RESEARCH PROPOSAL

A cross-sectional survey to find exercise prescription pattern, awareness and practice of exercise among the community dwelling diabetic people in Mangalore.

MASTER OF PHYSIOTHERAPY IN COMMUNITY BASED REHABLITATION

(MPT- CBR)

MS.ARTI JHA

DEPARTMENT OF PHYSIOTHERAPY

FR. MULLER MEDICAL COLLEGE, MANGALORE-575002

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MS. ARTI JHA
DEPARTMENT OF PHYSIOTHERAPY
FATHER MULLER MEDICAL COLLEGE
MANGALORE-575002
2. / NAME OF THE INSTITUTION / FATHER MULLER MEDICAL COLLEGE
MANGALORE
3. / COURSE OF THE STUDY / MASTER OF PHYSIOTHERAPY IN COMMUNITY BASED REHABLITATION (MPT-CBR)
4. / DATE OF ADMISSION TO THE COURSE / 31-05-2010
5. / TITLE OF THE TOPIC / A CROSS-SECTIONAL SURVEY TO FIND EXRCISE PRESCRIPTION PATTERN, AWARENESS AND PRACTICE OF EXERCISE AMONG THE COMMUNITY DWELLING DIABETIC PEOPLE IN MANGALORE.
6.
7.
8. / BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY:
A study on global prevalence of diabetes shows India today leads the world with over 32 million diabetic patients in 2000 and this number will increase to 79.4 million by the year 20301. Diabetes has become a great economic challenge as it drains 5-25% of the family income of an average Indian2.
Diabetes is a silent disease, many sufferers have become aware that they have diabetes only when they develop one of its life-threatening complications 3Diabetes is strongly associated with many complications, including retinopathy, nephropathy, and neuropathy (micro vascular) and ischemic heart disease, peripheral vascular disease and cerebrovascular disease (macro vascular), resulting in organ and tissue damage in approximately one third to one half of people with diabetes4. Physical activity is important for the prevention and management of type 2 diabetes and its related morbidities 5, 6.Diabetes education, with consequent improvements in knowledge, attitudes and skills, leads to better control of the disease, and is widely accepted to be an integral part of diabetes care7, 8.
Healthcare professionals are well aware of the public health impact of diabetes.They are playing important role in motivating patients to make their lifestyle changes 9,10.Because of the strong medical evidence that exercise is beneficial, several organizations, including the American Diabetes Association11 and American Heart Association12 recommend that health care providers counsel their patients about physical activity.
Physical therapists will play an important role in the care of people with diabetes because numerous interventions provided by physical therapists assist in alleviating symptoms, slow the metabolic progression to overt type 2 DM, and reduce morbidity and mortality associated with these complications. 13,14,15,16
Diabetic patients are expected to receive adequate information regarding need of exercise and how to perform it from healthcare professionals like Physicians, Physiotherapists and Diabetic nurses.
Despite the increasing prevalence of diabetes and the fact that better knowledge is associated with better outcomes, we lack structured diabetic education programme. Hence it is imperative to find from patients whether they have understood the need of exercise and how it should be done so that the life threatening complications can
be averted. Apart from the usefulness of exercise in diabetics, awareness of complications related to diabetics can also motivate the patient to do exercise, so this has to be addressed in the patient education programme17.
So this study aims to find the exercise prescription pattern received by the patient from health care professionals, their practice of exercise, their awareness regarding the need of exercise and complications as well as the prevalence of complications among them.
By knowing the patients awareness regarding need of exercise in diabetics and its complications, we will be able to understand the implications of this on the actual practice of exercise. Hence this study also aims to understand the correlation between awareness regarding need of exercise in diabetics and its complications with the practice of exercise.
OPERATIONAL METHODS:-
DIABETES MELLITUS:-
Diabetes mellitus is a group of metabolic diseases in which a person has high blood sugar either because the body does not produce enoughinsulin, or because cells do not respond to the insulin that is produced.
This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). There are three main types of diabetes: type 1 diabetes, type 2 diabetes, gestational pregnancy.
TYPE 2 DIABETES: -Results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency5.
EXERCISE PRESCRIPTION: -
Exercise prescription commonly refers to the specific plan of fitness-related activities that are designed for a specified purpose, which is often developed by a fitness or rehabilitation specialist for the client or patient.
Due to the specific and unique needs and interests of the client/patient, the goal of exercise prescription should be successful integration of exercise principles and behavioral techniques that motivates the participant to be compliant, thus achieving their goals18.
EXERCISES: -
