Attitudes, knowledge and educational needs in dementia care amongst physiotherapists working in Malta and Gozo

Abstract

Background: There is a dearth of international and local information on the physiotherapists’ attitudes, knowledge base and educational needs in dementia care. This research study was deemed important as it shed light on the knowledge, types of attitudes and the perceived educational needs of physiotherapists working in Malta and Gozo. The number of persons living with dementia in Malta, is set to double from a population of 6,552 to 14,117 persons living with dementia in 2050 (Alzheimer Europe, 2019). In fact, the percentage of the Maltese population living with dementia will represent 3.31% of the population in 2050 when compared to 1.38% for the years 2018-2019. These estimates show how increasing awareness about dementia and its management amongst the local physiotherapy profession workforce is of utmost importance to enhance the delivery of care, awareness of dementia, and improve the quality of life of persons living with dementia. Aims: The aims of the study were to (a) explore the attitudes, (b) look at the knowledge base, and (c) identify the training needs of the whole population of physiotherapists working in Malta and Gozo regarding persons living with dementia. This research study also aimed to establish any relationship between the physiotherapists’ profile characteristics and the knowledge, attitudes and training needs. Design: A cross-sectional, quantitative research design was used for this research study. A self-administered questionnaire survey was sent by post to all the physiotherapists working in Malta and Gozo, registered with the Council for the Professions Complimentary to Medicine, at the time of the study. The questionnaire survey contained questions related to (a) profile characteristics of age, work setting, and previous dementia training, (b) the Alzheimer’s Disease Knowledge scale (ADKS) which assessed the knowledge base of the professionals on dementia, (c) the Dementia Attitudes scale (DAS) which explored the physiotherapists’ attitudes towards persons living with dementia, and (d) the Training Needs Survey which identified the physiotherapists’ training needs with respect to dementia care. ii Results: The physiotherapists’ overall (a) mean knowledge score was 23.2, (b) mean attitude score was 108.7, and (c) training needs score amounted to 48.3. These scores implied a positive relationship between physiotherapists’ knowledge levels and attitudes towards persons living with dementia. On the other hand, the training needs were not dependent on the physiotherapists’ knowledge levels and attitudes towards persons living with dementia. An association between the physiotherapists’ mean knowledge levels and attendance to dementia training was noted. Physiotherapists who attended dementia training achieved higher mean knowledge scores (23.9) when compared to physiotherapists who did not attend such training (22.9). Equally, the physiotherapists who attended to dementia training achieved higher mean attitude scores (115.6) when compared to those who did not attend such training (mean attitude score:105.8). There was also a significant relationship between the mean attitude score and the number of hours of training. Physiotherapists with no hours of training scored lower mean attitude scores (106.6) when compared to those with over 16 hours of dementia training (116.4). There was also a significant difference in the mean attitude scores between those physiotherapists who worked in primary care and those who worked in a long-term care residence. Physiotherapists working in a long-term care residence had better attitudes towards persons living with dementia (mean attitude score: 118.1), when compared to those who worked in primary care (99.8). Conclusion: The research findings indicated how physiotherapists lacked knowledge in dementia care. The physiotherapists lacked knowledge mainly in the risk factors and disease progression domain of the Alzheimer’s disease knowledge scale. In addition, room for improvement was noted in respect of the physiotherapists’ attitudes towards persons living with dementia. The local physiotherapists further perceived the need for additional training in dementia, as the majority did not attend to any dementia training. Physiotherapists pointed to, (a) dealing with challenging behaviours, (b) communication skills specific to persons living with dementia including non-verbal communication, (c) how to recognize that a person is living with cognitive problems, and how to distinguish from other conditions (e.g. depression), and (d) how to care for younger persons living with dementia, as the main topics wherein more education and knowledge was required. These findings suggested how education for physiotherapists, changes in clinical practice, policy changes, and further research about physiotherapy in dementia care were warranted.