Abstract
INTRODUCTION: Technological advancements, scientific achievements in the healthcare field and 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 Nationa ...
INTRODUCTION: Technological advancements, scientific achievements in the healthcare field and 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 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 evaluatingthe 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 17in 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. 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 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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