Novel barriers and facilitators were identified for family involvement in physiotherapy and exercise for aged care facility residents with dementia: a qualitative study.

Abstract

QUESTION: What barriers and facilitators do physiotherapists and aged care facility staff perceive regarding the involvement of family caregivers in physiotherapy and exercise for residents with dementia? DESIGN: Reflexive thematic analysis with semi-structured interviews to explore the subjective experiences of physiotherapists and aged care staff, grounded in a constructivist ontology. METHODS: We conducted 28 semi-structured interviews with 19 physiotherapists and 9 aged care facility staff members concerned with family participation. Participants were selected from Dutch aged care facilities providing care for residents with dementia. Interviews were recorded and transcribed and subsequently analysed using inductive thematic coding. RESULTS: The perceived barriers included the burden placed on family caregivers, particularly during the transition to an aged care facility, and the need for adequate information and guidance to ensure successful involvement. In addition, it was found that an unwelcoming environment fostered by physiotherapists and staff hinder family members' participation. Facilitators included a proactive approach of physiotherapists regarding the collaboration and information provision on practical aspects of exercise, particularly when supported by technology or exergaming. Other facilitators were the family caregivers' previous healthcare experience and cultural factors emphasising the importance of family support. CONCLUSION: The study identified barriers to family caregiver involvement, such as perceived caregiver burden and lack of role clarity, alongside facilitators such as previous caregiving experience, culturally rooted family values and strong social or religious networks. Physiotherapists and aged care facilities could improve collaboration by proactively discussing family caregiver roles, adopting flexible approaches, and using inclusive (digital) communication methods to support ongoing caregiver engagement.