Knowledge about risk factors for falls and practice about fall prevention in older adults among physiotherapists in Nigeria

Physical Therapists' Attitudes, Beliefs, and Barriers Regarding Fall Screening and Prevention among Patients with Knee Osteoarthritis: A Cross-Sectional Study

Falls are commonly associated with knee osteoarthritis and represent a significant financial burden on the healthcare system. Therefore, the discovery of physical therapists' attitudes and practices regarding fall screening and prevention among patients with osteoarthritis should be investigated. Moreover, this study aimed to identify barriers that might limit its implementation among this population. A cross-sectional study design was used to collect the data. The electronic survey targeted licensed physical therapy professionals who currently work in clinical or academic settings in Saudi Arabia. The data were analyzed descriptively and inferentially using chi-square. Two hundred and six licensed physical therapists completed the survey, 119 females (57.8%) and 87 males (42.2%). The results of the structural equation modelling analysis showed that intention to use fall screening and management strategies was positively associated with the history of falls, identifying risk factors of falls, and documentation of risk factors of falls (p ≤ 0.0001). The most reported barriers to implement fall screening and prevention were lack of knowledge (n = 92, 45%), lack of training/skills (n = 84, 41%), and time constraints (n = 57, 45%), followed by patient compliance with 38% of the responses. The findings highlighted the importance of identifying the key opportunities for knowledge translation in clinical practices to enhance the sufficient implementation of fall screening and management in osteoarthritis care.

Prioritizing mobility factors for assessment during the transition of older adults from hospital to home: a cross-sectional survey of physiotherapists in Southeastern Nigeria

BACKGROUND

Assessing all factors influencing older adults' mobility during the hospital-to-home transition is not feasible given the complex and time-sensitive nature of hospital discharge processes.

OBJECTIVE

To describe the mobility factors that Nigerian physiotherapists prioritize to be assessed during hospital-to-home transition of older adults and explore the differences in the prioritization of mobility factors across the physiotherapists' demographics and practice variables.

METHODS

This cross-sectional study included 121 physiotherapists who completed an online questionnaire, ranking 74 mobility factors using a nine-point Likert scale. A factor was prioritized if ≥ 70% of physiotherapists rated the factor as "Critical" (scores ≥7) and ≤ 15% of physiotherapists rated a factor as "Not Important" (scores ≤3). We assessed the differences in the prioritization of mobility factors across the physiotherapists' demographics/practice variables using Mann Whitney U and Kruskal-Wallis tests.

FINDINGS

Forty-three of 74 factors were prioritized: four cognitive, two environmental, one financial, four personal, eighteen physical, seven psychological, and seven social factors. Males and those with self-reported expertise in each mobility determinants more frequently rated factors as critical.

CONCLUSION

Prioritizing many mobility factors underscores the complex nature of mobility, suggesting that an interdisciplinary approach to addressing these factors may enhance post-hospital discharge mobility outcomes.

Saudi Arabian Physical Therapists' Knowledge, Attitudes, and Clinical Practice in Diabetes Prevention and Management

Objective

This study explores physical therapists' current knowledge, attitudes, and practice toward the management and prevention of diabetes in Saudi Arabia.

Patients and Methods

A cross-sectional survey was distributed among physical therapists in Saudi Arabia. The questionnaire included several sections concerning their knowledge, attitude, and current practice toward diabetic management. A total of 301 physical therapists (32% female) participated in our study.

Results

The results suggest that only half of the participants agreed that diabetes management and prevention were within physical therapy's scope of service. However, approximately 30% of the participants did not regularly check or ask about the glucose levels of their patients with diabetes. Only 55% of the participants correctly answered the knowledge test questions.

Conclusion

This study found that physical therapists in Saudi Arabia have a modest level of diabetes knowledge. The findings indicate that physical therapy educational programs should address diabetes management. Furthermore, continued education is required for current practicing physical therapists in Saudi Arabia.

Developing tailored intervention strategies for implementation of stratified care to low back pain with physiotherapists in Nigeria: a Delphi study

BACKGROUND

Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain.

METHODS

A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively.

RESULTS

Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon's test showed stability in responses after the 5 statements failed to reach consensus: 'translate the STarT-Back Tool to pidgin language' 71% (p = 0.76), 'begin implementation with government hospitals' 63% (p = 0.11), 'share knowledge with traditional bone setters' 35% (p = 0.67), 'get second opinion on clinician's advice' 63% (p = 0.24) and 'carry out online consultations' 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: 'patient education' (96%), 'quality improvement appraisals' (96%), 'undergraduate training on psychosocial care' (96%) and 'patient-clinician communication' (95%).

CONCLUSION

There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.

Knowledge about foot-specific foot falls risk factors and exercise among physiotherapists in the UK and Portugal: A cross-sectional survey

Background and purpose

Foot‐related falls risk factors and specific foot and ankle exercise interventions are within the scope of Physiotherapy, yet little is known about United Kingdom (UK) and Portugal‐based (PT) physiotherapists' self‐perceived knowledge, confidence and practice of such interventions, or perceptions of patients' falls prevention knowledge. The purpose of this study was to assess levels of self‐reported knowledge, confidence, and practices surrounding foot‐specific falls risk and exercise for fall prevention in physiotherapists working in the UK and in Portugal. It also aimed to explore physiotherapists' views about their participants' falls prevention knowledge.

