SAJP South African Journal of Physiotherapy 0379-6175 2410-8219 AOSIS SAJP-79-1786 10.4102/sajp.v79i1.1786 Original Research Knowledge, awareness and use of current practice of palliative care amongst physiotherapists https://orcid.org/0000-0001-8091-5443 Yakasai Abdulsalam M. 1 https://orcid.org/0000-0001-8288-6105 Maharaj Sonill S. 1 https://orcid.org/0000-0002-8285-9235 Gidado Umar M. 2 https://orcid.org/0000-0002-1439-7251 Nuhu Jibril M. 1 2 https://orcid.org/0000-0003-4033-792X Haruna Sani A. 3 https://orcid.org/0000-0002-3084-5552 Danazumi Musa S. 4 5 Discipline of Physiotherapy, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria Department of Biochemistry, Faculty of Basic Medical Sciences, Maitama Sule University, Kano, Nigeria Department of Physiotherapy, Federal Medical Center, Nguru, Nigeria Department of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, Australia Corresponding author: Abdulsalam Yakasai, abdulpeace1@gmail.com 10102023 2023 79 1 1786 13022022 24052022 © 2023. The Authors 2023 Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. Background

Recently, there has been a marked increase in the incidence of cancer, HIV, and other noncommunicable diseases globally. Thus, the demand for palliative care (PC), including end-of-life care, continues to grow worldwide. Physiotherapy has an important role in PC as it aims to alleviate symptoms and improve quality of life by optimising independent levels of function.

 Objective

To assess the level of knowledge, awareness and current practice of PC amongst Nigerian physiotherapists in clinical practice.

 Method

Our study used a cross-sectional descriptive census-based method and recruited practising physiotherapists in Nigeria. An electronic questionnaire was used to collect data over 12 weeks, comprising 36 semistructured questions in four domains: personal information, knowledge, awareness and current practices regarding PC. Data were analysed using a pragmatist paradigm.

 Results

Of the 426 physiotherapists who participated, 50% (n = 213) had a postgraduate degree, 49.5% (n = 211) had a bachelor’s degree and 0.5% (n = 2) had a Doctor of Physical Therapy degree. The results also indicate that 73.9% (n = 315) of the participants had sufficient knowledge about PC, 80.5% (n = 343) had a sufficient level of awareness about PC and 66.7% (n = 284) were using current clinical practices in the rehabilitation of critically ill patients or those with chronic conditions.

 Conclusion

It was concluded that most Nigerian physiotherapists had sufficient knowledge and awareness about PC and were involved in the management of patients requiring PC physiotherapy.

 Clinical implication

It can be understood that a large proportion of Nigerian physiotherapists have clinical experience managing patients requiring PC, despite inadequate formal training in this field.

 palliative care physiotherapy knowledge awareness current practice physiotherapists Introduction

Recently, there has been increasing concern and need for more effective care for people with complex diseases and those with terminal illnesses. Palliative care is a specialised medical care aimed at providing pain relief and management of distressing and debilitating symptoms, optimising quality of life and mitigating suffering associated with life-threatening illnesses faced by patients and their families (NHS Choices 2017). This is achieved through early assessment, diagnosis and intervention to manage pain and other symptoms, as well as incorporating social, psychological and spiritual aspects of holistic care (Prevost & Grach 2012). According to Sujatha and Jayagowri (2017), palliative care is not restricted to cancer or terminally ill patients, as it was previously. The focus has now been broadened to include caring for patients with diseases that last for many years and those with various life-threatening conditions. In addition, palliative care now covers from the point of diagnosis to disease progression and end-of-life care (Murray et al. 2015). Palliative care also offers a support system for carers to cope during the patient’s illness and in bereavement after the loss of a relative or friend (Addington-Hall & Higginson 2011).

Advances in medical care have improved the survival of people around the globe and have resulted in an increase in the number of people reaching old age (Payne, Coyne & Smith 2002). Nigeria is amongst the low- to middle-income countries that are worst hit by deaths from noncommunicable diseases, according to the first World Health Organization (WHO) Global Status Report on noncommunicable diseases. The diseases with a rising burden in Nigeria include cancer, coronary artery diseases, chronic metabolic diseases, sickle cell disease, chronic respiratory diseases, stroke and mental disorders (Aregbeshola 2012). Individuals presenting with these chronic conditions or their comorbidities alongside those with terminal illnesses could benefit from palliative care physiotherapy. Palliative care has a multidisciplinary approach and is provided by specially trained health professionals, including medical practitioners, nurses, physiotherapists, pharmacists and many others within the healthcare system (Sujatha & Jayagowri 2017).

