Patient-Centered Care: A Pathway to Optimizing Aging and Preventing Diabetes
Did you know therapists can reduce the incidence of diabetes mellitus type 2?
Striking results of a 2002 NEJM landmark study show that lifestyle modifications such as moderate intensity exercise for 150 minutes per week reduce the incidence of diabetes mellitus better than Metformin (58% to 31%, respectively).1 A ten-week aerobic exercise program was shown to improve insulin-stimulated uptake by approximately 10%.3
Therapists have extensive training to develop effective programs at appropriate dosing levels to prevent diabetes. Yet, physical therapy is not thought of as part of the solution. Here’s how we can change that notion.
Patient-Centered Care
Therapists that use the International Classification of Functioning, Disability and Health (ICF) broaden their view of patient care by identifying facilitators and barriers to optimal outcomes through better engagement. To create lasting lifestyle changes, we must know the context in which the patient lives. True patient-centered care is the best route to achieve adherence toward a sustainable and healthy behavior change.2
Social Environment and Patient Beliefs
To improve this population’s health, we must answer the question: why do some patients do well and others do not? Two factors are at play: the patient’s social environment and the personal beliefs.
For example, a person who believes that diabetes is inevitable because a parent had diabetes (belief in genetic etiology alone) is less likely to participate in a diabetes prevention program. An assessment that incorporates the ICF may identify this untrue belief and allow the therapist and/or healthcare team to address it, increasing the likelihood of a successful outcome.
Patient Motivation
Attaining or sustaining health behavior change requires more than uncovering patient beliefs, it involves helping the patient want to make a change. Using motivational interviewing and teach back with patients suffering from chronic disease (such as heart failure), therapists may achieve better health outcomes, decreased re-hospitalization rates with sustainable gains to improve health.
Functional Assessment Tools
Therapists looking to provide evidenced-based best practice should use functional assessment tools that objectively quantify impairments such as fall risk, mobility limitation, and frailty. More recent research on objective measures shows certain biomarkers as predictive metrics. For example, walking speed has predictive cutoffs for mortality and hospital discharge. A walking (gait) speed of less than 0.7 m/s is predictive of hospitalization for any cause, requirement for a caregiver, nursing home placement, falls, fractures, or death in healthy elderly persons 75 years or older.4
These predictive metrics can help therapists design appropriate care plans. Better-defined patient levels of impairment may also reduce patient frustration with a program that is too difficult.
The Therapist’s Role
With a patient-centered care perspective, clinicians can work with their patients to optimize aging and prevent diabetes. As therapists, we can encourage positive patient behavioral changes and identify risks with assessment tools. It’s our role to improve population health and engagement with preventative strategies.
- Golden SH, Brown A, Cauley JA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. 2016;97(September 2012):1579-1639. doi:10.1210/jc.2012-2043.
- International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001. Available at: http://www.who.int/classifications/icf/en/.
- Østergård T, Jessen N, Schmitz O, Mandarino LJ. The effect of exercise, training, and inactivity on insulin sensitivity in diabetics and their relatives: what is new? Appl Physiol Nutr Metab. 2007;32(3):541-548. doi:10.1139/H07-031.
- Montero-Odasso M, Schapira M, Soriano ER, et al. Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci. 2005;60(10):1304-1309.
