Education and training to support physiotherapists working in dementia care: a scoping review protocol

Trish O'Sullivan; Tony Foley; Joseph G. McVeigh; Suzanne Timmons

doi:10.12688/hrbopenres.13219.2

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Study Protocol

Revised

Education and training to support physiotherapists working in dementia care: a scoping review protocol

[version 2; peer review: 3 approved]

Trish O'Sullivan ¹, Tony Foley², Joseph G. McVeigh¹, Suzanne Timmons³

PUBLISHED 22 Jun 2021

Author details Author details

¹ Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
² Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
³ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork and Mercy University Hospital, Cork, Ireland

Trish O'Sullivan
Roles: Conceptualization, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation

Tony Foley
Roles: Conceptualization, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

Joseph G. McVeigh
Roles: Conceptualization, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

Suzanne Timmons
Roles: Conceptualization, Investigation, Methodology, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Dementia Trials Ireland (DTI) and Dementia Research Network Ireland (DRNI) gateway.

Abstract

Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care.
Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care.
Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Qualitative, quantitative, mixed methods studies, case studies and observational studies will be included.
Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches. Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.

Keywords

Dementia, Physiotherapy, Education, Training

Corresponding author: Trish O'Sullivan

Competing interests: No competing interests were disclosed.

Grant information: This research forms part of a PhD which is being funded by University College Cork, Ireland

Copyright: © 2021 O'Sullivan T et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: O'Sullivan T, Foley T, McVeigh JG and Timmons S. Education and training to support physiotherapists working in dementia care: a scoping review protocol [version 2; peer review: 3 approved]. HRB Open Res 2021, 4:27 (https://doi.org/10.12688/hrbopenres.13219.2) First published: 10 Mar 2021, 4:27 (https://doi.org/10.12688/hrbopenres.13219.1) Latest published: 22 Jun 2021, 4:27 (https://doi.org/10.12688/hrbopenres.13219.2)

Revised Amendments from Version 1

The main differences are: we have removed the search of systematic reviews from the abstract and methods section. We have also included definitions on what constitutes education and training in the concept paragraph. We have also added a new reference (Gibbs et al) that is available at the bottom of the reference list.

See the authors' detailed response to the review by Katherine Lawler
See the authors' detailed response to the review by Amanda Phelan
See the authors' detailed response to the review by Louise Hopper

Introduction

Dementia is one of the greatest health and social care challenges of our time¹. Dementia is characterised by progressive cognitive impairment in domains such as memory, orientation, comprehension, language and judgement². The complexity of dementia, coupled with the significant health and social care costs make dementia a major challenge to our healthcare system. As Ireland’s ageing population continues to grow, it is estimated that by 2036, there will be over 112,000 adults in Ireland living with dementia³. The consequences of dementia for the individual and family are profound as it is associated with impairment in both physical and functional ability, as well as non-cognitive symptoms (often called behavioural and psychological symptoms of dementia). Physical impairments associated with dementia include impaired mobility, reduced muscle strength and poor balance while non-cognitive symptoms include agitation, anxiety, depression and delusions⁴. Rehabilitation interventions are an important component of the management of those with dementia and physiotherapy plays a key role in many aspects of dementia care, including the maintenance of mobility, falls risk assessment and strength training⁵. Even though physiotherapists working in acute and primary care settings carry a significant caseload of patients with dementia⁶, very little formal undergraduate and post-graduate training is available to allied health care professionals⁷. The World Health Organisation has acknowledged that developing the knowledge and skills of all healthcare professionals who are involved in dementia care is a priority⁸. Indeed the Irish National Dementia Strategy has included training and upskilling of healthcare professionals in dementia care as a primary objective³.

