovascular disease risk factors. Unfortunately, people with T2D are less likely than their normoglycemic peers to meet PA recommendations. Veterans of the armed forces experience T2D at even greater levels than the general population, with prevalence at about 20%. In addition, T2D and pre-diabetes are elevated among younger veterans, including those of recent conflicts. Reducing rates of T2D and the comorbidities associated with the disease is important to serve this population. Physical therapists (PTs) are movement and exercise specialists who are well equipped and trained to direct PA and exercise programs for health. While PTs see many individuals who have or are at risk for T2D, up to 80% of their clientele, these encounters are typically to address some other musculoskeletal complaint and not to assist in the management of diabetes. Objectives: This study was conducted to (1) assess the quality and effectiveness of existing PT-guided/directed PA interventions for patients with T2D, and (2) examine physical therapists’ perceptions on promoting PA interventions for patients with T2D. Methods Aim 1: To assess the quality and effectiveness of PT-guided PA interventions for people with T2D (chapter 2), a systematic review and meta-analysis of randomized controlled trials was completed. Standardized mean differences on extracted biomarkers and Hedge’s g were calculated to determine the effect of PT-guided PA interventions for people with T2D versus usual care. Effect size was analyzed at the overall level, as well as the study and biomarker level. Results Aim 1: A systematic search of four databases resulted in 21 randomized controlled trials of PA interventions directed by physical therapists for people with T2D. These trials took place around the globe and their duration ranged from approximately 2 weeks to 2 years. There was an overall moderate effect size for these PA interventions on biomarkers related to T2D management. Methods Aim 2: To examine the beliefs and experiences of physical therapists’ working for the Veterans Affairs (VA) healthcare system about the role of PT in management of T2D (chapter 3), a phenomenological qualitative study was completed. This study involved semi-structured interviews with physical therapists working for the VA using an interview guide to explore their beliefs, experiences, and perceptions about the role of PT in management of T2D for veterans. Results Aim 2: Twelve semi-structured interviews with physical therapists employed by the VA were analyzed. The 12 interviewees were primarily female, held a board-certified specialization, and had between 8 and 32 years of experience as physical therapists. From these interviews, 6 themes were identified around their beliefs and experiences: 1) prevalence and complexity of the disease (T2D); 2) health behaviors and locus of control; 3) the unique challenges involved in providing care to veterans; 4) opportunities and benefits of working for the VA; 5) confidence in the knowledge of the physical therapist; and 6) variable perceptions of the role of the physical therapist in managing T2D. Conclusions: Systematic review of existing trials shows that PT-directed PA can have a significant and meaningful impact on T2D management. The qualitative study showed that the combination of the resources available through the VA healthcare system and the physical therapists’ knowledge and training have them well equipped to address a challenging disease for medically complex patients who are also unique due to their veteran status. From the results of the two studies, physical therapists can help their patients manage T2D, and future intervention studies are needed to trial the incorporation of PT into routine care for veterans newly diagnosed with T2D.