Physiotherapy is concerned with optimising movement and achieving maximal possible function through preventive and curative means as well as rehabilitation (Kumar & Jim 2010). Despite the potential benefits of palliative care physiotherapy, evidence suggests a lack of palliative care for patients suffering from chronic conditions and end-of-life illnesses receiving physiotherapy treatment (Chartered Society of Physiotherapy 2004). As professionals, physiotherapists should have adequate knowledge, be well trained and have the skills to render palliative care physiotherapy for terminally ill patients and those living with chronic conditions from diagnosis to disease progression and the end-of-life stage (Chiarelli, Johnston & Osmotherly 2014). In Nigeria, awareness of palliative care is low even decades after its introduction (Daniel Chukwunyere 2019). Moreover, data concerning knowledge of Nigerian physiotherapists about palliative care are rarely documented, and it is not known whether they use palliative care physiotherapy in the rehabilitation of terminally ill patients and those living with chronic conditions. Our study examined the existing knowledge, awareness and practices of palliative care by registered physiotherapists working in Nigeria.

 Method

This was a cross-sectional survey using an online questionnaire, conducted to explore the knowledge, awareness and current practices of physiotherapists in palliative care physiotherapy. Our study was conducted amongst Nigerian physiotherapists working in various governmental and nongovernmental hospitals and clinics. The anonymised participants were recruited from the database of the Medical Rehabilitation Therapists (Registration) Board of Nigeria (MRTB). According to the inclusion criteria, participants (1) were either male or female, (2) had a minimum of bachelor’s degree in physiotherapy, (3) were currently residing and practising physiotherapy in Nigeria. Physiotherapists who were not registered with the MRTB were not included. A census-based method was used for our study, as the census is a method that gathers information about every member of the population. It provides intensive and in-depth information covering many facets of the problem in question (Lavrakas 2013).

Questionnaire design and validation

Our survey was based on an electronic structured questionnaire using Google Forms, developed by expert physiotherapists in the field of palliative care. The questionnaire consisted of 36 questions and four parts, namely (1) personal information (comprising 7 questions); (2) knowledge about palliative care physiotherapy (comprising 11 questions); (3) awareness about palliative care physiotherapy (comprising 6 questions); and (4) practices of palliative care physiotherapy (comprising 12 questions). Ten physiotherapy experts in the field of palliative care were piloted to check the content and face validity and appropriateness for the local context of the questionnaire. Then a cognitive debriefing session was held and recommendations from the participants were received for improving the quality of the survey. Appropriate amendments were made by members of our research team to ensure that the content was in line with the intended meaning and well suited to the aim and context of the study (Terwee et al. 2007). In addition, the questionnaire was equally assessed for divergent validity, as 20 physiotherapists completed it together with another questionnaire, the Physical Therapy in Palliative Care – Knowledge, Attitudes, Beliefs and Experiences (PTiPC-KABE) Scale (Morrow et al. 2017). Pearson’s Product Moment Correlation (PPMC) indicated an insignificant relationship between the two questionnaires [0.013 (n = 20, p = 0.893)], showing that the two questionnaires measured entirely different constructs. In order to establish test–retest reliability, 15 physiotherapists filled in the questionnaire at a 2-week interval. The result indicated a highly significant intra-class correlation coefficient [ICC = 0.788 (n = 20, p = 0.001)], indicating that the questionnaire is reproducible. The link to the final version of the online questionnaire was distributed to the participants via e-mail and WhatsApp. Reminder e-mails were sent every week to the participants in order to have a high response rate.

 Statistical analysis

A pragmatist paradigm was used to analyse data for both qualitative-constructivist and quantitative-positivistic approaches. The mixed methods data analysis used in our study was to give a broader perspective and more in-depth analysis of the subject matter (Kaushik & Walsh 2019).

 Qualitative analysis

Responses were scored as described in the study by Yakasai et al. (2020) using the scoring system as follows: agree, disagree and undecided. The questionnaire texts were analysed qualitatively using content analysis (Shelley & Krippendorff 2012). Firstly, the authors read the questions several times to have a better understanding of the text and to maintain the meaning of the content according to the local context. Secondly, two of the authors performed coding separately by combining the questions into units which were labeled as codes (i.e., group of words with similar meanings and/or connotations). The codings were compared, discussed and consensus was reached amongst the authors. Thirdly, the codes were synthesised and grouped into meaningful subcategories and labeled with appropriate titles: knowledge, awareness and practice. Finally, the codes were subcategorised and merged into broader categories and then pooled into major themes: sufficient knowledge, insufficient knowledge, lack of knowledge; sufficient awareness, insufficient awareness, lack of awareness; and standard practice, substandard practice and lack of practice.