Understanding what constitutes effective education, for those caring for patients with dementia in the healthcare setting is an ongoing challenge⁹. The diversity of knowledge, abilities, skills and qualities required to be a competent healthcare professional in dementia care highlights both the complexity and importance of education in this area. However, there remains a gap in the literature on what effective dementia care training for physiotherapists should address, consist of, how it should be delivered and how it should be evaluated. Even though basic didactic knowledge is outlined in the curricula of most allied health professional courses¹⁰, Surr and Gates argued that the ability to effectively transfer theoretical knowledge from the curricula to clinical practice remains challenging⁹. A preliminary search of the JBI Database of Systematic Reviews and the Cochrane Library, Medline and CINAHL databases did not find any scoping reviews of dementia educational interventions for physiotherapists. Similarly, a search of the PROSPERO database found no similar systematic review protocol registered or currently ongoing. However, previous research^9,11,12 has explored what constitutes effective dementia training and education for the wider health and social care workforce. For instance, a critical synthesis⁹ that analysed dementia training for hospital staff examined staff’s knowledge gains, changes in attitudes, confidence and behaviour change. This review found that the aspects of dementia training that were most effective are those strategies that participants can apply in their day to day practice and are related to the content and delivery⁹. The 20 papers included in this review by Surr and Gates⁹, evaluated 16 different training programmes, however, the methods of evaluation varied from study to study. Moreover, it is difficult to quantify perceived increase in knowledge as a result of training, as many questionnaires measuring knowledge are non-validated⁹. It is evident that dementia training can lead to more positive attitudes which in-turn results in improved patient outcomes¹³. Yet, in spite of this, there remains a paucity of evidence in the literature as to what constitutes effective dementia training for physiotherapists and more importantly, what type of curriculum will translate into better patient care.

Aim

This scoping review aims to explore and chart the evidence relating to education and training for physiotherapists working with people with dementia with a view to identifying any gaps within the literature.

Objectives

To identify studies that have evaluated physiotherapy dementia educational interventions.
To critically appraise included studies, in order to update the current evidence base.
To use the findings of the review to inform the design and delivery of a dementia educational programme for physiotherapists.

Purpose

A greater understanding of what constitutes effective dementia education and training for physiotherapists will lead to appropriately designed educational interventions for physiotherapists, ultimately leading to the opportunity for enhanced patient care.

Inclusion criteria

Population

The review will consider studies that include dementia education or training for both qualified physiotherapists and student physiotherapists. It will also include studies that looked at multi-disciplinary dementia training only if physiotherapy was an included profession.

Concept

The proposed scoping review is designed to explore education and training for physiotherapists working in dementia care. Therefore all studies with a focus on any aspect of physiotherapy education and training will be considered. Education is a learning process that deals with unknown outcomes, and circumstances which require complex knowledge synthesis, skills and experience to solve problems¹⁴. Training has application when there is some recognised skill that has to be mastered and practice is required for the mastery of it¹⁴. Effective learning in health care education includes elements of training set in the context of life- long learning. As dementia care incorporates clinical, social, ethical and medical issues, it is important that concepts from both education and training are included.

As defined by the World Health Organisation, knowledge translation is “the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health”¹⁵. Knowledge translation needs to move beyond the simple dissemination of knowledge to the actual use of knowledge. Within the Cochrane Collaboration, the Cochrane Effective Practice and Organisation of Care Group (EPOC) review the effects of knowledge translation activities¹⁶ and have explored the effectiveness of professional behaviour change strategies. The EPOC give clear definitions of education meetings, education outreach and audit and feedback¹⁶. The authors will be guided by the EPOC to ensure the inclusion of studies that meet the definition of these educational interventions.

Context

This scoping review aims to establish the breadth and extent of the current literature published on dementia training for physiotherapists and student physiotherapists. Therefore, studies conducted in any setting (acute/primary care/residential care) or any educational setting in any geographical location will be considered. The WHO describes primary care as “first contact, accessible, continued, comprehensive and co-ordinated care”¹⁷.

Types of studies

This scoping review will look at all, qualitative, quantitative and mixed methods studies that explore dementia education and physiotherapy. Case studies, as well as observational studies will also be included.

Methods

This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews¹⁸. This protocol was registered with Open Science Framework on 26 October 2020.

Search strategy

As recommended in the JBI guidelines, a three step search strategy will be used¹⁸. The first step, which has already been completed, involved a broad search of Medline (via EBSCO) and CINAHL using keywords for physiotherapy, dementia and education. This initial search was then followed by an analysis of the text words found in the identified titles and abstracts^19,20. This ensured that relevant literature was captured. The search strategy was developed by one reviewer (TOS) with assistance from a librarian in University College Cork. The final search strategy for CINAHL is presented in Table 1. The final step in the search strategy will include a detailed search of the reference lists of identified studies. Databases to be searched as part of this review include: Medline, CINAHL, PsycINFO and SocINDEX. Google Scholar and Open-Grey will be searched for grey literature. Only studies published in English will be considered.

Table 1. Search Strategy: CINAHL plus full text.

