Abstract
Alzheimer’s disease (AD) is a growing global health concern, yet physical therapists’ (PTs) knowledge and attitudes toward AD in Syria remain understudied. This study assessed these factors to identify gaps and inform interventions. A cross-sectional study of 279 Syrian PTs used validated scales (ADKS, DAS). Descriptive and inferential statistics were used to analyze knowledge, attitudes, and associated factors. PTs showed moderate knowledge (72.6% accuracy in AD-assessment/diagnosis and 59.5% in AD caregiving) but significant gaps (55.9% incorrectly linked tremors to AD). Attitudes toward AD patients were mixed: 72.4% recognized individualized care needs for AD patients, yet 70.9% expressed fear of working with AD patients. Both higher education (p = 0.044) and prior dementia experience (p = 0.018) correlated with better AD knowledge and more positive attitudes. Syrian PTs need targeted education on AD symptoms, risk factors, and AD-specific caregiving. Thus, integrating AD-specific training into curricula and AD-focused clinical rotations is critical to improving care for AD patients.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-026-38586-5.
Keywords: Alzheimer’s disease, Physical therapists, Knowledge, Attitudes, Syria, Dementia care
Subject terms: Diseases, Health care, Medical research, Neurology, Neuroscience
Introduction
Alzheimer’s disease (AD), the most common neurodegenerative disorder worldwide, accounts for 60–70% of all dementia cases1,2. Dementia has been studied previously in Syria and the Middle East with prevalence rates estimated at approximately 6.5% in adults > 60 years old. In specific studies, prevalence rates have been reported as high as 8% to 10% in certain populations, indicating a growing concern regarding dementia’s impact in the Middle East1–3. AD is often associated with negative connotations due to its link to severe cognitive decline, which can deter individuals from seeking timely help for AD-related concerns. AD represents a perceived loss of identity, diminishing the perceived value of those affected by AD. Additionally, the caregiving burden for individuals with AD can lead to caregiver stress and guilt, while the misconception that AD is an inevitable aspect of aging fosters hopelessness about AD management. Moreover, biologically, AD is characterized by amyloid-beta plaques and tau tangles in the brain, which promote neuronal degeneration, decline of cognition, and loss of memory. AD is under strong genetic influence, and PSEN2 associated with familial AD4. The significant economic impact of AD raises concerns about rising healthcare costs, and widespread misconceptions contribute to fear and discrimination against individuals living with the disease5. AD is one of the most prevalent neurodegenerative conditions among individuals ≥ 65 years old. Globally, one in nine people ≥ 65 years old (11%) lives with AD, while approximately one-third of those aged ≥ 85 (32%) are affected by the disease5. In treating dementia, both pharmacological and non-pharmacological therapies have been implemented through various intervention programs, including cognitive therapy, behavioral therapy, reminiscence therapy, and occupational therapy to support symptom management and improve quality of life for affected individuals6.
Consequently, Physiotherapists (PTs) are an essential part of global care in individuals with AD because they devise individualized exercise programs to preserve physical functioning, reduce the fall risk, maintain patients independence, and support AD caregivers7–9. Their interventions become particularly important in an aging population, where preserving mobility and quality of life is considered a priority.
The context of AD care in Syria is further shaped by unique challenges within its healthcare system. In Syria, PTs are distributed across the country’s major medical hubs and regions, with the majority practicing in urban centers where they are affiliated with university hospitals, general medical facilities, and rehabilitation centers. A smaller proportion of Syrian PTs practice in rural areas; however, access to specialized training and resources is often lacking in these regions due to healthcare infrastructure gaps. Collectively, Syrian PTs serve as frontline providers for individuals with neurodegenerative conditions, including AD, but their distribution remains concentrated in urban areas, creating disparities in care accessibility for rural populations.
AD awareness encompasses understanding of the disease and associated information, including effective behaviors for managing AD and responding to its symptoms8. Attitudes toward AD involve both cognitive and emotional perspectives that shape personal views about the condition, particularly in relation to elderly individuals affected by AD9. This attitude toward AD is a crucial factor influencing a PT’s behavior, alongside their awareness of the disease10. When a PT is well-informed about AD and holds a positive attitude toward it, they can better assist individuals with AD and their families in accessing support from local communities or government services11. Unfortunately, there remains a significant lack of AD-specific awareness among key stakeholders that hinders timely assistance.
Despite the prevalence of AD in Syria, there is a notable lack of research examining the PTs’ awareness, knowledge, and attitudes toward this condition. To date, no studies have been published that specifically address these aspects among Syrian PTs. This gap in the literature has prompted us to investigate the level of awareness, knowledge, and attitudes of PTs toward AD, with the aim of contributing to a better understanding of how these factors may influence care for individuals affected by the disorder.
