Recreational physiotherapy in long-term care institutions

What are the residents' perceptions regarding recreational physiotherapy?

Living in institutions – especially long-term care institutions (LTCIs) – may be limiting for older adults since their context is not often in favour of physical activity or participation in social and daily activities. This may directly impact physical and mental health by leading to further sedentarity and disabilities.

Promoting physical activity in LTCIs is therefore essential. On the other hand, it is a real challenge for physiotherapists taking care of older residents. Previous studies highlighted that physical activity as part of recreational physiotherapy can provide both physical and psychological benefits for older people in a long-term care context: less pain, less falls, better daily functioning, improved motivation and social interaction. However, some barriers may limit these positive effects, either institutional (structural issues such as lack of space) or behavioural (resident issues).

It seems necessary to fully understand older peoples' perceptions of recreational physiotherapy in LTCIs: knowing their feelings and attitudes about physical activity may help physiotherapists to better adapt their work while including residents' feedback in their care strategies. The aim of the present qualitative study was to assess the perceptions and experiences of older adults regarding recreational physiotherapy in LTCIs. It was found that they experienced physical, psychological and social benefits.

Participants’ perceptions of recreational physiotherapy can be summarised as follows :

  • “Activity for myself”: older people described their physical feelings when performing the programme, either positively (“you get better”) or negatively (“there is nothing different in doing it”). Exercises were associated with health problems and complaints which either encourage or restrain physiotherapy (practicing exercise to get better). Globally, activity implied both physical and emotional well-being while being a time of personal distraction.
  • “Activity with others”: the fact that recreational physiotherapy took place in group sessions brought interaction between residents, made activities even more dynamic and developed a spirit of care as participants showed concern with performance and efforts of others.
  • “Activity itself”: participants highlighted the positive effects of physical activity performed in group, either physically (motor function), emotionally (leisure, well-being) and socially (relationship). They particularly appreciated group exercises for their stimulation and confirmed that a one-hour session is fine to fully benefit from recreational physiotherapy while not feeling too tired. Finally, older people insisted on the importance of the relationship with the therapist and his/ her ability to adapt and personalise the programme to each participant’s specificity.

The authors concluded that practicing physical exercises on a regular basis as part of recreational physiotherapy for older people living in LTCIs seems to bring physical and emotional well-being while it also strengthens social bounds.

> From: Linhares et al., Physiother Theory Pract 17 (2020) (Epub ahead of print). All rights reserved to Taylor & Francis Group, LLC. Click here for the online summary.

Expert opinion

The present study highlights the fact that physical activity can be perceived either as positive (a way to feel good and heal) or negative (a barrier due to preexisting pain or incapacity) for older people in institutions.

Encouraging physical activity for this population is always a challenge, considering older peoples' singularities and characteristics. This study reminds us that proposing pleasant and multicomponent activities matching older peoples' needs, adapting exercises to their own physical and cognitive capabilities, assisting them while performing exercises and developing empathy with therapists are tools to improve the level of physical activity and the related benefits for older residents in LTCIs.

Performing activities within a group is also a key element in providing physiotherapy for LTCIs residents, as it encourages physical activity and stimulates a shared and common experience with partners. This helps them feel alive with a sense of togetherness, while improving self-confidence.

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