Date of Search: 19/09/20.

Number	Search Terms	Records Retrieved
#1	Physiotherapy or Physical Therapy or Physiotherapist or Rehabilitation	124,447
#2	Dementia or Alzheimer’s Disease or Cognitive Impairment or Dementia Vascular or Memory Loss	91,389
#3	Education or training or learning or teaching	420,523
#4	#1 and #2	2,589
#5	#4 and #3	399

Study selection

Following the search, all identified citations will be collated and uploaded to EndNote X9.2 and duplicates removed. Titles and abstracts will then be reviewed independently by two reviewers (TOS and TF) for assessment against inclusion criteria. Where uncertainty occurs, a third reviewer (JMcV) will be consulted. The full texts of selected studies will be then screened for inclusion. Full text studies that do not meet the inclusion criteria will be excluded and reasons for exclusion recorded. The results of this search will be comprehensively detailed and reported in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram^21,22.

Data extraction

Data extraction will focus on identifying and charting data relating to physiotherapy education in dementia care. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool¹⁸. The data extracted will include study characteristics such as author, year, type of study, publication title, country, clinical setting, participants, purpose, education content, mode of delivery, key findings, barriers and facilitators to learning and limitations. The Kirkpatrick Framework²³, a hierarchy of evaluation of training, will be used to classify data extracted. The Kirkpatrick Framework²³ was chosen as it is widely used to evaluate educational interventions in healthcare. The four level model outlined by Kirkpatrick comprises of 1) reaction, 2) learning, 3) behaviour and 4) results²³. The draft data extraction tool will be independently piloted on three papers by two reviewers (TOS, JMcV) and modified where necessary. Modifications will be detailed in the full scoping review report. Data will be extracted by one reviewer (TOS) and reviewed by another reviewer. Any disagreements that arise will be resolved through discussion or with a third reviewer. Missing or additional data will be obtained by contacting study authors where required.

Data presentation

A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review. The review will characterise what constitutes effective dementia care training for physiotherapists, the various teaching and learning approaches used and the outcomes of the training intervention. Kirkpatrick’s framework will be used to report the effectiveness of the educational intervention. This will involve looking at reaction and satisfaction of participants, learning and knowledge, participants behaviour and patient outcomes. The various dementia training interventions will be tabulated in suitable categories.

Dissemination of information

The findings of this review will be disseminated in several ways. The scoping review will be published in an international peer reviewed journal, the results will also be presented at national and international conferences. More locally, the findings of the review will be disseminated through the Dementia Research Network Ireland (DRNI) and to clinical colleagues in the Health Service Executive (HSE).

Study status

This study is at stage 1: scoping review to explore and chart the evidence relating to education and training of physiotherapists working in dementia care.

Data availability

Underlying data

No data are associated with this article.

Acknowledgements

The authors wish to acknowledge Donna O’ Doibhlin, librarian, University College Cork who assisted in developing the search strategy.

