Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof‐of‐concept randomised controlled trial

Abstract

Background The benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered. Aim To explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period. Design An embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis. Participants Purposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited. Results Analysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities. Conclusion Our findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT.

Manual therapy in diabetic patients with tibio-tarsal dorsiflexion deficit and forefoot overload. Functional assessment of plantar pressures and gait after manual treatment. A Case Report

“…The role of manual treatment associated with an exercise programme under the supervision of a physiotherapist, an education in continuous speci c exercise to increase tibio-tarsal dorsi-exion and reduce forefoot pressures, may be essential for subjects who, after an adequate training programme, become capable of performing physical activities independently (25,26).…”

Manual Therapy in Diabetic Patients with Tibio-tarsal Dorsiflexion Deficit and Forefoot Overload: A Case Report

“…The role of manual treatment associated with an exercise programme under the supervision of a physiotherapist, an education in continuous specific exercise to increase tibio-tarsal dorsi-flexion and reduce forefoot pressures, may be essential for subjects who, after an adequate training programme, become capable of performing physical activities independently (Lepesis et al 2022;Searle et al 2017).…”

Systematic review and meta‐analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance

“…52,53 However, the purpose of this review was to inform the intervention design of a proof-of-concept RCT which investigated the effects of mobilisations combined with stretches on ankle ROM, PPPs and balance. 56 Lastly, the effects of exercise interventions on balance in people with diabetes have not been investigated.…”