Physical Therapist As Community Educator for Diabetes Education
Purpose/Hypothesis: The purpose of this study was to determine if peer-led sessions led by a physical therapist on diabetes self-management impacted health behaviors, empowerment, and knowledge of diabetes. Peer-led means an educational session or support group led by a lay-person or a non-certified diabetes educator.
Number of Subjects: Twenty-six adults from Northeast Arkansas with a diagnosis of prediabetes or diabetes participated in the study.
Materials and Methods: Four topically driven sessions were provided by a physical therapist from the community. Exercise was included in each session. Pre and post-intervention questionnaires were used to assess changes in knowledge using the Revised Diabetes Knowledge Test (DKT2), empowerment using the Diabetes Empowerment Scale-Short Form, and health behaviors.
Results: A statistically significant difference was found in the empowerment scale with an increase in mean scores from 31.23 to 36.04. A paired samples t-test found statistically significant difference in scores on DKT2, (t(25)=-2.54, p<.05). Significant changes in health behaviors were found for knowledge of A1C levels, frequency of foot exams, and days of exercise per week. Using the DKT2, a Cohen's D was calculated at .419 indicating a moderate effect size. An Absolute Benefit Increase (ABI) was calculated with an outcome of 2.17.
Conclusions: A low ABI indicates groups as small as 2 or 3 can demonstrate a benefit in knowledge. A peer-led approach to diabetes education has the potential to overcome multiple barriers to receiving education. Peer-led education may be low or no cost in communities where individuals feel welcomed and travel is minimized. Exercise is a prescriptive part of diabetes care making physical therapists an excellent choice as a peer-leader for education.
Clinical Relevance: With high numbers of individuals diagnosed with prediabetes and diabetes, there are inadequate numbers of certified diabetes educators or time available during a doctor's visit to address the needed education. Type 2 diabetes costs over $300 billion per year in the United States with an estimated 100 million with diabetes or prediabetes. Complications due to diabetes place individuals at increased risk for heart attack, stroke, amputations, blindness, kidney failure, disability, and early death. Many are referred for care through physical therapy. Education has been shown to be effective in improving health behaviors that decrease complications with the potential to decrease disability, early death, and economic costs of diabetes. The most common risk factors of obesity and sedentary lifestyle can be addressed through physical therapy.