Commentary on “Effectiveness of tele-guidance for physiotherapy in older patients with type 2 diabetes: A randomized controlled trial”

Dear editor,

We read with interest the article by Kataoka H. et al., titled “Effectiveness of tele-guidance for physiotherapy in older patients with type 2 diabetes: A randomized controlled trial.”¹ The study found that once-weekly physiotherapy remote guidance can effectively improve the knee joint extension of older patients with type 2 diabetes mellitus (T2DM) and increase the compliance of physiotherapy, providing a new effective intervention strategy for older patients with T2DM. However, while the study offers significant clinical implications, a few aspects warrant further discussion.

First, a study has shown that patients with T2DM have a moderate or more severe risk of hearing loss. In terms of the duration of diabetes, diabetes for 8 years or more is associated with a higher risk². At the same time, natural aging may also be accompanied by hearing loss. These cases will affect the effect of telephone communication and guidance, and then affect the accuracy of the results. Such patients should be excluded.

Second, the confounding factor of patient medication should be controlled in the study. Diabetics taking certain drugs, such as metformin, will have a protective effect on sarcopenia³. In patients with abnormal lipid metabolism, the use of statins may cause muscle pain or weakness⁴. Therefore, the accuracy of the available results may be somewhat compromised.

In addition, the EuroQol 5-dimensional questionnaire is more subjective in evaluating health-related quality of life (HRQOL), which may be affected by the patients' emotions, understanding, and subjective judgment. Moreover, the three types of answers in each dimension are not detailed enough, and it may not be possible to accurately assess subtle changes in a certain dimension. A variety of assessment tools and multi-dimensional data collection should be used to accurately understand the degree of change.

Overall, the study emphasizes the effectiveness of tele-guidance on physiotherapy in older patients with T2DM and provides a new strategy for health care management. By implementing these recommendations, researchers can improve the quality of their study, and further improvement in the study design can provide more reliable guidance for clinical practice.

The authors declare no conflict of interest.

Approval of the research protocol: N/A.

Informed consent: N/A.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

No funding was received for this work.