| Abstract |
Technological a dvancements, scientific a chievements i n t he healthcare f ield a nd
improvements in living conditions have reduced the mortality rate and led to a significant
increase in average life expectancy. However, at the same time, populations in urban
centres have grown, and individuals’ way of life has led to many negative consequences on
their health, such as a reduction in physical function. The World Confederation of Physical
Therapy (WCPT) states that physiotherapy, as a therapeutic intervention, can help prevent
decline in functionality and improve the quality of life as people grow older. According to
the international bibliography, physiotherapy can propose specialized treatment protocols
for the elderly, both with therapeutic exercise and with analgesic methods. The WCPT
recognizes the specialization of geriatric physiotherapy as an official specialty. In addition,
it determines that it belongs to the "regulated professions". Since 2000, some European
National Health Services have launched an effort to evaluate physiotherapy services. In the
context of data from Greece, it seems that there is no strong documentation that correlates
the effectiveness and satisfaction of patients with the benefits of physiotherapy. This
finding leads to the need to evaluate physiotherapy’s effectiveness with appropriate tools to
identify elements that must be changed, in the short or long term, to optimize therapeutic
effects. It is noteworthy that during the Covid-19 pandemic the role of physiotherapy
became particularly important, both for the sick and the non-sick elderly, who were forced
to limit their outdoor physical activity as part of measures for protection against the spread
of the virus. However, it seems that the effectiveness of physiotherapy intervention in
Πολιτικές Υγείας και Επιστήμες Υγείας / Η Περίπτωση της Φυσικοθεραπείας / Εφαρμογές σ 16 την Τρίτη Ηλικία
the elderly in Greece today has not been adequately assessed. From the above findings,
the question arises, what are the parameters that affect the quality of life of the elderly
receiving physiotherapy with the current services. In addition, the findings lead to the
need of evaluating the physiotherapy effectiveness, in order to identify the elements that
may need to be changed, to optimize the therapeutic results and provide effective Health
services to the elderly adults.
The purpose of this study was to investigate the health policies related to physiotherapy
intervention and that affect the quality of general, physical and mental health of the elderly
as well as the functionality of the Greek urban old population. Additionally, the aim of
the study was to carry out an investigation of the perception and the degree of satisfaction
with physiotherapy by these patients with musculoskeletal problems. The study focuses on
this age group, as a category of people in the special population that is in the forefront of
research due to the change in the indicators of the average age and life quality.
RESEARCH METHODOLOGY
An observational study was designed for a group of third-age people who had participated
in a physiotherapeutic intervention for musculoskeletal problems, called group A, with
another group of individuals of the same age who did not participate in a physiotherapeutic
intervention, called control group B, designated. In terms of physiotherapy, it was essential
that all members of group A had ten kinesiotherapy sessions, regardless of having used
any other physiotherapeutic method. For research purposes, the participants were asked to
answer the IQOLA SF-36 questionnaire Greek Standard Version 1.0, under the supervision
of a person not involved in the research. Furthermore, some basic demographic data, such
as educational level, sex and age, as well as data about satisfaction were collected, with a
Likert five-point scale questionnaire. The research proposal was approved by the Bioethics
Committee of the General Hospital of Patisia. The study was designed to be conducted
with simple randomization. The data were collected at the outpatient services area at the
Internal Medicine Clinic of the General Hospital of Patisia. Three hundred questionnaires
were distributed in total, every Tuesday and Thursday, to every third user appearing in the
aforementioned medical services area, over a 2-month span.
Results A total of 201 questionnaires were answered; 90 of the questionnaires were
answered by males of an average age of 69.57, and 111 of them were answered by females
of an average age of 70.32. Ninety-nine of the participants received musculoskeletal
physiotherapy and were assigned to the physiotherapy group named group A (average
age of 68.67 years), and 102 of them were assigned to the non-physiotherapy group named
group B (average age of 70.02 years). The inclusion criteria were as follows: age between
60 and 85 years old, the completion of the physiotherapy intervention one month before the
introduction to the research, the absence of serious musculoskeletal dysfunctions before
reaching the age of 60 years and the ability to read and speak Greek. The duration of the
data collection process was restricted to less than a two-month span to ensure homogeneity
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in exterior and interior conditions, such as weather, social events, work, insurance and any
other changes in health services. The statistical analysis of the study is descriptive. The
frequencies and rates of the participants in each category of the categorical variables and
the average, standard deviation, minimum and maximum of the continuous variables were
recorded. The data were analysed with the statistical package SPSS, version 17.00. All of
the statistical tests were two-sided. A p-value of <0.05 indicated a statistically important
difference. Moreover, important differences with borderline statistical significance were
recorded (0.05<P<0.1). The statistical analyses of the data indicated homogeneity of the
data of the two groups.The numbers of males and females were relatively equal, and
the educational levels of the participants did not display noteworthy differences. The
members in group A (50.7%) had ratings nearly equal to those in group B. The body areas
influenced by the age-related diseases spanned the whole body. Additionally, homogeneity
appeared in groups that had both individuals who were medication-receiving (yes,
58.2%) and individuals who were non-receiving. Regarding the general health parameters
questionnaire, the factors that showed statistically important results are as follows: females
in group A had a lower rating by 5 units on general health than did the males (p=0.070
borderline), individuals with higher education had a lower rating by 7.3 units than those
without higher education (p=0.029), individuals with upper limb problems had a lower
rating by 18.9 units than those without problems (p<0.0005), individuals on medication
had a lower rating by 9.8 units than those who were not on medication (p=0.001), and the
individuals in the intervention group had a higher rating by 6.4 units on general heath than
those in the control group (p=0.035). With regard to the parameter of sociability, the factors
that showed statistically important results are as follows: individuals with a higher level
of education had a lower rating by 12.8 units on social role than those with a lower level of
education (p=0.005), individuals with lower limb problems had a lower rating by 12.4 units
than individuals without lower limb dysfunctions (p=0.015), and individuals who received
a physiotherapeutic intervention had a lower rating by 8.2 units than the individuals in
group B (p=0.048). With regard to the parameter of the mental health questionnaire, the
factors that showed statistically important results are as follows: an increase in age by
one year lowered mental health ratings by 0.40 units (p=0.055), and the individuals with
upper limb problems had a lower rating by 12.3 units on mental health than those who had
good upper limb function (p=0.012). In contrast, the lower limb function, as mentioned
above, negatively affects sociability to a significant degree. Regarding the perception of
the sample and its degree of satisfaction with the physiotherapy intervention, the statistical
analysis showed that they needed a mean of 14.5 physiotherapy sessions, with a mean start
delay of 13 days. Nevertheless, 73.5% had a positive opinion about physiotherapy, 61.8%
were satisfied with it and 79.4% would like to repeat the therapy. It was recorded that
30.3% stopped the medication, 25.4% continued with it on an occasional basis and 36.8%
continued systematically. Males were significantly more satisfied (p=0.023) in comparison
to females, 24.4% of the participants state that they are very satisfied with the way their
treatment was covered, and 36.3% satisfied.