Exercise is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body. Exercise is utilized to improve health, maintain fitness and is important as a means of physical rehabilitation6.
AWARENESS:-
Awareness is the state or ability to perceive, to feel, or to be conscious of events, objects or sensory patterns17.
HEALTH CARE PROFFESIONALS: -
A person who by education, training, certification, or licensure is qualified to and is engaged in providing health care18.
COMMUNITY:-
The definition accepted by the WHO Experts Committee is “A community is a social group determined by geographical boundaries and /or common values and interest. Its members know and interact each other. It functions within a particular social structure and exhibits and creates certain norms, values and social institutions. The individual belongs to the broader society through his family community22.
RESEARCH QUESTION:
  • Is there a prescribed pattern of exercises given to community dwelling diabetics by health care professionals?
  • What is the level of awareness of the benefits of exercise and its implementation among community dwelling people?
  • What is the prevalence of complications of diabetes among community dwelling diabetic people?
  • Is there a correlation between practice of exercise with awareness of benefits of exercise and knowledge of complications?
HYPOTHESIS:
  • Health care professionals are delivering proper exercise prescription to diabetic patients.
  • Diabetic patients have sufficient knowledge regarding benefits of exercise and they practice exercise.
  • Diabetic patients who have awareness of benefits of exercise and knowledge of complications will practice exercise.
6.2 REVIEW OF LITERATURE:
A study done by the Deepa Mohan et al on the awareness and knowledge of diabetes in Chennai- CURES-9 on 26,001 subjects, shows there is lack of awareness among the Chennai residents regarding diabetes. Around 25% of them were not even aware of the condition called diabetes. They concluded that the awareness and knowledge regarding diabetes is notadequate inIndia. More diabetes awareness programmes are required in developing countries like India18.
A cross-sectional survey done by the Elaine H. Morrato, et al, “Are health care professionals advising patients with diabetes or at risk for developing to exercise more?” They concluded that the majority of patients with these disease report that they have been advised by the health care professional to exercise more. But the current study show that 34%of the total sample had been advised to exercise.21Since health care professionals are already providing exercise advice to some patients, there may be an opportunity to raise their awareness about opportunities to provide this advice to all patients, even those who are not obese or with many risk factors for type 2 diabetes19.
A study done on the Diabetes knowledge, beliefs and practices among the people with diabetes attending a university hospital in Karachi, Pakistanfoundthat the diabetes patients in Karachi had significant deficit in the knowledge regarding diabetes. The study suggests that not only the knowledge, but also the beliefs and practices of diabetes patients were less than satisfactory. Their finding was also supported by the evidence that the people with type 1 or type 2 diabetes on insulin are more adherent to self-monitoring of blood glucose.23
In 2002, a cross-sectional survey was done by H L Wee, H K, S C Li on the Public Awareness f Diabetes Mellitus in Singapore want to identify area of knowledge that require additional educational efforts. A total of 1337 subjects were interviewed and public represented by the samples in this survey is generally well informed about diabetes except for few areas. Health care professionals should be more active in circulating health information about diabetes to the public. An improved educational programme that tackles theareas of weaknesses or misconceptions can potentially increase the level of public awareness of diabetes22.
A Cross sectional study, “physical activity/excercise and type 2 diabetes” was doneSigal RJ et alin 2004to emphasize on the advances that have occurred since the last technical review which was published. Major developments technical review included are increase our understanding of the effects of exercise on glucoregulation, clinical trials demonstrate that life interventions reduces incidence of type 2 diabetes in people with improved glucose tolerance, cohort studies showing that the low aerobic fitness and low physical activity level increased risk of overall and cardiovascular diseases and on the new data, on safety of resistance training in population on high risk for CVD they recommended on the types, amount, intensities of aerobic physical activities for people with diabetes. This study provides evidence that both diet and exercise can be effective diabetes prevention modalities.6
6.3OBJECTIVES OF THE STUDY:
•To find out the pattern of exercise prescription for diabetic patients by health care professionals.
•To find the awareness of diabetic patients regarding benefits of exerciseand knowledge of complications.
•To find the exercise practice of diabetic patients.
•To find the complications among diabetic patients.
