title: Web-based physiotherapy for people with chronic health conditions: South Asians with type 2 diabetes
Creators: name: Albalawi, Hani
Publisher: name: University of Glasgow
Year: 2019
Subjects: subject: Physiotherapy, exercise, diabetes, type 2 diabetes, culture, South Asians, ethnic minority, intervention development, co-design, digital health, web-based intervention, tele-rehabilitation.

description: South Asians are disproportionally affected by type 2 diabetes (T2DM) and its complications. Structured exercise is recommended for people with T2DM, however, evidence regarding the effectiveness of exercise in T2DM management has emerged from studies mainly involving white Europeans. In addition, South Asians are less likely to engage in exercise due to barriers such as lack of gender-specific exercise facilities and family commitment. The aims of this thesis were to investigate the effectiveness of exercise interventions in the management of T2DM in South Asians and to explore the acceptability and the likely effect of a web-based exercise intervention as a solution to facilitate the engagement of South Asians with T2DM in exercise interventions. This was done through three studies. The first study was a systematic review of clinical trials examining the effectiveness of exercise interventions in the management of T2DM in South Asians. This review included 18 studies which involved 1,063 participants and examined the effect of aerobic, resistance, balance and combined exercise programmes. All these types of exercise programmes were associated with improvements in at least one of the following: glycaemic control, blood pressure, waist circumference, blood lipids, muscle strength, functional mobility, quality of life and neuropathy progression. However, further studies of robust methodology are required to strengthen the findings and to identify the most appropriate exercise dose. The second study was a three-stage user-centred design process which aimed to customise a web-based physiotherapy platform to be accessible and culturally relevant for South Asians. The first stage involved two gender-specific exploratory focus groups to explore South Asians’ views and identify their needs. Three themes were identified that enabled an understanding of South Asians’ perceptions regarding exercise, using technology as a delivery method and also highlighted the modifications needed to make the platform acceptable and culturally relevant for South Asians. The second stage involved refining and customising the platform based on participant views gathered during stage one. Several modifications were made to the platform which included translating the available exercise videos into Urdu as well as filming new exercise video clips with actors from different ethnic backgrounds wearing modest clothes. The final stage involved two gender-specific confirmatory focus groups to obtain feedback on the modifications made to the platform in the previous stage. One theme was identified at this stage highlighting participants views on the modified platform. The final output of this study was the co-production of an accessible and culturally relevant web-based exercise platform for people from South Asian communities that was used in the final study to deliver a web-based exercise intervention. The final study was a pilot, randomised controlled study embedded with interviews to investigate the feasibility, the acceptability and the likely effect of a 12-week personalised exercise programme delivered using a web-based platform, compared to usual care, in terms of glycaemic control, muscle strength, functional ability, blood lipid profile, blood pressure and quality of life in adult South Asians with T2DM. Twenty-four out of 33 participants (73%) completed the post intervention assessment. Five participants were interviewed at the end of the intervention. No adverse events were reported from this study. Seventy-six percent of participants used the platform and accessed the intervention. The adherence to the intervention was satisfactory (ranged from 57% during the first four weeks to 31% in the last four weeks). Participants who were interviewed perceived the intervention as being helpful, practical, and a trusted source of knowledge. Female participants in particular felt that the intervention helped them to overcome the cultural barriers to exercise that are related to the lack of gender-specific exercise facilities. Participants liked the platform and described it as easy to use. Participants suggested a few modifications to further improve the ease of use. In terms of effectiveness, compared to the control group, participants in the intervention group showed trends towards improvements with moderate to large effect sizes in the following outcomes: total cholesterol levels, triglyceride levels, handgrip strength, the Timed up and Go, and the physical health sub-domain of the WHO Quality of Life-BREF. In conclusion, the studies within this thesis indicate that exercise is beneficial for South Asians with T2DM. The web-based exercise intervention was found feasible and acceptable to South Asians with T2DM and has the potential for effectiveness. Further powered studies are required to strengthen, expand and confirm the current findings.