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Table 2 Themes, subthemes and quotations

From: Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial




Support from others to do the exercises

Family support by reminding benefits of exercise

“I used to do it when my wife said have you done your exercises today … so I really needed prompt to be reminded (P4)

Support from physiotherapist by positive motivation

“It wasn’t difficult, it was rather pleasant, having the physiotherapy treatment here every week it was great, quite relaxing” (P14)

Psychological factors to motivate exercise adherence

Moral obligation to do the exercises being a study participant

“My feeling is that once, my philosophy in life always been, if you start something you must finish it. And that’s in any facet in life, if you start something you must finish it” (P3)

Contributing to research and helping future people with diabetes

“I found participating in this research very useful and I just want to help other people and want to help me as well” (P5)

Gaining confidence and seeing the benefits of being study participants

“I have noticed my ankles are freer, now at home I will walk through the hallway without my walking stick, I haven’t been doing that for a long time” (P12)

Physical factors contributing to exercise adherence

Exercises improved mobility and flexibility in foot and ankle joints

“Since doing the exercises, I have noticed big improvements in my movements, it has eased off the stiffness in my ankles and big toes” (P14)

Physiotherapy visits helped foot and ankle mobility

I feel having the physiotherapy was making my joints feel better, not so tight, less restriction in my ankle joints” (P11)

Exercises and Physiotherapy visits helped to reduce pain experiences

“I found the physio sessions so helpful, so pain relieving especially when he was pulling my leg” (P5)

Exercises and Physiotherapy improve participation in Activities of Daily Living

“Bending the foot is much easier now, like picking things from the floor, or climbing up the stairs or walking a long distance” (P11)

Acceptability of home exercises during and beyond the study

Instruction for stretches were easy to understand and exercise diary easy to complete

“The stretches were easy to understand and had some pretty pictures to tell me what I was meant to do anyway” (P8)

Home stretches don’t take long to complete

“It wasn’t taking me very long to do the exercises so that didn’t put me off” (P11)

Stretches were enjoyable to do

“Stretches became

more enjoyable, the more I did them” (P10)

Continue with stretches beyond study

“I will indefinitely carry on doing them every morning, they have improved my walking and my confidence” (P15)

Social factors that contributed to exercise disengagement

Insufficient time and lack of routine to do the home stretches

“Not doing them as often … .laziness I suppose (patient laughs) and time; mornings can be quite rushed bang bang and off to work, evenings you get home and then you are tired, you think let’s get to bed” (P13)

Emotional limitations that influence exercise avoidance

Lack of self-motivation and non-enjoyment of exercise

I didn’t think they (home exercises) were time consuming, 10 min, which is not a lot of time but I think we find excuses sometimes, don’t we? (P13)

Preconceived opinions and experiences of little or no benefit of the intervention (physiotherapy and/or exercises)

“I didn’t really notice any difference at all in my walking (home stretches), but I don’t really have any problems with walking” (P2)

Physical circumstances that made exercise participation burdensome

Perceived pain by the intervention (physiotherapy and/or exercises)

“I think it is useful to have the daily exercises, certainly, but having some physiotherapy especially on my ankles when the pressure was put on my ankles by the physio, that tended to be quite painful – so that was one of the reasons why I tended to protect myself” (P6)

Perceived side-effects from existing comorbidities influence the exercise frequency

“My walking has been very difficult because of my stenosis … It was all rather put off because of my stenosis which was getting in the way; up until my stenosis got really bad, the exercises were helping me no end” (P5)