Methods
Study population, and setting
PTs working across Syria’s five medical universities located in the provinces of Damascus, Homs, Latakia, Hama, and Aleppo and those employed in general hospitals and rehabilitation centers were included. They have direct contact with patients with AD and are responsible for the physical rehabilitation treatment of patients. The study population may cover PTs of different ages, genders, educational backgrounds, and work experience to ensure the representativeness of the sample. The study covers different regions of Syria, including big cities and small towns, to consider the possible differences in the medical level and the understanding of AD. The study participants were recruited between 1 st September 2024 and 30 March 2025.
Sample size
Convenience sampling was used due to logistical constraints, with participants recruited via academic networks and hospitals to ensure regional diversity, with a total of 279 participants. The participants were recruited by distributing the questionnaire via Google Forms through their academic therapist group or by hard copy. The sample size was determined using the Raosoft 1 Sample Size Calculator, with the sample size (n) and margin of error (E) calculated using the formula: n = N*x/[(N-1)E²+x], where N denotes the total population size. For this study, a margin of error of 5% and a 95% confidence level were set, with N set at 12,000 and a response distribution of 50%. This calculation utilized a z-score of 1.96, yielding a minimum recommended sample size of 197, the inclusion of an adequate sample size effectively minimized random error in the study results.
Data collection
Before administering the questionnaire, participants were provided with a concise description of the research objectives, procedures, and intended use of the collected data. All questions were mandatory prior to survey submission. Participation was entirely voluntary, with no compensation provided, and the study conformed to the Declaration of Helsinki guidelines for research involving human beings. The Ethical Committee at Al Baath University Institutional Review Board approved the study with reference number: IRB-2,023,128-S. All procedures were carried out following the relevant guidelines and regulations and the informed consent was obtained from all participants and/or their family members.
Study tools
The survey instrument was structured into three distinct sections. The initial section was dedicated to gathering sociodemographic information, encompassing variables, gender, education level, and prior experience with dementia.
The second section incorporated the 30-item Alzheimer’s Disease Knowledge Scale (ADKS). We also adapted components from the published and previously tested ADKS12, the Alzheimer’s Disease Awareness Scale (ADAS)13, and the Dementia Attitudes Scale (DAS)14, besides incorporating questions to assess the needs specifically for Physical Therapists practitioners in the region. as previously documented14. The ADKS is composed of 30 True/False items, which are further categorized into 7 domains. These domains specifically address symptoms (4 items), risk factors (6 items), assessment and diagnosis (4 items), the course of the disease (4 items), life impact (3 items), caregiving (5 items), and treatment (4 items). For each item, a correct response was assigned a score of 1, while an incorrect response received 0. The total ADKS score was calculated by summing up the scores of all correct responses. The ADKS was selected because it is suitable instrument for evaluating knowledge of AD among PTs13. The 30-item employs pre-defined, standardized correct/incorrect responses established during the scale’s original development and psychometric validation12,13. These responses are grounded in global clinical guidelines (e.g., National Institute on Aging-Alzheimer’s Association [NIA-AA] criteria, World Health Organization [WHO] dementia frameworks) and evidence from AD epidemiology, symptomology, and caregiving research.
The validity of the ADKS answer key was enhanced by expert panel review, neurologists, geriatricians, AD researchers, and psychometric testing with test-retest reliability = 0.81; Cronbach’s alpha = 0.7112, while its prior use in LMICs comparable to Syria established contextual relevance13,15. Utilizing such a standardized key ensured methodological consistency with previous studies and eliminating subjective scoring bias.
The third section featured the Dementia Attitudes Scale (DAS), a scale with established validity and reliability16. The DAS consists of 20 items, each rated on a 3-point Likert scale and the response options were “Disagree”, “Neutral”, and “Agree”. The total scores for the 20-item can range from 20 to 140. The scale is partitioned into two primary domains: the dementia knowledge domain (items 3, 7, 10, 11, 12, 14, 15, 18, 19, 20) and the social comfort domain (items 1, 2, 4, 5, 6, 8, 9, 13, 16, 17). Each of these domains has a score range of 10–70, and the sum of the scores from both domains yields the overall DAS score. Notably, the negatively worded items in the DAS (items 2, 6, 8, 9, 16, 17) were reverse-coded. The DAS was employed to assess PTs’ attitudes towards AD and related dementias16.
Regarding the psychometric properties, the DAS was originally reported to have an internal consistency, as measured by Cronbach’s alpha, ranging from 0.83 to 0.85. The ADKS demonstrated a test-retest reliability coefficient of 0.81 and an internal consistency Cronbach’s alpha of 0.7112. To further ensure the reliability of the entire questionnaire, a pilot study was conducted with 20 PTs. The results of this pilot study indicated a total Cronbach’s alpha of 0.87, thereby confirming the questionnaire’s validity and reliability prior to the implementation of the main study.