 Quantitative analysis

The Shapiro–Wilk test was used to assess the normality of the data, whilst Levene’s test was used to assess the homogeneity of variance. As the data were normally distributed, PPMC was used to examine the relationship between knowledge, awareness and practice of palliative care, whilst a one-way analysis of variance (ANOVA) was used to determine the differences between the outcomes as dependent variables (knowledge, awareness and palliative care practice) and independent variables (novice, experienced and expert professionals). Bonferroni post-hoc analysis was conducted to determine where a significant difference exists. An alpha level was set at 0.05 and confidence interval at 95%. All data were analysed using SPSS 24.0 (SPSS, Inc.).

 Ethical considerations

Our study was approved by the institutional review board where the study was conducted (reference number: NHREC/06/12/19/79). The participants were informed that clicking the link and assessing the questionnaire was taken as providing consent to participate in our study, as the informed consent form was attached to the questionnaire.

 Results Demographic characteristics of the physiotherapists

Participants were divided into three predefined age groups that covered 191 (44.8%) young adults, 164 (38.5%) middle-aged adults and 71 (16.7%) older adults as described by Petry (2002) (see Table 1). In total, 426 physiotherapists participated in our study; 68.8% (n = 293) were practising in government hospitals with 31.2% (n = 133) practising in private hospitals and nongovernmental organisations. With regard to educational qualification, 50% (n = 213) of the physiotherapists had postgraduate degrees, 49.5% (n = 211) had a bachelor’s degree in physiotherapy and only 0.47% (n = 2) had a Doctor of Physical Therapy degree. In addition, 189 (44.4%) participants were within the first decade of their professional career (novice professional period), 150 (35.2%) were within the second decade of their professional career (experienced period) and 87 (20.4%) were within the third decade of their professional career (expertise).

Demographic characteristics of the participants (n = 426).

Demographics n % Mean s.d.
Q1: Age: - - 37.83 ± 6.95
Young adults (19–35 years) 191 44.9 - -
Middle-aged adults (36–55 years) 164 38.4 - -
Older adults (above 55 years) 71 16.7 - -
Q2: Gender: - -
Male 258 60.6 - -
Female 168 39.4 - -
Q3: Work setting:
Government hospital 293 68.8 - -
Private hospital 133 31.2 - -
Q4: Education level:
Doctor of Philosophy 57 13.4 - -
Master of Science 156 36.6 - -
Doctor of Physiotherapy 2 0.5 - -
Bachelor of Physiotherapy 211 49.5 - -
Q5: Practice level:
1st decade of practice 189 44.4 - -
2nd decade of practice 150 35.2 - -
3rd decade of practice 87 20.4 - -
Q6: Rank:
Physiotherapist 185 43.4 - -
Senior physiotherapist 101 23.7 - -
Principal physiotherapist 96 22.5 - -
Chief physiotherapist 32 7.5 - -
Assistant director of physiotherapy services 10 2.4 - -
Deputy director of physiotherapy services 2 0.5 - -
Q7: Speciality:
Orthopaedic physiotherapist 157 36.9 - -
Neurological physiotherapist 99 23.2 - -
Cardiopulmonary physiotherapist 53 12.4 - -
Geriatric physiotherapist 41 9.6 - -
Paediatric physiotherapist 66 15.5 - -
Women’s health physiotherapist 10 2.47 - -

s.d, standard deviation.

 Findings on physiotherapists’ knowledge about palliative care

Findings on the knowledge of physiotherapists about palliative care were assesssed and presented as number of codes and themes that emerged as follows: sufficient knowledge, insufficient knowledge and lack of knowledge (Table 2). After summation of the codes, 73.9% (n = 315) of the physiotherapists had ‘sufficient knowledge’, 20.7% (n = 88) of them had ‘insufficient knowledge’ and 5.4% (n = 23) showed ‘lack of knowledge’. Physiotherapists in the sufficient knowledge group had adequate knowledge about palliative care physiotherapy. Those in the insufficient knowledge group had some knowledge but inadequate awareness. Physiotherapists in the lack of knowledge group had no knowledge about palliative care physiotherapy.

Physiotherapists’ responses on knowledge, awareness and current practice of palliative care physiotherapy (n = 426).