Methods

A self‐report online survey was developed, and pilot tested in both nations. Registered Physiotherapists were invited to participate through their professional associations, social media and snowballing. Mann‐Whitney tests were used to compare mean ranks of ordinal variables between nations and Chi‐square test to assess the independency between pairs of variables. Spearman's correlation coefficient (rs) was used to measure the association between pairs of variables (p < 0.05).

Results

682 physiotherapists participated in the survey [UK n = 229 (mean (SD) age = 43(10) years, 86.9% female]; PT n = 453 (mean (SD) age = 33(9) years, 78.3% female]. Among physiotherapists with a caseload of ≥70% older adults, more PT‐based physiotherapists held postgraduate qualifications (p = 0.01). Most physiotherapists correctly identified generic and foot‐specific risk factors (≥70% of participants for each item). More UK‐based physiotherapists reported always prescribing ankle and foot exercises (42.6% vs. 33%, p =< 0.001) and displayed higher levels of self‐reported confidence surrounding exercise‐based interventions.

Discussion

Our sample of UK and Portugal‐based physiotherapists are aware of the contribution of foot‐specific risk factors and exercise to falls prevention, with the former group being more confident in exercise‐based interventions. Both groups of physiotherapists perceived that their older patients had little knowledge about these topics, with UK older adults having slightly better knowledge on generic falls risk factors at first contact. Future studies and strategies for knowledge translation and education in foot health and foot function screening and management for physiotherapists, within a falls prevention scope, may be informed by this study.

Factors of balance determining the risk of falls in physically active women aged over 50 years

BACKGROUND

Balance disorders are believed to be one of the main reasons for falls in older adults. They are related to natural processes of ageing, resulting in deterioration of information integration and processing from the vestibular, somatosensory and visual systems. The consequence is an increased number of postural sways, which are some of balance factors. Balance control in static and dynamic activities is an essential element of daily functioning of older citizens. It seems that balance assessment is essential to determine the risk of falls, as well as to determine which factors of balance have greatest impact on the risk of falls.

METHODS

The study involved physically active female students (n = 36, mean age 67,11 ± 5,35) of a University of the Third Age. We used the Balance System SD platform to assess their balance in four tests with eyes open and with eyes closed and to determine the risk of falls. We assessed the relationships between individual balance indices (overall stability index, anterior/posterior stability index, medial/lateral stability index) and the falls risk index. We also determined those factors which predicted the risk of falls the most.

RESULTS

The studied subjects had low risk of falls for their age category. In most measurements there were relationships between the risk of falls and the size of sways in the coronal plane and the overall stability index. We also found that the overall stability index calculated in measurements with eyes closed predicted the risk of falls of the studied physically active females most accurately (R² 0.391 F(1.34)=23.475; <0.000). The subjects were physically active and their falls risk index was low - this allowed us to presume that there was a relationship between these two factors. Preventive programmes should include exercise performed with eyes closed, and tests conducted with eyes closed seem to be most sensitive in determining balance disorders in physically active women.

Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study

BACKGROUND

Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results.

AIM

This study aimed to explore physiotherapists' awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in the care of PLWH in selected regions of sub-Saharan Africa.

METHOD

An exploratory descriptive qualitative research method was employed to explore physiotherapists' perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis.

RESULTS

The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal.

CONCLUSION

Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH.

The clinical experiences of Nigerian physiotherapists in managing environmental and socioeconomic determinants of mobility for older adults

Study Aim: To describe how physiotherapists in northern Nigeria managed the environmental and socioeconomic determinants of mobility for older adults.Methods: We adopted a qualitative description approach, purposely selected and conducted telephone interviews with 20 physiotherapists from Abuja [the Federal Capital Territory], four of the six states in North-central, and one state in the North-west regions of Nigeria. Data were analyzed using qualitative content and constant comparative analyses.Result: The physiotherapists had between 5 and 11 years practice experience in managing older adults with mobility limitations. Three iterative stages of identification, intervention, and documentation emerged as clinical experiences of Nigerian physiotherapists in managing environmental and socioeconomic determinants of mobility for older adults. Identification stages included determining older adults with mobility limitation through patients'/physiotherapists' reports and identifying the environmental (e.g. staircase location, floor types, furniture, and the urban built environment) and socioeconomic (e.g. education, income, and occupation) factors. The clinical decision of the "best" individualized approach to intervention, providing reassurance and education during and after the intervention were sub-stages for the intervention stage. There is a potential gap in the documentation process of these stages as most of the physiotherapists (n = 15; 75%) reported not doing so.Conclusion: This study suggested three iterative stages of identification, intervention, and documentation of the environmental and socioeconomic determinants of mobility for older adults. While there was a potential gap in regard to documentation of these stages in patients' case notes, physiotherapists especially in North-central Nigeria believed that co-developing a pragmatic set of clinical questions focusing on these determinants of mobility could encourage physiotherapists to explicitly document them. As the approach used in our research is purely descriptive, a grounded theory approach would potentially provide more detailed sub-stages that could be a more effective guide for physiotherapists to use during clinical practice.