Feasibility of telephysiotherapy on glucose control and physical performance in patients with diabetic peripheral neuropathy at tertiary care center- A Pilot Study.

To determine the feasibility of a tele-physiotherapy program in diabetic peripheral neuropathy (DPN) patients. The purpose of this study is to determine the clinical effects of tele physical therapy intervention on glucose control, exercise capacity, and physical performance in patients with Diabetic Peripheral Neuropathy. Several literatures reported the effectiveness of exercises in controlling the complications of diabetes mellitus. DPN results in uncontrolled diabetes mellitus, lack of physical activities, poor lifestyle, and unawareness of exercise importance. Lack of compliance for exercise sessions among diabetic neuropathy patients. During our routine physiotherapy clinical services, it has been observed that the patient’s compliance with exercise sessions was poor with challenges including commuting to the center, dependency on family members, expenditure, etc. So, a physiotherapist provides remote care services to their patients through tele communication as they recognize the benefits that telehealth can bring such as cost savings, changes in their (exercise capacity), physical performance and quality of life, greater compliance with treatment plans, and a unique opportunity for to reach social disadvantage groups where cost, geographical location or cultural barriers may limit health services. So, a lack of regular supervised exercises can increase disease complications. The improvement in technology in the health field introduced tele physiotherapy, which has been effective in treating patients with various conditions and who have challenges being physically available. With the scope of literature reviewed, we observed only one literature on the use of tele rehab in Type 2 DM, in Western countries. Hence, this study intends to explore the use and feasibility of tele physiotherapy intervention with a focus on home-based exercises and education in DPN patients. The study will be started after obtaining ethical clearance from the institutional ethical committee. Study set up - R.L. Jalappa Hospital and Research Center. DPN patients will be contacted and those who consent to the study will be recruited. The participants will be recruited based on inclusion criteria. The variables mentioned will be documented during the initial contact with the patient. The outcome measures will be HBA1c level and short physical performance battery used for assessing the blood glucose level and physical performance in patients with DPN. The duration of the study will be three months weekly 1 session so total of 12 sessions. The time and date of the session will be informed before the start of the session. The follow-up of the included participants will be done by telephonic conversation. Home-based exercise guides using online platforms will be offered for 3 months. Glucose control and physical performance will be measured at baseline and after 12 weeks of sessions on an opd visit. Supervised Home exercise sessions to control diabetes and diabetic nerve damage offered through an online platform will make it easy and feasible for DPN patients to adhere to exercises. Hence the effects of exercise performance are expected to result in better glucose control and improved physical performance which include balance, flexibility, mobility, and stability and lower extremity functional capacity.

The results of this study will also throw light on the feasibility, adherence, and effect of Tele physiotherapy as a safe and alternative treatment mode for DPN. In addition to this, telerehabilitation services can provide health benefits, and save time, labor, treatment costs, and health access for remote areas (rural communities.)

Feasibility of setting the telerehabilitation services for DPN at RLJ center. Hence future studies should include the tele physiotherapy program for chronic DM patients. All information reporting on the feasibility, cost, access to rehabilitation services, and implementation process including the barriers and facilitators of telerehabilitation.