•To find the correlation between practice of exercise with awareness of benefits of exercise and knowledge of complications.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA :-
Community dwelling diabetic individuals in and around the Mangalore.
7.2 METHOD OF COLLECTION OF DATA :
STUDY DESIGN:-
A cross sectional survey.
SAMPLE PROCEDURE AND SAMPLE SIZE:-
Convenience sampling of sample size 1000 subjects.
INCLUSION CRITERIA:
  • Community dwelling diabetic individual in and around the Mangalore.
TOOLS :
QUESTIONNARE
Contents are:-
  • Exercise prescription pattern by health care professionals.
  • Awareness regarding exercises and benefits of exercises.
  • Practice of exercise and presence of complications.
METHOD OF THE STUDY-
A questionnaire will be prepared to find pattern of exercise prescription by health care professionals, awareness of diabetic patients regarding usefulness of exercise and complications of diabetesand practice of exercise
This will be validated by the experts and also translated in Kannada language and circulated among community dwelling diabetic people.
STATISTICAL ANALYSIS: The result will be analyzed by using frequencies, percentage and Chi-square test.
7.3 Does the study require any investigation or intervention to be conducted on patients or animals?
No
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
LIST OF REFERENCES :
  1. W. S.,Roglie G,Green A, King H. Global prevalence of diabetes estimates for the ear 2000 and projection for 2030. Diabetes Care 2004; 27:1047-53.
  2. Shobhana R, Rama P,Lavanya A ,Williams R, Vijay V, Ramchandran A.Expenditure on health care incurred by diabetic subjects in developing countries a study from South India. Diabetes res ClinPract 2000;48;37-42
  3. Diabetic fact and figures: American Diabetes Association.
  4. UK prospective Diabetic study (UKPD) VIII. Study design progress and performance. Diabetologia (1991; 34:128-34).
  5. Robert S. MD , Robert M., EdD, John B, PhD,Marshall H. MD, MPH, David E, MD, Judith F, MD, Theodore G., MD, HenryN. Ginsberg, MD, Richard , PhD, Robin N, MS, Marion R, MD, LeonardS, PhD, Michael, MD, Frank V, MD and Bernard Z, MD.American Diabetes Association, National Institute of Diabetes and Digestive and kidney Disease: The prevention or delay of type 2 diabetes. Diabetes Care(suppl. 1):S62-S69,2003.
  6. Sigal RJ, Kenny GP, WassermanDH, Castaneda S C: Physical activity/exercise and type 2 diabetes. Diabetes Care 27:2518-2539, 2004.
  7. Fritsche A, Stumvoll M, Goebbel S, Reinaurr KM. Long term effects of a structured inpatient diabetic teaching and treatment programme in type 2 diabetic patients: influence of mode of follow-up. 1999, 46(2):135-41.
  8. Nicolucci A, Ciccarone E, Consoli A, Di Martino ,Penna G, Latorre A, Relationship between patient practice-oriented knowledge and metabolic control in intensively treated type 1 diabetic patients: results of the validation of the knowledge and practice diabetic Questionnaire. Diabetic nutrition and metabolism, 2000, 13(5):276-83.
  1. Thomas RJ, Kottke TE, Brekke MJ, Brekke LN, Brandel CL, Aase LA Attempts at changing dietary and exercise habit to reduce the risk of cardiovascular disease: Who’s doing what in the community? Prev.Cardiol %:102-108,2002.
  2. Abid A, Galuska D, Khan LK, Gillespie C, Ford ES, SerdulaMK.Are health care professionals advising obese patients to lose weights? JAMA 282:157-1578,1999.
  3. American Diabetes Association: Standards of medical care in diabetes. Diabetes Care 28(suppl.-1):S4-S36, 2005.
  4. Gerald F. Fletcher, MD.How to implement physical activity in primary and secondary prevention: a statement for health care professionals from the force on risk reduction, American Heart Association. Circulation96:355-357, 1997.
  5. GD Smith, Ybracha, Kenneth H., James D. Lewis H.Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial. Ann Intern- med, 2005; 142:313.
  6. Prevention of type 2 DM by changes in lifestyle among subjects with impaired glucose tolerance. N Eng. J 1989; 321:337.
  7. Early metabolic defects in person at increased risk for NIDDM. N Eng. J Med 1989; 321:337-343.
  8. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Eng J med 2002:346:393-403.
  9. G. Rafique,S.I. Azamand F. White.Diabetes knowledge, beliefs and practices among people with diabetes attending a university hospital in Karachi, Pakistan.Eastern Mediterranean Health Journal, Vol. 12, No. 5, 2006.
  10. D Mohan, D Raj, CS Shanthirani, MDatta, NC Unwin, A Kapur, V. Mohan.Awareness and knowledge of diabetes in Chennai- CURES-9.vol 53, apl 2005.
  1. Elaini H. M, Vahram G, PW. Sullivan, J O. Hill. Are Health Care Professionals AdvisingPatients With Diabetes or At Risk forDeveloping Diabetes to Exercise More? Diabetes Care 29:543-548, 2006.
  2. Wee CC, McCarthy EP, Davis RB,Phillips RS: Physician counselling about exercise. JAMA282:1583-1588,1999.
  3. Ruggiero L et al. Diabetes self management. Self- reported recommendations and patterns in a large population. Diabetes Care, 1997,20(4):568-76
  4. WeeHL, HoHK, LiSC. Public awareness of DM in Singapore. SingaporeMed J 2002; 43: 128-34.
  5. Park’s Textbook of Preventive and Social Medicine 19th edition 2007. WHO(197), Tech. Rep. Sr. No 558.

