Qualitative research concerning physiotherapy approaches to encourage physical activity in older adults with dementia

PLOS ONE RESEARCH ARTICLE Qualitative research concerning physiotherapy approaches to encourage physical activity in older adults with dementia Masami Yokogawa ID1*, Yoshimi Taniguchi2, Yumi Yoneda3 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Physical Therapy, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan, 2 Department of Clinical Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan, 3 Rehabilitation Division, Enyama Kenko Clinic, Nanao, Japan * Abstract Background OPEN ACCESS Citation: Yokogawa M, Taniguchi Y, Yoneda Y (2023) Qualitative research concerning physiotherapy approaches to encourage physical activity in older adults with dementia. PLoS ONE 18(7): e0289290. https://doi.org/10.1371/journal. pone.0289290 Editor: Anuchart Kaunnil, Faculty of Associated Medical Sciences, Chiang Mai University, THAILAND Received: August 9, 2022 Accepted: June 24, 2023 Physical exercise is known to improve the level of activities of daily living and physical function in people with dementia; however, symptoms of dementia often pose challenges when implementing physical therapy. This study aimed to elucidate how physiotherapists (PTs) engage with older adults with dementia to encourage exercise and participation in physical activity. Methods In this qualitative study, four PTs working with older adults with dementia in long-term care facilities in Japan were recruited and interviewed. We used a modified grounded theory approach to assess how PTs engaged with older adults with dementia during physiotherapy sessions. Published: July 27, 2023 Copyright: © 2023 Yokogawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: MY. number JP16K01540 JSPS KAKENHI https://www.jsps.go.jp/english/index. html The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Results Based on PT responses, five categories of engagement were identified: “make structured preparations for clients to begin physical activity,” “link exercise therapy to a client’s daily life,” “discover changes in daily life,” “ascertain cognitive function,” and “accommodate client differences.” Concepts were derived under each category. The category “make structured preparations for clients to begin physical activity” served as a preceding stage for PTs to engage with older adults with dementia. PTs linked exercise therapy to each client’s daily life activities to encourage voluntary participation in daily physical activity. PTs ensured the performance of routine patterns of movement and modified these movement patterns per clients’ differing paces. Conclusion PTs provided exercise and movement training based on various degrees of client involvement and made structured preparations for clients to begin physical activity that were linked PLOS ONE | https://doi.org/10.1371/journal.pone.0289290 July 27, 2023 1 / 14 PLOS ONE Encouraging physical activity in older adults with dementia to exercise therapy. Our findings may prompt PTs to encourage older people with dementia to participate in physical therapy and benefit from exercise. Introduction Dementia is a syndrome involving more severe cognitive decline than the degree expected from the usual consequences of biological aging [1]. The number of people with dementia worldwide is estimated to increase from 57 million in 2019 to 152.8 million in 2050 [2]. The same report estimated that Japan, compared with other countries, has the lowest rate of increase in patients with dementia. However, the affected population is expected to increase from 4.12 million to approximately 5.24 million people. Since the incidence of dementia is known to increase exponentially with age [3], and population aging is a global phenomenon, older people in healthcare should be approached with the assumption of having dementia. Physiotherapists (PTs) working in rehabilitation provide services to maintain and improve people’s movements and functions [4]. The opportunities for PTs to treat and care for older adults with dementia have increased in relation to long-term care, acute phase care, convalescent phase care, and in-home medical care. Older adults with dementia have been reported to have a lower physical function at discharge than those without [5], despite being a population more in need of physiotherapy. Nonetheless, previous studies reported that older patients with dementia who had sustained a hip fracture received less physiotherapy than those without dementia [6, 7]. Patients with dementia may be perceived as unsuitable candidates for rehabilitation therapy when introducing home care services owing to difficulties recalling or following instructions [5, 7]. In addition, some healthcare experts consider it challenging for older people with dementia to continually participate in rehabilitation programs due to the effects of core, behavioral, and psychological symptoms [8]. In recent years, exercise has been shown to improve the level of activities of daily living (ADL) and physical function [9–11] and reduce behavioral and psychological symptoms [11] in patients with dementia. Receiving less physiotherapy and failing to continually participate in it are challenges in benefiting from exercise; a solution to this might be for PTs to provide tailored exercise therapies specific to older adults with dementia. Older adults with dementia may be clinically complex, and a greater level of dementia education is needed to address this complexity [12]. In this respect, identifying the practices and perceptions of PTs who engage with older adults with dementia could be helpful. Several studies have investigated PTs’ experiences and reflections when treating older adults with dementia [13–15]. Fjellman-Wiklund et al. reported on exercise in relation to older adults with dementia and listed factors essential for its efficacy, stating that knowledge gained through reflectionon-action and in-action is important [13]. Hall et al. described physiotherapy challenges facing older adults with dementia and the need to specifically modify and tailor physical therapy sessions to better meet the needs of this patient cohort [14]. PTs’ positive experiences in relation to rehabilitation possibilities for older adults with dementia have also been reported [14]. In an earlier study, we investigated how PTs working in long-term care became involved with older adults with deme (...truncated)