Question Response n %
Knowledge questions
Q1: Palliative care is an interdisciplinary medical care approach aimed at optimising the quality of life and mitigating suffering amongst people with serious and complex illnesses. Agree 346 81.2%
Disagree 80 18.8%
Undecided 0 0%
Q2: Palliative care provides relief from symptoms and stress for patients with life-threatening and life-limiting illnesses and their families. Agree 299 70.2%
Disagree 123 28.9%
Undecided 4 0.9%
Q3: Palliative care goals are through prevention, early identification and relief of physical (including pain), psychological, psychosocial and spiritual suffering and by optimising independent function to improve health-related quality of life. Agree 326 76.5%
Disagree 6 1.4%
Undecided 94 22.1%
Q4: Palliative care was initially developed in response to the needs of cancer or terminally ill persons alone. Agree 300 70.4%
Disagree 126 29.6%
Undecided 0 0%
Q5: Palliative care is now applicable to diseases that last for many years and other life-threatening conditions that remain symptomatic and have functional limitations. Agree 89 20.9%
Disagree 312 73.2%
Undecided 25 5.7%
Q6: Palliative care is appropriate at any age and any stage of a serious illness and can be provided together with curative treatment. Agree 193 45.3%
Disagree 201 47.2%
Undecided 32 7.5%
Q7: A number of chronic life-threatening conditions are prevalent in Nigeria, including HIV, cerebrovascular disease, diabetes mellitus and chronic pulmonary disease. People presenting with these conditions or their sequelae could benefit from a palliative care approach. Agree 423 99.3%
Disagree 0 0%
Undecided 3 0.7%
Q8: Palliative care begins at any time of a serious disease, most especially at the time of the diagnosis process, and continues through cure or until death and then into bereavement. Agree 201 47.2%
Disagree 151 35.4%
Undecided 74 17.4%
Q9: Palliative care is not against the values of physiotherapy. Agree 214 50.3%
Disagree 212 49.8%
Undecided 0 0%
Q10: Physiotherapists have an important role in the palliative care team, providing symptom management and improving quality of life by optimising independent levels of function. Agree 370 86.9%
Disagree 0 0%
Undecided 56 13.1%
Q11: Palliative care is provided by a primary care provider and is supported by a team of specialists, usually a physician, nurse, physiotherapist, social worker and spiritual care counselor. Agree 109 25.6%
Disagree 0 0%
Undecided 317 74.4%
Awareness questions
Q1: Palliative care is as important as curative care in physiotherapy practice. Agree 301 70.6%
Disagree 77 18.1%
Undecided 48 11.3%
Q2: Physiotherapists are aware of palliative care to patients who are terminally ill and their families. Agree 345 80.9%
Disagree 81 19.1%
Undecided 0 0%
Q3: There is societal support for and awareness of the need for physiotherapy in palliative care. Agree 256 60.1%
Disagree 70 16.4%
Undecided 100 23.5%
Q4: Physiotherapists are well qualified to support and communicate with terminally ill or dying patients and their families. Agree 404 94.8%
Disagree 0 0%
Undecided 22 5.2%
Q5: Palliative care is necessary for physiotherapy education in Nigeria. Agree 426 100%
Disagree 0 0%
Undecided 0 0%
Q6: Curative care is more important than palliative care in the physiotherapy environment. Agree 0 0%
Disagree 208 48.8%
Undecided 218 51.2%
Current practice questions
Q1: Do medical doctors refer patients for physiotherapy palliative care? Yes 169 39.7%
No 51 11.9%
Maybe 206 48.4%
Q2: Do medical staff support physiotherapists in palliative care in your workplace? Agree 70 16.4%
Disagree 0 0%
Undecided 356 83.7%
Q3: Do you refer or invite other health care professionals if the need arises in the course of managing patients who require physiotherapy palliative care? Agree 426 100%
Disagree 0 0%
Undecided 0 0%
Q4: List any three conditions that require palliative care in your specialty. Complete response 121 28.4%
Incomplete response 67 15.7%
No response 238 55.9%
Q5: If you refer patients who will benefit from palliative care to other health professionals, to whom do you refer? Oncologist 207 48.6%
Neurologist 3 0.7%
Nephrologists 111 26.1%
Cardiologists 7 1.7%
Pulmonologist 98 23.0%
Q6: TENS, heat, massage, lymphedema treatment and acupuncture are common forms of pain relief modalities and are employed often in palliative care. Agree 189 44.4%
Disagree 0 0%
Undecided 237 55.6%
Q7: Therapeutic massage, cold therapy, TENs, range of motion, strengthening exercises and gait training are employed for treating patients with cancer. Agree 226 53.1%
Disagree 0 0%
Undecided 200 46.9%
Q8: Psychological and physical activity-based interventions have been proven to be better in improving the quality of life in patients with cancer-related fatigue in palliative care. Agree 367 86.2%
Disagree 0 0%
Undecided 59 13.8%
Q9: Physical activity is indirectly associated with improved quality of life through pathways that include fatigue, pain, social support and self-efficacy in individuals with multiple sclerosis in palliative care. Agree 226 53.1%
Disagree 0 0%
Undecided 200 46.9%
Q10: Improvements in social support, self-efficacy and reduced functional limitations following physical activity programme in multiple sclerosis patients are important. Besides drugs, physiotherapy is the mainstay in the management of spasticity in multiple sclerosis in palliative care. Agree 301 70.7%
Disagree 0 0%
Undecided 125 29.3%
Q11: Aerobic and resistance exercise training programmes decrease pain, depression and stress, and increase the quality of life and better physical self-concept in patients with spinal cord injury in palliative care. Agree 174 40.9%
Disagree 201 47.2%
Undecided 51 11.9%
Q12: Breathing retraining, such as diaphragmatic breathing or pursed lip breathing, are useful in palliative management of dyspnoea. Agree 221 51.9%
Disagree 0 0%
Undecide 205 48.1%
Q13: Positioning techniques, relaxation, breathing awareness exercises, walking and stair climbing activities, coping and pacing, and activity modification are useful in physiotherapy management of breathlessness in palliative care. Agree 226 53.1%
Disagree 0 0%
Undecided 200 46.9%
Findings on physiotherapists’ awareness about palliative care