Faculty Opinions recommended

References

1. Livingston G, Sommerlad A, Orgeta V, et al.: Dementia prevention, intervention, and care. Lancet. 2017; 390(10113): 673–2734. PubMed Abstract | Publisher Full Text
2. Timmons S, O’Shea E, O’Neill D, et al.: Acute hospital dementia care: results from a national audit. BMC Geriatr. 2016; 16: 113. PubMed Abstract | Publisher Full Text | Free Full Text
3. Department Of Health: The Irish National Dementa Strategy, Editor. Dublin, Ireland. 2014. Reference Source
4. Jennings A, Linehan M, Foley T: The knowledge and attitudes of general practitioners to the assessment and management of pain in people with dementia. BMC Fam Pract. 2018; 19(1): 166. PubMed Abstract | Publisher Full Text | Free Full Text
5. Hall AJ, Lang IA, Endacott R, et al.: Physiotherapy interventions for people with dementia and a hip fracture-a scoping review of the literature. Physiotherapy. 2017; 103(4): 361–368. PubMed Abstract | Publisher Full Text
6. Foley T, Jennings A, Sheehan C, et al.: A qualitative study of the dementia-care experiences and educational needs of physiotherapists in the Republic of Ireland. Physiotherapy. 2020; 107: 267–274. PubMed Abstract | Publisher Full Text
7. Longley V, Peters S, Swarbrick C, et al.: What influences decisions about ongoing stroke rehabilitation for patients with pre-existing dementia or cognitive impairment: a qualitative study? Clin Rehabil. 2018; 32(8): 1133–1144. PubMed Abstract | Publisher Full Text | Free Full Text
8. WHO: Alzheimer's Disease International Dementia: A Public Health Priority. 2012. Reference Source
9. Surr CA, Gates C: What works in delivering dementia education or training to hospital staff? A critical synthesis of the evidence. Int J Nurs Stud. 2017; 75: 172–188. PubMed Abstract | Publisher Full Text
10. Lorio AK, Gore JB, Warthen L, et al.: Teaching dementia care to physical therapy doctoral students: A multimodal experiential learning approach. Gerontol Geriatr Educ. 2017; 38(3): 313–324. PubMed Abstract | Publisher Full Text
11. Surr CA, Gates C, Irving D, et al.: Effective dementia education and training for the health and social care workforce: A systematic review of the literature. Rev Educ Res. 2017; 87(5): 966–1002. PubMed Abstract | Publisher Full Text | Free Full Text
12. Elvish R, Burrow S, Cawley R, et al.: 'Getting to Know Me': The second phase roll-out of a staff training programme for supporting people with dementia in general hospitals. Dementia (London). 2018; 17(1): 96–109. PubMed Abstract | Publisher Full Text
13. Staples WH, Killiam CB: Development of an instrument to measure attitudes of physical therapy providers working with people with dementia. Am J Alzheimers Dis Other Demen. 2012; 27(5): 331–8. PubMed Abstract | Publisher Full Text
14. Gibbs T, Brigden D, Hellenberg D: The Education versus Training and the Skills versus Competency debate. SA Fam Pract. 2004; 46(10): 5–6. Publisher Full Text
15. Straus SE, Tetroe J, Gragham I: Defining knowledge translation. CMAJ. 2009; 181(3–4): 165–168. PubMed Abstract | Publisher Full Text | Free Full Text
16. Grimshaw JM, Eccles MP, Lavis JN, et al.: Knowledge translation of research findings. Implement Sci. 2012; 7: 50. PubMed Abstract | Publisher Full Text | Free Full Text
17. Hickson M, Wanner A, Collinson A: Dietitian-led clinics in primary care: a scoping review protocol. JBI Database System Rev Implement Rep. 2019; 17(12): 2525–2531. PubMed Abstract | Publisher Full Text
18. Peters M, Godfrey C, McInerney P, et al.: Chapter 11: Scoping Reviews. In: Aromatans E, Munn Z [Editors]. Joanna Briggs Institute Reviewers Manual. The Joanna Briggs Institute, 2017. Reference Source
19. Arksey H, O’Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8(1): 19–32. Publisher Full Text
20. Levac D, Colquhoun H, O’Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5: 69. PubMed Abstract | Publisher Full Text | Free Full Text
21. Moher D, Shamseer L, Clarke M, et al.: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4(1): 1. PubMed Abstract | Publisher Full Text | Free Full Text
22. Tricco AC, Lillie E, Zarin W, et al.: PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7): 467–473. PubMed Abstract | Publisher Full Text
23. Smidt A, Balandin S, Sigafoos J, et al.: The Kirkpatrick model: A useful tool for evaluating training outcomes. J Intellect Dev Disabil. 2009; 34(3): 266–74. PubMed Abstract | Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 10 Mar 2021

Author details Author details

Trish O'Sullivan
Roles: Conceptualization, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation

Tony Foley
Roles: Conceptualization, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

Joseph G. McVeigh
Roles: Conceptualization, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

Suzanne Timmons
Roles: Conceptualization, Investigation, Methodology, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This research forms part of a PhD which is being funded by University College Cork, Ireland

Article Versions (2)

version 2

Revised

Published: 22 Jun 2021, 4:27

https://doi.org/10.12688/hrbopenres.13219.2

version 1

Published: 10 Mar 2021, 4:27

https://doi.org/10.12688/hrbopenres.13219.1

© 2021 O'Sullivan T et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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O'Sullivan T, Foley T, McVeigh JG and Timmons S. Education and training to support physiotherapists working in dementia care: a scoping review protocol [version 2; peer review: 3 approved]. HRB Open Res 2021, 4:27 (https://doi.org/10.12688/hrbopenres.13219.2)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Version 2

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Reviewer Report 22 Jun 2021

Amanda Phelan, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland

Approved

https://doi.org/10.21956/hrbopenres.14518.r29717

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Reviewer Report 28 May 2021

Amanda Phelan, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland

Approved

https://doi.org/10.21956/hrbopenres.14373.r29352

Thank you for the opportunity to review this paper. The focus of enhancing skills in professionals' support of people living with dementia is a key priority, particularly in the context of an increasing ageing population.

