The role of physiotherapists and kinesiologists in physical activity interventions for diabetes management in primary care settings: a modified Delphi study

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Proctor, Carly
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Introduction: With an ever-growing prevalence, diabetes is a significant burden on the health care system and primary care which is where most diabetes care takes place. Physical activity is an effective and underutilized intervention in diabetes prevention and management. However, exercise specialists like physiotherapists and kinesiologists are not commonly members of diabetes care teams. Effective interprofessional collaboration with exercise specialists for diabetes care requires role clarity. Purpose: To promote effective interprofessional collaboration in primary care settings for diabetes care and physical activity by, (a) establishing the competencies of entry-level physiotherapists and kinesiologists for physical activity as an intervention for diabetes in primary care settings and (b) developing a referral pathway for physical activity interventions based on the distinct discipline-specific competencies for use by interprofessional primary care teams. Methods: Eleven physiotherapy and three kinesiology subject matter experts participated in two rounds of Delphi surveys to develop discipline and context specific competencies. These competencies were used to draft clinical tools (competency profiles and referral pathway), that were member-checked and modified based on focus group findings. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively. Results: There was consensus on 38 physiotherapy and 27 kinesiology competencies that highlighted the complexity of physical activity interventions for diabetes and the distinct roles of physiotherapists and kinesiologists in this practice area. Physiotherapy competencies highlight their unique role in supporting people with all types of diabetes to engage in physical activity despite complex medical or physical barriers. Focus group feedback resulted in modifications to the layout of the referral pathway to reflect that both professions can provide physical activity interventions for people with complex personal and environmental barriers or less complex medical or physical care needs. Kinesiologists may require additional training or mentorship, especially when working with people with type 1 diabetes or who are pregnant. Conclusions: The developed clinical tools support improved interprofessional collaboration by clarifying physiotherapy and kinesiology roles in physical activity interventions for diabetes and highlighting how the two distinct professions can contribute to addressing the growing diabetes epidemic in primary care.
physical therapy, physical therapist, exercise, kinesiology, exercise professionals, physiotherapy, Delphi, diabetes, primary health care, primary care