The number of codes for awareness about palliative care physiotherapy and the themes that emerged are illustrated in Table 3. The codes were labelled and categorised into three major themes as follows: adequate awareness, inadequate awareness and lack of awareness. After summation of the codes, 80.5% (n = 343) of the physiotherapists had ‘adequate awareness’, 13.4% (n = 57) had ‘inadequate awareness’ and 6.1% (n = 26) showed ‘lack of awareness’. Adequate awareness indicated that the participants were well aware of palliative care physiotherapy. Inadequate awareness indicated that the participants had some level of awareness, although inadequate, and lack of awareness indicated that the participants were not aware of palliative care physiotherapy.

Themes and number of codes for physiotherapists’ knowledge, awareness and current practice (n = 426).

Themes Number of codes n %
Physiotherapists’ knowledge (n = 426)
Sufficient knowledge 8610 315 73.9
Insufficient knowledge 2422 88 20.7
Lack of knowledge 605 23 5.4
Physiotherapists’ awareness (n = 426)
Sufficient knowledge 5196 343 80.5
Insufficient knowledge 872 57 13.4
Lack of knowledge 388 26 6.1
Physiotherapists’ practice (n = 426)
Standard practice 8148 284 66.7
Substandard practice 520 18 4.2
Lack of practice 3567 124 29.1

Q, question.

 Findings on physiotherapists’ practice of palliative care

The number of codes for practice of palliative care physiotherapy and the themes that emerged are illustrated in Table 3. The codes were labelled and categorised into three major themes as follows: standard practice, substandard practice and lack of practice. After summation of the codes, 66.7% (n = 284) of the physiotherapists used ‘standard practice’, 4.2% (n = 18) used ‘substandard practice’ and 29.1% (n = 124) had ‘lack of practice’. Standard practice indicated that the participants had adequate skills in the management of palliative care patients. Substandard practice indicated that participants in this group had inadequate skills in the management of palliative care patients, and lack of practice indicated that the participants in this group had no skills in managing patients in need of palliative care.

 Correlation between physiotherapists’ knowledge, awareness and practice of palliative care

The relationship between physiotherapists’ knowledge, awareness and practice of palliative care is presented in Table 4. The results indicate that knowledge was moderately and strongly related with awareness (r = 0.68, p = 0.001, n = 426) and practice of palliative care (r = 0.85, p = 0.001), respectively. Additionally, practice of palliative care was strongly related with awareness (r = 0.74, p = 0.001, n = 426).

Spearman’s rank correlation between therapists’ knowledge, awareness and practice (n = 426).

Variables Knowledge
 Awareness
 Practice
r p r p r p
Knowledge - - 0.68 0.001 0.85 0.001
Practice - - 0.74 0.001 - -

r, coefficient of correlation; p, level of significance.

 Findings on differences in knowledge, awareness and practice of palliative care

The one-way ANOVA was carried out to determine differences in knowledge, awareness and practice of palliative care (Table 5). The results indicated statistically significant differences in knowledge (F = 14.43, df = 2.423, p = 0.0001), awareness (F = 6.32, df = 2.423, p = 0.0001) and practice of palliative care (F = 10.21, df = 2.423, p = 0.0001), with a significant linear trend for knowledge (p = 0.0001), awareness (p = 0.014) and practice of palliative care (p = 0.003) to increase with higher professional experience. Post-hoc analysis indicated statistically significant differences with large effect sizes in the independent variables only between novice and expert, with experts having more knowledge [mean difference = 7.22 (3.35, 10.12), effect size (ɳ2) = 0.768, p = 0.023], awareness [mean difference = 3.48 (2.35, 6.82), effect size (ɳ2) = 0.711, p = 0.007] and palliative care practice [mean difference = 7.01 (3.66, 9.87), effect size (ɳ2) = 0.862, p = 0.003] than novice physiotherapists. The effect sizes (ɳ2) indicate 76.8%, 71.1% and 86.2% of the variation in knowledge, awareness and the practice of palliative care by expert professionals.

One-way ANOVA for the difference in knowledge, awareness and current practice (n = 426).

