(1) Background: This study aimed to evaluate the feasibility of a telehealth home-based exercise program for older people with dementia living in Indonesia with support from their informal carers. (2) Methods: Pre–post intervention single group study with three assessment time-points (baseline, 12 and 18 weeks). Participants with dementia underwent a 12-week physiotherapist-delivered telehealth exercise program, with informal carer supervision between supervised online sessions, and continued the exercises for a further six weeks without physiotherapist online supervision. (3) Results: Thirty dyads of older people with dementia and their informal carers were recruited; four (13.3%) withdrew across the 12-week intervention and one (3.3%) in the 6-week self-maintenance period. Median adherence was 84.1% (IQR [25, 75] = 17.1) during the 12-week intervention, and 66.7% (IQR [25, 75] = 16.7) in the self-maintenance period. No falls/adverse events were reported. Physical activity level, some aspects of function and disability, health-related benefits of exercise, exercise enjoyment and quality of life of older people with dementia improved significantly at 12 and 18 weeks. (4) Conclusions: The telehealth exercise program is feasible and safe and may have benefits for the health outcomes of community-living older people with dementia in Indonesia. Additional strategies are necessary to enhance longer-term adherence to the program.
Background: There is a growing evidence on the benefits of exercise for older people living with dementia in developed countries. However, cultural, health-care systems and environmental differences may impact on the uptake of exercise and outcomes in different regions of the world. Objective: This study synthesised the available evidence examining the effectiveness of exercise interventions on improving physical function and reducing behavioural symptoms in community-dwelling older people living with dementia in Asia, and the impact on their informal carers. Methods: Six databases were searched to November 2021. Randomised controlled trials (RCTs) or quasi-experimental studies evaluating exercise interventions for community-dwelling older people with dementia living in Asia were included. The Cochrane risk-of-bias tool for randomised trials and Downs and Black checklist had been used to assess methodological quality of the studies. Meta-analyses using a fixed effects model assessed the effects of exercise interventions where sufficient data were available. Mean difference (MD) with 95% confidence interval (CI) was used to pool results. Results: Nine studies (five RCTs) were included (Hong Kong-4, China-1, South Korea-2, Taiwan-1, Indonesia-1). Exercise improved dynamic balance [Functional Reach (2 studies, [Formula: see text] people with dementia), [Formula: see text], 95% CI (1.55, 3.67)], but not for the Berg Balance Scale ([Formula: see text], 95% CI [[Formula: see text]2.88, 5.07]), Timed Up and Go ([Formula: see text], 95% CI [[Formula: see text]7.27, 0.33]) and 5 times sit to stand tests ([Formula: see text], 95% CI [[Formula: see text]5.27, 1.54]). Single studies where data could not be pooled showed no effect of exercise on behavioural symptoms or impact on informal carers. Conclusion: Exercise appeared to have a beneficial effect on improving balance performance among older people with dementia living in Asia, however, this evidence is limited and inconsistent, and should be interpreted with caution. Further high-quality large RCTs are necessary for advancing the evidence base of exercise interventions for this population.
Objectives The aims of the study were to i) explore the current practice, roles, and perceptions of physiotherapists who treat older people with and without dementia in Indonesia, ii) identify the characteristics of physiotherapists associated with treating older people and older people with dementia, and iii) identify the level of knowledge and attitudes about dementia among physiotherapists treating people with dementia in Indonesia. Methods This was a cross‐sectional study in which registered physiotherapists in Indonesia were surveyed online using Qualtrics. Descriptive statistics, linear regression and univariate logistic regression were used in this study. Multiple logistic regression was conducted to identify the characteristics of physiotherapists associated with treating older people and/or people with dementia. The Dementia Knowledge Assessment Scale (DKAS) was used to assess level of knowledge and attitudes about dementia. Qualitative data from the survey were analyzed using thematic content analysis. Results The online survey was sent to 6327 physiotherapists who met the inclusion criteria and 1061 (16.8%) returned the survey. Eight hundred and eighty‐four (83.3%) respondents worked with older patients, and 632 (59.6%) worked with people with dementia. The multiple regression analysis showed that physiotherapists who have been practicing for longer (years) (OR: 1.0, 95%CI: 1.0–1.1, p ≤ 0.001) and were working in a geriatrics area (OR: 3.0, 95%CI: 1.4–6.5, p = 0.005) were more likely to treat older people with dementia. The DKAS mean score (SD) was 32.1 (±5.1)/50 indicating some limitations in dementia knowledge by respondents, and 62% of physiotherapists reported low levels of confidence in treating older people with dementia. Conclusions The relatively low dementia knowledge, and generally low confidence in treating people with dementia among Indonesian physiotherapists were important findings in this study. This study highlights opportunities for improvement in physiotherapist's knowledge and skills in this emerging area of practice in Indonesia.
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