Physiotherapists have a key role in this regard, yet having bespoke education and training may be limited, despite the high potential for enhancement of quality of life.

From a cursory review of this area within the context of a literature search, there seems to be scant literature on physiotherapy and education and training. The literature appears to generally describe contributions (actual and potential) of physiotherapy and treatment efficacy. Consequently, the focus to widen the search to include multi-disciplinary teams within which physiotherapists deliver care allows more scope, but care will have to be taken to isolate the education and training needs for physiotherapy professionals in particular.

Defining what types/forms of education and training would be useful: within undergraduate programmes for physiotherapists, within postgraduate for physiotherapists, or within interdisciplinary graduate programmes.

In addition, identifying what is 'training'-is this bespoke to the discipline, inter-discipline, accredited continuous professional education programmes, study days etc. Is there a focus on competencies acquisition in clinical practice (and validated by a mentor?).

The process of the literature search is enhanced by the skills of the subject librarian and the mapping to Kirkpatrick's framework will enable a credible anchor for classification.

The methods for data extraction and resolving any disputes are transparent. Details of data dissemination are clear and suggest this is also of interest to physiotherapists outside the HSE (ie private hospitals) and has the potential to raise areas of competency development potential of private physiotherapists who deliver care in nursing homes.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: safeguarding, public health, older people, missed care

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response 14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

14 Jul 2021

Author Response

Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank ... Continue reading Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank you again.

"From a cursory review of this area within the context of a literature search, there seems to be scant literature on physiotherapy and education and training. The literature appears to generally describe contributions (actual and potential) of physiotherapy and treatment efficacy. Consequently, the focus to widen the search to include multi-disciplinary teams within which physiotherapists deliver care allows more scope, but care will have to be taken to isolate the education and training needs for physiotherapy professionals in particular".

Thank you for this very valid point Amanda. As you correctly stated, this is very little on just Physiotherapy alone, hence why the authors widened the search to include inter-professional educational interventions as long as the discipline of Physiotherapy was represented. This scoping review follows on from a previous study by two of the authors (Tony Foley and Trish O Sullivan) which explored the educational needs of physiotherapists working in dementia care in the Republic of Ireland.

"Defining what types/forms of education and training would be useful: within undergraduate programmes for physiotherapists, within postgraduate for physiotherapists, or within interdisciplinary graduate programmes".

Thank you Amanda. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.
Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank you again.

"From a cursory review of this area within the context of a literature search, there seems to be scant literature on physiotherapy and education and training. The literature appears to generally describe contributions (actual and potential) of physiotherapy and treatment efficacy. Consequently, the focus to widen the search to include multi-disciplinary teams within which physiotherapists deliver care allows more scope, but care will have to be taken to isolate the education and training needs for physiotherapy professionals in particular".

Thank you for this very valid point Amanda. As you correctly stated, this is very little on just Physiotherapy alone, hence why the authors widened the search to include inter-professional educational interventions as long as the discipline of Physiotherapy was represented. This scoping review follows on from a previous study by two of the authors (Tony Foley and Trish O Sullivan) which explored the educational needs of physiotherapists working in dementia care in the Republic of Ireland.

"Defining what types/forms of education and training would be useful: within undergraduate programmes for physiotherapists, within postgraduate for physiotherapists, or within interdisciplinary graduate programmes".

Thank you Amanda. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

14 Jul 2021

Author Response

Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank ... Continue reading Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank you again.

"From a cursory review of this area within the context of a literature search, there seems to be scant literature on physiotherapy and education and training. The literature appears to generally describe contributions (actual and potential) of physiotherapy and treatment efficacy. Consequently, the focus to widen the search to include multi-disciplinary teams within which physiotherapists deliver care allows more scope, but care will have to be taken to isolate the education and training needs for physiotherapy professionals in particular".

