KNOWLEDGE, CONFIDENCE AND EDUCATION NEEDS OF CANADIAN PHYSIOTHERAPISTS WORKING WITH PEOPLE LIVING WITH DEMENTIA

S. Hunter¹, C. Arnold², M. Auais³, L. Beaupre⁴, V. Dal Bello-Haas⁵, C. McArthur⁶, T. Liu-Ambrose⁷, K. Nugent⁸, M. Savundranayagam⁹

¹University of Western Ontario, School of Physical Therapy, London, Canada, ²University of Saskatchewan, School of Rehabilitation Science, Saskatoon, Canada, ³Queens University, School of Rehabilitation Therapy, Kingston, Canada, ⁴University of Alberta, School of Physical Therapy, Edmonton, Canada, ⁵McMaster University, School of Rehabilitation Science, Hamilton, Canada, ⁶Dalhousie University, School of Physical Therapy, Halifax, Canada, ⁷University of British Columbia, Physical Therapy, Vancouver, Canada, ⁸University of Western Ontario, Faculty of Health Sciences, London, Canada, ⁹University of Western Ontario, School of Health Studies, London, Canada

Background: Physiotherapy for people living with dementia (PLWD) can improve mobility, prevent falls and maintain independence. The Dementia Strategy for Canada (2019) included the goal to develop a skilled healthcare workforce in this area. Yet, providing expert health care to PLWD is recognized as a global challenge. Research has identified the following limitations among healthcare professionals to working with PLWD: negative attitudes, lack of confidence and lack of educational opportunities. Therefore, it is important to understand the experiences of physiotherapists working with PLWD to identify education needs and develop training to deliver optimal care for this vulnerable group.

Purpose: To evaluate the knowledge, confidence and education needs of physiotherapists in working with people living with dementia.

Methods: An online survey in English or French was completed by physiotherapists registered to practice in Canada. Data were collected on demographics, training experience in dementia, Confidence in Dementia Scale (Elvish et al. 2014), Dementia Knowledge Assessment Scale (DKAS) 2.0 (Annear et al. 2015), Impact of Cognitive and Behavioural Symptoms on Physiotherapy Treatment (Staples & Killian 2012) and strategies for cognitive and behavioural symptoms (McGilton et al. 2007).

Results: A total of 130 physiotherapists completed the survey (age=39.8(10.7) years and 12.5(11.0) years of practice). Education on dementia and working with PLWD was reported by 55% of participants during entry-to-practice training and 65% after graduation. Only 47.3% reported being satisfied that their training was sufficient. The severity of dementia impacted the evaluation of training. Training was reported as sufficient by 60.3% in mild dementia, 49.6% in moderate dementia and 29.2% for severe dementia. Knowledge of dementia was 60% on the DKAS, with sub-scores of 60% in causes and characteristics, 67% for communication and behaviour, 50% for care considerations and 65% for risks and health promotion. Confidence in working with people with dementia was 67.4% with scores ranging from 38% to 88%. People reported they had strategies to address behavioural symptoms for anxiety (67%), agitation (61%), disinhibition (58%) and aggression (49%). People reported they had strategies to address cognitive symptoms for memory problems (79%), decreased initiative (62%), lack of insight (52%) and language impairment (50%). Overall, 59.7% reported good job satisfaction in caring for people with dementia.

Conclusions: The study found confidence and job satisfaction for working with PLWD was fair to good overall. Education needs included knowledge of dementia and rehabilitation strategies for addressing behavioural and cognitive symptoms that can be employed across disease severity, particularly for those with severe dementia. Targeted education to build confidence and competence needs to begin in entry-to-practice training and be available in post-professional courses for physiotherapists.

Implications: As the number of people living with dementia increases, physiotherapists will have more direct contact with clients with dementia across all clinical settings (e.g., acute care and community settings). Providing optimal physiotherapy care to people living with dementia will pose serious challenges for healthcare providers, especially if they are unprepared. This study will inform the development of education content for physiotherapy students and physiotherapists working with people living with dementia.

Funding acknowledgements: University of Western Ontario Faculty Scholar Award.

Keywords:
Education
Dementia
Survey & questionnaire

Topics:
Older people
Education: clinical
Neurology

Did this work require ethics approval? Yes

Institution: University of Western Ontairo

Committee: Health Research Ethics Board

Ethics number: HSREB#116890