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Barriers and facilitators for the implementation of exercise therapy among patients with diabetic neuropathy: a mixed
Shalimol Us1, K T Moly1, Menon V Usha2
1Amrita College of Nursing, AIMS Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Objective:
This mixed methods systematic review will aim to identify, synthesize, and integrate quantitative and qualitative evidence on the barriers and facilitators affecting the implementation of exercise therapy for patients with diabetic neuropathy.
Introduction:
Diabetic neuropathy is one of the most prevalent and debilitating complications of diabetes, often leading to impaired mobility, pain, reduced physical function, and diminished quality of life. Exercise therapy is widely recommended as a core component of management; however, its implementation in clinical and community settings remains inconsistent.
Eligibility Criteria:
This review will include qualitative, quantitative, and mixed methods studies involving adults (≥18 years) with type 1 or type 2 diabetes mellitus and diabetic peripheral neuropathy. The review will consider evidence relating to barriers and facilitators influencing the implementation, uptake, adherence, or delivery of exercise therapy from multiple perspectives, including patient (eg, beliefs, motivation, health literacy), provider (eg, knowledge, attitudes, training), and health system (eg, accessibility, policies, financing, service delivery).
Methods:
The review will follow the JBI methodology for mixed methods systematic reviews using a convergent integrated approach. The data will be extracted from databases and gray literature, including MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid) Scopus, Cochrane CENTRAL, ProQuest Dissertations and Theses Global, the WHO International Clinical Trials Registry Platform (ICTRP), and Google Scholar. Two reviewers will independently extract data using a customized form, screen titles, abstracts, and full texts, and assess methodological quality. Qualitative data will be transformed into "qualitized" statements and integrated with quantitative findings. A single set of integrated findings will be developed using meta-aggregation and narrative integration techniques, resulting in synthesized statements and practical recommendations. The review will follow PRISMA reporting guidelines.
Review Registration:
PROSPERO CRD420261284500.