Thank you for this very valid point Amanda. As you correctly stated, this is very little on just Physiotherapy alone, hence why the authors widened the search to include inter-professional educational interventions as long as the discipline of Physiotherapy was represented. This scoping review follows on from a previous study by two of the authors (Tony Foley and Trish O Sullivan) which explored the educational needs of physiotherapists working in dementia care in the Republic of Ireland.

"Defining what types/forms of education and training would be useful: within undergraduate programmes for physiotherapists, within postgraduate for physiotherapists, or within interdisciplinary graduate programmes".

Thank you Amanda. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.
Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank you again.

"From a cursory review of this area within the context of a literature search, there seems to be scant literature on physiotherapy and education and training. The literature appears to generally describe contributions (actual and potential) of physiotherapy and treatment efficacy. Consequently, the focus to widen the search to include multi-disciplinary teams within which physiotherapists deliver care allows more scope, but care will have to be taken to isolate the education and training needs for physiotherapy professionals in particular".

Thank you for this very valid point Amanda. As you correctly stated, this is very little on just Physiotherapy alone, hence why the authors widened the search to include inter-professional educational interventions as long as the discipline of Physiotherapy was represented. This scoping review follows on from a previous study by two of the authors (Tony Foley and Trish O Sullivan) which explored the educational needs of physiotherapists working in dementia care in the Republic of Ireland.

"Defining what types/forms of education and training would be useful: within undergraduate programmes for physiotherapists, within postgraduate for physiotherapists, or within interdisciplinary graduate programmes".

Thank you Amanda. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 28 May 2021

Louise Hopper, School of Psychology, Dublin City University, Dublin, Ireland

Approved

https://doi.org/10.21956/hrbopenres.14373.r29386

This study comprises of the protocol for a scoping review of dementia care training for physiotherapists. A clear rationale is provided for the need for this review. Although previous reviews have been conducted relating to dementia care needs and dementia care training in healthcare professionals more broadly, no review to date has focused solely on physiotherapists despite previous research indicating that the training that produces the best outcome is that which identifies care elements that can be successfully implemented in daily interactions. The protocol methodology provides sufficient information to replicate the study. A validated model (JBI) will be followed, which is a strength of this protocol.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dementia care, policy, education and psychosocial interventions

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response 14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

14 Jul 2021

Author Response

Thank you Louise for taking the time to review our protocol. Your positive comments and observations with regard to the research gap greatly helped re-affirm that this research is warranted. ... Continue reading Thank you Louise for taking the time to review our protocol. Your positive comments and observations with regard to the research gap greatly helped re-affirm that this research is warranted. Thank you again.

Trish
Thank you Louise for taking the time to review our protocol. Your positive comments and observations with regard to the research gap greatly helped re-affirm that this research is warranted. Thank you again.

Trish
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

14 Jul 2021

Author Response

Thank you Louise for taking the time to review our protocol. Your positive comments and observations with regard to the research gap greatly helped re-affirm that this research is warranted. ... Continue reading Thank you Louise for taking the time to review our protocol. Your positive comments and observations with regard to the research gap greatly helped re-affirm that this research is warranted. Thank you again.

Trish
Thank you Louise for taking the time to review our protocol. Your positive comments and observations with regard to the research gap greatly helped re-affirm that this research is warranted. Thank you again.

Trish
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Reviewer Report 30 Mar 2021

Katherine Lawler, Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tas, Australia

Approved

https://doi.org/10.21956/hrbopenres.14373.r29074

Thank you for the opportunity to review this paper. I wish to thank the authors for their commitment to pursuing research which ultimately aims to improve health and wellbeing outcomes for people living with dementia.

This paper describes a protocol for a scoping review about education and training for physiotherapists both practicing and at undergraduate level, in the field of dementia care. The authors present a compelling argument for the importance of dementia, the role physiotherapists can play, and the global imperative to improve education and training for health professionals working in this field.

I have included a few brief comments below for consideration. However, the paper in its current form provides an excellent platform for building a scoping review upon, particularly with the authors' careful use of JBI methodology and the PRISMA-ScR checklist. I look forward to reading the final results.

Introduction

Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?

Inclusion Criteria

Comment 2: World Health Organisation (rather than Healthcare)
Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help.

Methods

Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to your research librarian!)
Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: physiotherapy; dementia care; systematic reviews

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

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Author Response 14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

14 Jul 2021

Author Response

Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and ... Continue reading Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and the author's responses. Thank you again.

"Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?"