Professional experience n Mean s.d. F df p-value p-value trend
Difference in knowledge (n = 426) - - - 14.43 2.423 0.0001 0.0001
Novice 189 9.67 2.12 - - - -
Experienced 150 10.92 2.87 - - - -
Expert 87 16.89 1.95 - - - -
Difference in awareness (n = 426) - - - 6.32 2.423 0.002 0.014
Novice 189 3.88 0.06 - - - -
Experienced 150 5.03 0.21 - - - -
Expert 87 7.34 0.16 - - - -
Difference in current practices (n = 426) - - - 10.21 2.423 0.0001 0.003
Novice 189 4.87 1.77 - - - -
Experienced 150 8.01 2.63 - - - -
Expert 87 11.88 2.37 - - - -

N, number of physiotherapists; s.d., standard deviation; F, ANOVA; df, degree of freedom; ANOVA, analysis of variance.

 Discussion

Palliative care is often compared to and considered synonymous with pain medicine, geriatric medicine and rehabilitative medicine. However, this form of care has evolved to include rehabilitation of individuals with serious illnesses, having team members including medical practitioners, nurses, pharmacists, physiotherapists and other health professionals having assigned roles. Although physiotherapists may not be formally trained to become specialists in palliative care in low- and middle-income countries, there are special interest groups whose members focus on palliative care and have garnered experience over the years in the management of patients requiring palliative care in these countries. Despite this, there is a lack of evidence concerning knowledge, awareness and practice of palliative care amongst physiotherapists in sub-Saharan Africa, particularly Nigeria. To the best of the authors’ knowledge, there are no studies available on the knowledge, awareness and practice of palliative care amongst Nigerian physiotherapists.

The results of our study show that more than half of the surveyed physiotherapists (73.9%) had sufficient knowledge about palliative care physiotherapy. This could be because of the increase in the number of patients who require palliative care services in the nation, such as patients with cancer and stroke across Nigeria (Budkaew & Chumworathayi 2013). Our findings also indicate that some physiotherapists had insufficient knowledge and a few lacked knowledge of palliative care physiotherapy. The current findings are somewhat in agreement with those of Morrow et al. (2017), who reported amongst physiotherapists in South Africa. It was suggested that the knowledge of the scope of palliative care is still limited, and this suggestion is supported by the moderate score (56%) of the ‘palliative care knowledge’ domain. These contradict the results of a recent study by De Oliveira, Rodrigues and Barreto (2021) conducted on the knowledge of Brazilian physiotherapists on palliative care in paediatrics. The results indicated that only 34.1% of physiotherapists reported having adequate knowledge about palliative care physiotherapy.

The participants in our study indicated an adequate level of awareness (80.5%) about palliative care physiotherapy. A high level of knowledge about palliative care is considered an important factor in the development of positive awareness toward palliative care. However, the reason for this adequate level of awareness may be related to continuing professional development programmes organised by the palliative care physiotherapy specialty group in Nigeria. Our findings are similar to the results of previous studies. Mawani et al. (2015) assessed the awareness of palliative care amongst physiotherapy students. About 80% of the participants strongly agreed that palliative care is as important as curative care in physiotherapy, and 70% agreed that palliative care should be included in the course content of physiotherapy education. Akinyemiju et al. (2015) surveyed palliative care awareness amongst health professionals. Their results indicate that 98% of the professionals had adequate awareness about palliative care. Sujatha and Jayagowri (2017) assessed palliative care awareness amongst undergraduate health care students. They concluded that 70% of students from the medical college were aware of palliative care.

Our study revealed that 66.7% of the participants adopted the practice of palliative care physiotherapy. This indicates that the majority of the physiotherapists had adequate skills and/or training in the rehabilitation of terminally ill patients. This result supports the findings by Morrow et al. (2017) on the practice of palliative care amongst physiotherapists in South Africa. The results show that physiotherapists apply standard current practices in the management of patients needing palliative care speciality.

Our results also indicate that knowledge was moderately and strongly correlated with awareness and application of palliative care practices. The findings also indicate significant differences in knowledge, awareness and practices of palliative care physiotherapy between the expert and the novice, with experts having more knowledge and awareness and practising palliative care more in the rehabilitation of individuals with chronic illness or the terminally ill. In addition, our finding that significant linear trends for knowledge, awareness and practices of palliative care increase with increasing professional experience is similar to the work of Morrow et al. (2017). Their results indicated a significant association with years of experience on the ‘attitudes of physiotherapy in the palliative care’ domain, with a negative correlation between number of years qualified and percentage score (Spearman r = −0.14; p = 0.03). However, a study by Yakasai et al. (2020) indicated that expert physiotherapists have better knowledge and better practise compared to novice physiotherapists. Similar findings were also reported in previous studies, which indicated that expert physiotherapists have better knowledge and also use better reflection methods in the clinical decision-making process when compared to novice physiotherapists (Case, Harrison & Roskell 2000; Doody & McAteer 2002; May et al. 2013; Wainwright et al. 2010).