CONSENT FORM

I, ______hereby agree to provide my fullest consent and co-operation as a subject for the dissertation work of Ms .Arti Jha titled “A cross-sectional survey to find exercise prescription pattern, awareness and practice of exercise among the community dwelling diabetic people in Mangalore” as a part of her post- graduation in physiotherapy.

The possible benefits as well as the procedure and duration of the study have been explained to me. The questions and queries I have posed have been answered to my satisfaction and I am aware that my identity will be kept confidential. I am also aware that I can discontinue the study at anytime I wish to do so.

Place:

Date: Signature

9. / SIGNATURE OF THE
CANDIDATE
10. / REMARKS OF THE GUIDE
11. / NAME AND DESIGNATION OF
11.1 GUIDE
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMENT
11.4 SIGNATURE / MR.JIDESH V .V
ASSISTANT PROFESSOR
DEPT OF PHYSIOTHERAPY
MR.NARASIMMAN S.
ASSOCIATE PROFESSOR
DEPT OF PHYSIOTHERAPY
12. / 12.1 REMARKS OF THE
CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE

QUESTIONNARE:-TO FIND EXRCISE PRESCRIPTION PATTERN, AWARENESS OF EXERCISE AND COMPLICATIONS OF DIABETESAND PRACTICE OF EXERCISE.

TO BE FURTHER MODIFIED AND VALIDATED.

Name: ______

Date of birth: ______

Gender: ______

Address: ______

Tele: ______

E-mail: ______

Education (highest degree): ______

Occupation: ______

Marital status (circle one):

Married

Not married

Divorced

Widowed

Other......

Height and weight: ______

Date ......

Diabetes questionnaire

  1. When was your diabetes first diagnosed?
  1. How old were you when your diabetes was first diagnosed?
  1. What is the normal value of glucose fasting?
  1. What is the normal value of glucose post prandial?
  1. Are you on Insulin or medications?
  1. If on Insulin, for how long are you taking Insulin?

Diet:

  1. Are you aware that diet can maintain the glucose levels?
  1. Have you modified your diet according to your diabetic level?
  1. If yes, how have you modified......
  1. If no, what is the reason?

Exercise:

  1. Are you advised for regular exercise by any of the health care professional?
  1. List any regular exercise regimen you follow
  1. How long should you do exercise each day and how many days a week?
  1. What are the benefits of regular exercise on Diabetes

a) it controls glucose levels

b) helps on weight reduction and fat accumulation

c)reduce the chances of Diabetic complications

d)reduces your dependency on medications and Insulin

e)improves your quality of life

Blood glucose monitoring:

  1. How often do you check your blood sugar?
  2. When was your last Glucose level check up?

11. Hyperglycemia (high blood sugars):

What are the warning signals of Hypoglycemia: ______

Does hypoglycemia affect your lifestyle? In what way?

What precautions do you take to combat hyperglycemia?

Have you ever been in a coma because of high blood sugars? If so, when?

12. Eyes:

How often do you see the eye doctor?

Have you been diagnosed with retinopathy (decrease in visual acuity):

?right year of onset ______year of laser surgery ______

?left year of onset ______year of laser surgery ______

Have you been diagnosed with diabetic macular edema (blurred vision):

?right year of onset ______year of laser surgery ______

?left year of onset ______year of laser surgery ______

Do you know that exercise can prevented eyes problems?

If yes, how?

13. Kidneys:

Have you ever been told you have high blood pressure? If so, what year were you first told?

What is your usual blood pressure?

Do you monitor your own blood pressure (B/P) at home?

If so, how often:

Do you take medication for high blood pressure, if so what:______

Do you know that exercise can prevented kidney problems?

If yes, how?

14. Nerves:

Please check any of the following problems you experience:

?Numbness or tingling of extremities ?Foot ulcers