Thank you Katherine for this valid point. This was discussed at length between the authors. We have widened the scope of the inclusion criteria to include inter-professional training if the discipline of physiotherapy were represented within the population of the educational intervention.

"Comment 2: World Health Organisation (rather than Healthcare)"

Thank you. This has been amended.

"Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help".

Thank you Katherine. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.

"Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to
your research librarian!)"

Thank you Katherine. As the data search is now complete the authors are not in a position to search this database but will consider it for subsequent studies within this PhD.

"Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research."

Absolutely. We are currently at data extraction and under outcomes, we are using the Kirkpatrick framework to inform us what level the educational intervention reached. This as you have mentioned will be useful when we proceed to our mapping study of undergraduate/postgraduate dementia education available in Higher Educational Institutes (Study 2).
Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and the author's responses. Thank you again.

"Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?"

Thank you Katherine for this valid point. This was discussed at length between the authors. We have widened the scope of the inclusion criteria to include inter-professional training if the discipline of physiotherapy were represented within the population of the educational intervention.

"Comment 2: World Health Organisation (rather than Healthcare)"

Thank you. This has been amended.

"Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help".

Thank you Katherine. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.

"Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to
your research librarian!)"

Thank you Katherine. As the data search is now complete the authors are not in a position to search this database but will consider it for subsequent studies within this PhD.

"Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research."

Absolutely. We are currently at data extraction and under outcomes, we are using the Kirkpatrick framework to inform us what level the educational intervention reached. This as you have mentioned will be useful when we proceed to our mapping study of undergraduate/postgraduate dementia education available in Higher Educational Institutes (Study 2).
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

14 Jul 2021

Author Response

Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and ... Continue reading Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and the author's responses. Thank you again.

"Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?"

Thank you Katherine for this valid point. This was discussed at length between the authors. We have widened the scope of the inclusion criteria to include inter-professional training if the discipline of physiotherapy were represented within the population of the educational intervention.

"Comment 2: World Health Organisation (rather than Healthcare)"

Thank you. This has been amended.

"Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help".

Thank you Katherine. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.

"Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to
your research librarian!)"

Thank you Katherine. As the data search is now complete the authors are not in a position to search this database but will consider it for subsequent studies within this PhD.

"Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research."

Absolutely. We are currently at data extraction and under outcomes, we are using the Kirkpatrick framework to inform us what level the educational intervention reached. This as you have mentioned will be useful when we proceed to our mapping study of undergraduate/postgraduate dementia education available in Higher Educational Institutes (Study 2).
Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and the author's responses. Thank you again.

"Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?"

Thank you Katherine for this valid point. This was discussed at length between the authors. We have widened the scope of the inclusion criteria to include inter-professional training if the discipline of physiotherapy were represented within the population of the educational intervention.

"Comment 2: World Health Organisation (rather than Healthcare)"

Thank you. This has been amended.

"Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help".

Thank you Katherine. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.

"Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to
your research librarian!)"

Thank you Katherine. As the data search is now complete the authors are not in a position to search this database but will consider it for subsequent studies within this PhD.

"Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research."

Absolutely. We are currently at data extraction and under outcomes, we are using the Kirkpatrick framework to inform us what level the educational intervention reached. This as you have mentioned will be useful when we proceed to our mapping study of undergraduate/postgraduate dementia education available in Higher Educational Institutes (Study 2).
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Version 2

VERSION 2 PUBLISHED 10 Mar 2021

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Version 2 (revision) 22 Jun 21			read
Version 1 10 Mar 21	read	read	read

Katherine Lawler, University of Tasmania, Hobart, Australia
Louise Hopper, Dublin City University, Dublin, Ireland
Amanda Phelan, Trinity College Dublin, Dublin, Ireland

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34 Views

22 Jun 2021 | for Version 2

Amanda Phelan, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland

34 Views Cite this report Responses(0)

Approved

I am happy with this version apart from some minor punctuation errors.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Safeguarding, public health, older people, missed care

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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53 Views

28 May 2021 | for Version 1

Amanda Phelan, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland

53 Views Cite this report Responses(1)

Approved

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

safeguarding, public health, older people, missed care

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Author Response

14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

Thank you Amanda for taking the time to review our protocol. Your insight and suggestions will undoubtedly improve our edited submission. Please see below your comments and our responses. Thank you again.