Limitations of our study

Our study is not without limitations. Firstly, it was conducted in Nigeria and may not be generalisable to other settings. Secondly, the design was cross-sectional and cannot therefore establish cause and effect.

 Implications for physiotherapists

Our findings suggest that physiotherapists have adequate knowledge and awareness and use palliative care physiotherapy. However, mentorship and workshops on palliative care physiotherapy are needed for novice clinicians. Thus, palliative care physiotherapy should be included in undergraduate curricula.

 Conclusion

Based on the findings, it can be concluded that a large proportion of Nigerian physiotherapists have knowledge, awareness and clinical experience in managing patients requiring palliative care physiotherapy. Furthermore, expert physiotherapists have better knowledge and awareness and also use current practices more in palliative care physiotherapy compared to novice physiotherapists.

 Acknowledgements

The authors thank the physiotherapy heads of departments and participants for engaging in the study.

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

 Authors’ contributions

A.M.Y., M.S.D., J.M.N., U.M.G. and S.S.M. participated in the study conception, design, acquisition and analysis of the data. A.M.Y., S.A.H., S.S.M and J.M.N. participated in drafting the manuscript, interpretation of the data, critical revision for publication and approval for submission.

 Funding information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

 Data availability

The data are not publicly available because of restrictions, as they contain information that could compromise the privacy of research participants. Relevant files of this work will be shared on request from the corresponding author.

 Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

 References Addington-Hall, J.M. & Higginson, I.J., 2011, Palliative care for non-cancer patients. Palliative care for non-cancer patients, Oxford University Press, Oxford, New York. Akinyemiju, Y., O’Connor, T.L., Salako, O., Jimoh, M. & Nwogu, C.E., 2015, ‘Palliative care awareness among health care professionals in Nigeria’, Journal of Clinical Oncology 33(15_suppl), e20548–e20548. https://doi.org/10.1200/JCO.2015.33.15_SUPPL.E20548 Aregbeshola, B., 2012, Addressing the public health challenges Nigeria faces, iNigerian.com, viewed 10 February 2019, from https://www.inigerian.com/addressing-the-public-health-challenges-nigeria-faces/. Budkaew, J. & Chumworathayi, B., 2013, ‘Knowledge and attitudes toward palliative terminal cancer care among thai generalists’, Asian Pacific Journal of Cancer Prevention 14(10), 6173–6180. https://doi.org/10.7314/APJCP.2013.14.10.6173 Case, K., Harrison, K. & Roskell, C., 2000, ‘Differences in the clinical reasoning process of expert and novice cardiorespiratory physiotherapists’, Physiotherapy 86(1), 14–21. https://doi.org/10.1016/S0031-9406(05)61321-1 Chartered Society of Physiotherapy, 2004, House of Commons – Health Committee: Written evidence from the Chartered Society of Physiotherapy (LTC 08), viewed 16 September 2019, from https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/401/401vw07.htm. Chiarelli, P.E., Johnston, C. & Osmotherly, P.G., 2014, ‘Introducing palliative care into entry-level physical therapy education’, Journal of Palliative Medicine 17(2), 152–158. https://doi.org/10.1089/jpm.2013.0158 Danazumi, M.S., Yakasai, A.M., Dermody, G. & Nuhu, J.M., 2022, ‘Knowledge and current practices of Nigerian physiotherapists on the physical activity and exercise training in the rehabilitation of patients with asthma’, Journal of Asthma 59(3), 597–606. https://doi.org/10.1080/02770903.2020.1868500 Daniel Chukwunyere, N., 2019, ‘Palliative care: The Nigerian perspective’, in Palliative care, IntechOpen. De Oliveira, J.L.R., Rodrigues, R.P. & Barreto, L.A., 2021, ‘The knowledge of physical therapists on palliative care in pediatria em a maternal children’s’, Revista Pesquisa Em Fisioterapia 11(2), 375–383. https://doi.org/10.17267/2238-2704RPF.V11I2.3769 Doody, C. & McAteer, M., 2002, ‘Clinical reasoning of expert and novice physiotherapists in an outpatient orthopaedic setting’, Physiotherapy 88(5), 258–268. https://doi.org/10.1016/S0031-9406(05)61417-4 Horne-Thompson, A. & Bramley, R., 2011, ‘The benefits of interdisciplinary practice in a palliative care setting: A music therapy and physiotherapy pilot project’, Progress in Palliative Care 19(6), 304–308. https://doi.org/10.1179/1743291X11Y.0000000017 Kassa, H., Murugan, R., Zewdu, F., Hailu, M. & Woldeyohannes, D., 2014, ‘Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia’, BMC Palliative Care 13(1), 6. https://doi.org/10.1186/1472-684X-13-6 Kaushik, V. & Walsh, C.A., 2019, ‘Pragmatism as a research paradigm and its implications for social work research’, Social Sciences 8(9), 255. https://doi.org/10.3390/socsci8090255 Kumar, S. & Jim, A., 2010, ‘Physical therapy in palliative care: From symptom control to quality of life: A critical review’, Indian Journal of Palliative Care 16(3), 174. https://pubmed.ncbi.nlm.nih.gov/21218003/. Lavrakas, P., 2013, ‘Census’, in Encyclopedia of survey research methods, Sage, Newbury Park, Califonia, USA. Mawani, A., Khanzada, S., Talpur, M. & Talpur, F., 2015, ‘Awareness of palliative care among physical therapy student of ISRA University Hyderabad’, IOSR Journal of Research & Method in Education Ver. III 5(3), 2320–7388. https://www.iosrjournals.org/iosr-jrme/papers/Vol-5%20Issue-3/Version-3/G05333436.pdf May, S., Withers, S., Reeve, S. & Greasley, A., 2013, ‘Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems: A qualitative study’, Journal of Manual and Manupulative Therapy 18(2), 84–88. https://doi.org/10.1179/106698110X12640740712770 Morrow, B.M., Barnard, C., Luhlaza, Z., Naidoo, K. & Pitt, S., 2017, ‘Knowledge, attitudes, beliefs and experience of palliative care amongst South African physiotherapists’, The South African Journal of Physiotherapy 73(1), a384. https://doi.org/10.4102/SAJP.V73I1.384 Murray, S.A., Firth, A., Schneider, N., Van Den Eynden, B., Gomez-Batiste, X., Brogaard, T., et al., 2015, ‘Promoting palliative care in the community: Production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care’, Palliative Medicine 29(2), 101–111. https://doi.org/10.1177/0269216314545006 NHS Choices, 2017, What end of life care involves – End of life care guide, NHS Choices, viewed 15 September 2019, from https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/. Payne, S.K., Coyne, P. & Smith, T.J., 2002, ‘The health economics of palliative care’, Oncology 16(6), 801–808, viewed 10 February 2019, from https://pubmed.ncbi.nlm.nih.gov/12088300/. Petry, N.M., 2002, ‘A comparison of young, middle-aged, and older adult treatment-seeking pathological gamblers’, The Gerontologist 42(1), 92–99. https://doi.org/10.1093/GERONT/42.1.92 Prevost, V. & Grach, M.C., 2012, ‘Nutritional support and quality of life in cancer patients undergoing palliative care’, European Journal of Cancer Care 21(5), 581–590. https://doi.org/10.1111/j.1365-2354.2012.01363.x Shelley, M. & Krippendorff, K., 2012, ‘Content analysis: An introduction to its methodology’, Journal of the American Statistical Association 79(385), 240. https://doi.org/10.2307/2288384 Sujatha, R. & Jayagowri, K., 2017, ‘Assessment of palliative care awareness among undergraduate healthcare students’, Journal of Clinical and Diagnostic Research : JCDR 11(9), JC06. https://doi.org/10.7860/JCDR/2017/29070.10684 Terwee, C.B., Bot, S.D.M., Boer, M.R., De Windt, D.A.W.M., Van Der Knol, D.L., Dekker, J., et al., 2007, ‘Quality criteria were proposed for measurement properties of health status questionnaires’, Journal of Clinical Epidemiology 60(1), 34–42. https://doi.org/10.1016/J.JCLINEPI.2006.03.012 Wainwright, S.F., Shepard, K.F., Harman, L.B. & Stephens, J., 2010, ‘Novice and experienced physical therapist clinicians: A comparison of how reflection is used to inform the clinical decision-making process’, Physical Therapy 90(1), 75–88. https://doi.org/10.2522/PTJ.20090077 World Health Organization, 2002, Towards a common language for functioning, disability and health: ICF The international classification of functioning, disability and health, World Health Organization, Geneva, Switzerland. Yakasai, A.M., Danazumi, M.S., Zakari, U.U., Usman, I.L., Abdullahi, A. & Shehu, U.T., 2020, ‘Knowledge and current practices of physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures’, Epilepsy & behavior: E&B, 104(Pt A), 106891. https://doi.org/10.1016/j.yebeh.2019.106891

How to cite this article: Yakasai, A.M., Maharaj, S.S., Gidado, U.M., Nuhu, J.M., Haruna, S.A. & Danazumi, M.S., 2023, ‘Knowledge, awareness and use of current practice of palliative care amongst physiotherapists’, South African Journal of Physiotherapy 79(1), a1786. https://doi.org/10.4102/sajp.v79i1.1786