The experiences of physiotherapists treating people with dementia who fracture their hip

Abstract

BackgroundIt is estimated that people with dementia are approximately three times more likely to fracture their hip than sex and age matched controls. A report by the Chartered Society of Physiotherapy found that this population have poor access to rehabilitation as inpatients and in the community. A recent scoping review found a paucity of research in this area, indeed there has been no qualitative research undertaken with physiotherapists.In order to address this evidence gap, the aim of this current study was to explore the experiences of physiotherapists treating this population.MethodsSemi-structured interviews with physiotherapists were undertaken in order to gain an in-depth understanding of how they manage this population. Physiotherapists were recruited from all over the UK and a purposive sampling strategy was employed. Thematic analysis was utilised.ResultsA total of 12 physiotherapists were interviewed, at which stage data saturation was reached as no new themes were emerging. The participants had a broad range of experience both in physical and mental health settings. Analysis identified three separate themes: challenges, “thinking outside the box” and realising potential.Physiotherapists felt significant pressures and challenges regarding many aspects of the management of this population. Mainly this was the result of pressures placed on them by guidelines and targets that may not be achievable or appropriate for those with dementia. The challenges and importance of risk taking was also highlighted for this population with an appreciation that standard treatment techniques may need adapting. “Rehabilitation potential” was highlighted as an important consideration, but challenging to determine.ConclusionInterventions for the management of people with dementia and hip fracture need to consider that a traditional biomedical physiotherapy approach may not be the most appropriate approach to use with this population. However physiotherapists reported feeling pressurised to conform to a biomedical approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0474-8) contains supplementary material, which is available to authorized users.

How is the emerging role of domiciliary physiotherapists who treat residents with dementia in nursing homes perceived by allied health professionals? A phenomenological interview study

“…Similar roles for physiotherapists have been described in hospitals and residential care (Dalley & Sim, ; Lefmann & Sheppard, ; Stewart, Macha, Hebblethwaite, & Hames, ), although Hall, Goodwin, Lang, and Endacott () considered that the literature on physiotherapy in people with dementia (following hip fracture) lacks detail, with ‘physiotherapy’ assumed to be a treatment in itself rather than a term encompassing multiple treatment techniques. Given the literature suggesting negative attitudes or fear of physiotherapists about treating residents with dementia (Hall et al, ; Staples & Killian, ), an encouraging finding in our study was the positive attitude towards the need for individualised care and the specialist role reported amongst most participants. In common with literature regarding other neuro‐degenerative conditions, there appears to be an impetus for health professionals (Keus et al, ; While, Forbes, Ullman, & Mathes, ) to adopt a specialist role, which includes enhanced understanding about the disease.…”

“…Given the literature suggesting negative attitudes or fear of physiotherapists about treating residents with dementia (Hall et al, 2017;Staples & Killian, 2012b), an encouraging finding in our study was the positive attitude towards the need for individualised care and the specialist role reported amongst most participants. In common with literature regarding other neuro-degenerative conditions, there appears to be an impetus for health professionals (Keus et al, 2014;While, Forbes, Ullman, & Mathes, 2009) to adopt a specialist role, which includes enhanced understanding about the disease.…”

“…Although guidelines are available for health and social care professionals who treat people with dementia, none are specifically for physiotherapists. Recent, qualitative evidence from the United Kingdom suggests that challenges exist to providing physiotherapy to people with dementia following hip fracture (Hall et al, 2018;Hall, Watkins, Lang, Endacott, & Goodwin, 2017). This includes a lack of knowledge and resource limitations, from the physiotherapist's viewpoint (Hall et al, 2017) and difficulties obtaining and receiving ongoing physiotherapy, from the viewpoint of people with dementia or their carers (Hall et al, 2018).…”

“…Recent, qualitative evidence from the United Kingdom suggests that challenges exist to providing physiotherapy to people with dementia following hip fracture (Hall et al, 2018;Hall, Watkins, Lang, Endacott, & Goodwin, 2017). This includes a lack of knowledge and resource limitations, from the physiotherapist's viewpoint (Hall et al, 2017) and difficulties obtaining and receiving ongoing physiotherapy, from the viewpoint of people with dementia or their carers (Hall et al, 2018). In terms of physiotherapy intervention, a systematic review cautiously suggested that exercise programmes might improve the performance of activities of daily living in older people with dementia, although the impact of the setting, particularly nursing homes, was proposed as an important factor for further investigation (Forbes, Forbes, Blake, Thiessen, & Forbes, 2015).…”

People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway

“…Physiotherapists who reported working successfully with people with dementia following hip fracture spent time developing a rapport with their patients by adapting their communication and developing a "person centred care approach" as opposed to a biomedical approach [20]. We found it was important to not explain participants' behaviour in terms of their personality or disposition which places undue emphasis on internal characteristics of the person rather than searching for external factors.…”