Πολιτικές Υγείας και Επιστήμες Υγείας / Η Περίπτωση της Φυσικοθεραπείας / Εφαρμογές στην Τρίτη Ηλικία
Πολιτικές Υγείας και Επιστήμες Υγείας / Η Περίπτωση της Φυσικοθεραπείας / Εφαρμογές σ 18 την Τρίτη Ηλικία
CONCLUSIONS
From this study, and in relation to the international literature, the effect of physiotherapy
on the general health of the elderly adults became clearer. It seems that physiotherapy
contributes to the improvement of general health, with a positive effect on social roles
and mental health, regardless of whether the individuals receive medication. The results
were very informative about the dominant effects of the various factors that positively
and negatively affect older Greek people and the functional consequences that frequently
develop. It was found that the criterion of kinesiotherapy, as a method of treatment for the
elderly, has multifactorial positive effects on general health by improving functionality
and addressing kinesiophobia by enhancing sociability and mental health, because it can
reduce the feeling of insecurity when moving, a finding that is consistent with international
data. It is noted also that kinesiotherapy seems to enhance the effectiveness of medication.
Regarding the perception of the therapy by the participants, it is shown that the elderly
adults declare satisfied from physiotherapy, they believe that they were helped and would
like to repeat it. Regarding their therapy’s beginning, it was found that there was a delay.
Although the number of sessions performed was regarded as sufficient, the way that
the therapy was covered by insurance and the information that was provided were not
considered to be satisfactory. Nevertheless, elements are identified that would potentially
adversely affect the therapeutic outcome. They record the delay in the time of starting the
treatment and the insufficient number of sessions according to what is predetermined by
the insurance agency. In the perception of the participants, it was recorded that they did
not have sufficient information about their treatment and the insurance coverage. The
elements mentioned can be modified in a positive direction through the planning of the
provision of therapeutic services. These are very useful observations on the policy that the
state mechanism can make through the insurance agencies and other bodies, formulating
appropriate instructions and clinical recommendations for the number of sessions, the
type of treatment, while controlling the negative factors that may delay the beginning of
physiotherapy intervention. The almost 100% participation of the sample to present its
views leads to the conclusion that the process of evaluating the therapeutic results by health
service users is welcome and therefore necessary, because it places the patient at the center
of the system.
However, the project has some limitations. First, it was conducted within a specific
time period, and it does not have the advantage of re-evaluation. There were no before
and after intervention data. Furthermore, it was not possible to separate the kinds of
physiotherapeutic intervention and all the methods that might have been applied, and
personal kinesiotherapy was chosen as a criterion only. For these reasons, it is deemed
necessary to conduct new research with a larger sample population and a focus on the
disease that each participant suffers. It would be useful to expand the study to include other
physiotherapeutic methods, such as group kinesiotherapy, consulting physiotherapy, and
hydrotherapy, and their interactions with other interventions, such as occupational therapy,
nutrition and psychological support. Last, it could include sample populations from different
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areas in Greece to add elements such as the climate of the area in which the participants
live, the temperature, whether they live in a continental or an island environment, the way
of life, and job. From these data, a comparison of functional problems that older individuals
face can be conducted, depending on the place and way of life, as well as risk factors in the
different Greek regions. Thus, properly organized and well-specialized physiotherapy can
be prescribed for Greek individuals of the third age and can function as a method of tertiary
prevention of musculoskeletal dysfunction, contribute to a reduction in the prevalence of
polypharmacy and improve individuals’ quality of life.
Summarizing the results of the present study, it is confirmed that the assessment of the
degree of satisfaction of the elderly who received physiotherapy care is a very useful tool. In
the case of patients with musculoskeletal disorders, it seems that this therapeutic approach
improves their quality of life by having a positive effect on biological, social and emotional
levels on the one hand and on the other hand creates positive perceptions and a high level
of satisfaction among physiotherapy users through their insurance. The findings were quite
informative regarding the prevalence of various factors that positively or negatively affect
the Greek elderly and the functional effects that occur more often. The positive message
that emerges from this and the mentioned Greek studies is that the process of research
documentation for the evaluation of the quality of physiotherapy in Greece has begun.
Patients' perceptions of the effectiveness of physiotherapy can be a useful guide in policy
making. The field of health is undergoing changes and the health professions must prove
and highlight their role in the provision of qualitative services.
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