"From a cursory review of this area within the context of a literature search, there seems to be scant literature on physiotherapy and education and training. The literature appears to generally describe contributions (actual and potential) of physiotherapy and treatment efficacy. Consequently, the focus to widen the search to include multi-disciplinary teams within which physiotherapists deliver care allows more scope, but care will have to be taken to isolate the education and training needs for physiotherapy professionals in particular".

Thank you for this very valid point Amanda. As you correctly stated, this is very little on just Physiotherapy alone, hence why the authors widened the search to include inter-professional educational interventions as long as the discipline of Physiotherapy was represented. This scoping review follows on from a previous study by two of the authors (Tony Foley and Trish O Sullivan) which explored the educational needs of physiotherapists working in dementia care in the Republic of Ireland.

"Defining what types/forms of education and training would be useful: within undergraduate programmes for physiotherapists, within postgraduate for physiotherapists, or within interdisciplinary graduate programmes".

Thank you Amanda. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

48 Views

28 May 2021 | for Version 1

Louise Hopper, School of Psychology, Dublin City University, Dublin, Ireland

48 Views Cite this report Responses(1)

Approved

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dementia care, policy, education and psychosocial interventions

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

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Reviewer Report

55 Views

30 Mar 2021 | for Version 1

Katherine Lawler, Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tas, Australia

55 Views Cite this report Responses(1)

Approved

Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?

Inclusion Criteria

Comment 2: World Health Organisation (rather than Healthcare)
Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help.

Methods

Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to your research librarian!)
Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

physiotherapy; dementia care; systematic reviews

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Author Response

14 Jul 2021

Trish O'Sullivan, Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland

Thank you Katherine for taking the time to review our protocol. Your insight, expertise and suggestions will help us greatly in submitting our revised version. See below your comments and the author's responses. Thank you again.

"Comment 1: I hesitated around the description of the gap in the literature. At first glance I felt concerned that the review would yield no results, as the gap was discussed quite extensively. On second reading I wondered if the gap related more to a gap in synthesised evidence. Perhaps this could be clarified. If there is a paucity of evidence available regarding dementia training for physiotherapists, does the scope of the review need widening? Perhaps including other allied health professions, for example?"

Thank you Katherine for this valid point. This was discussed at length between the authors. We have widened the scope of the inclusion criteria to include inter-professional training if the discipline of physiotherapy were represented within the population of the educational intervention.

"Comment 2: World Health Organisation (rather than Healthcare)"

Thank you. This has been amended.

"Comment 3: Consider whether defining 'training' vs 'education' is relevant for this review. Both are in the title but there appears to be a stronger emphasis on training. I would suggest including both is valuable but defining terms may help".

Thank you Katherine. This was also highlighted by another reviewer so thank you for bringing this to our attention. A definition of both education and training has been inserted into the concept paragraph. This distinction will help clarify the type of educational intervention.

"Comment 4: ERIC may be a good database to consider, with an education focus (but I will defer to
your research librarian!)"

Thank you Katherine. As the data search is now complete the authors are not in a position to search this database but will consider it for subsequent studies within this PhD.

"Comment 5: It could also be interesting to map specific gaps in physio education/training relating to Kirkpatrick's framework, to inform future research."

Absolutely. We are currently at data extraction and under outcomes, we are using the Kirkpatrick framework to inform us what level the educational intervention reached. This as you have mentioned will be useful when we proceed to our mapping study of undergraduate/postgraduate dementia education available in Higher Educational Institutes (Study 2).

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Education and training to support physiotherapists working in dementia care: a scoping review protocol

Abstract

Keywords

Revised Amendments from Version 1

Introduction

Aim

Objectives

Purpose

Inclusion criteria

Population

Concept

Context

Types of studies

Methods

Search strategy

Table 1. Search Strategy: CINAHL plus full text.

Study selection

Data extraction

Data presentation

Dissemination of information

Study status

Data availability

Underlying data

Acknowledgements

References

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Open Peer Review

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Open Peer Review

Reviewer Status

Reviewer Reports

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Are you a HRB-funded researcher?

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Education and training to support physiotherapists working in dementia care: a scoping review protocol

Abstract

Keywords

Revised Amendments from Version 1

Introduction

Aim

Objectives

Purpose

Inclusion criteria

Population

Concept

Context

Types of studies

Methods

Search strategy

Table 1. Search Strategy: CINAHL plus full text.

Study selection

Data extraction

Data presentation

Dissemination of information

Study status

Data availability

Underlying data

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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