Data analysis
In this study, data analysis was conducted using SPSS version 26.0, with descriptive statistics summarizing sociodemographic characteristics, ADKS scores, and DAS scores. Qualitative data were described via frequencies and percentages, while quantitative data were characterized using means and standard deviations. Following normality testing with the Kolmogorov-Smirnov test: the Mann-Whitney U test (for comparisons between two independent groups) and the Kruskal-Wallis test (for comparisons between > two groups). For the Mann-Whitney U test, the effect size was calculated as r = Z/√N. For the Kruskal-Wallis test, the effect size was calculated as eta-squared (η²= (H-k + 1)/(n-k)), where H is the Kruskal-Wallis H statistic, k is the number of groups, and n is the total sample size. The strength of the correlation between ADKS and DAS scores was assessed using Spearman’s rank correlation coefficient (ρ). The interpretation of effect sizes followed established guidelines: for r, 0.1 = small, 0.3 = medium, 0.5 = large; for η², 0.01 = small, 0.06 = medium, 0.14 = large; for ρ, 0.1 small, 0.3 medium, 0.5 large. All tests were conducted at a 0.05 significance level.
Results
Demographic characteristics of the physiotherapists
Among 279 participants, 14 (5.0%) were excluded due to missing data (Fig. 1). The final analyzed sample (N = 265) included complete responses for ADKS and DAS items.
Fig. 1.
CONSORT-style Flowchart of Participant Selection and Data Completeness.
The sample was predominantly aged 30–39 years (41.21%). Males constituted of 62.36% vs. 37.63% female. Educational attainment was high, with 62.72% holding a bachelor’s degree, 30.10% high school, 11.11% master’s degree, and 3.22% doctoral degree. Most participants (65.59%) had prior experience with dementia therapy, compared to 34.40% without such experience. The mean duration of overall therapy experience was 11.0 ± 6.76 years, while experience with dementia-specific therapy averaged 5.0 ± 7.43 years, indicating substantial variability in clinical exposure to dementia care (Table 1).
Table 1.
Demographic characteristics of the physical therapist (N = 279).
| Items | Characteristics | N (%) | Mean ± SD |
|---|---|---|---|
| Age | 20–29 | 78 (27.95%) | |
| 30–39 | 115 (41.21%) | ||
| 40–49 | 56 (20.07%) | ||
| 50 ≥ | 30 (10.75%) | ||
| Gender | Male | 174 (62.36%) | |
| Female | 105 (37.63%) | ||
| Education level | High school | 84 (30.10%) | |
| Bachelor | 175 (62.72%) | ||
| Master | 31 (11.11%) | ||
| Doctor | 9 (3.22%) | ||
| Prior experience with therapy dementia | No | 96 (34.40%) | |
| Yes | 183 (65.59%) | ||
| Therapy experience with therapy dementia (year) | 11 ± 6.76 | ||
| Experience with dementia therapy (year) | 5 ± 7.43 |
Domain knowledge of alzheimer disease
The assessment of knowledge revealed notable gaps among 278 participants across various domains. In terms of symptoms, 55.91% mistakenly believed tremors are common in AD, while 70.60% correctly identified difficulty handling money as an early symptom. Regarding risk factors, only 20.78% thought mental exercise could prevent AD, though 66.30% recognized high cholesterol as a risk factor. In assessment and diagnosis, 66.30% noted that agitation might indicate other health issues and 23.29% understood that sudden memory problems are unlikely due to AD. Concerning the disease course, 63.08% accurately stated the average of life expectancy is 6 to 12 years post-symptom onset and 35.12% incorrectly believed recovery is possible. In life impact, 61.64% acknowledged the link between AD and depression, while misconceptions persisted about living arrangements and driving safety. Furthermore, 66.30% recognized the benefit of simple instructions for caregiving, but 15.41% wrongly believed caregivers should immediately take over self-care tasks. Lastly, 73.83% affirmed the role of psychotherapy in less severe AD cases, although 22.58% incorrectly thought reminder notes could worsen cognitive decline. The misconception linking tremors to AD (55.9%) mirrors findings in LMICs17, suggesting systemic gaps in AD education ‘Supplementary Table 1’.
The Fig. 2 shows the domain-specific knowledge accuracy rates of AD among participants, with Treatment (95.20%) and Course (88.50%) demonstrating the highest accuracy, indicating a good understanding of therapeutic approaches and disease progression, while Symptoms (79.80%), Assessment & Diagnosis (72.60%), and Life Impact (64.30%) show moderate proficiency, though with misconceptions like linking tremor to AD’s. The lowest accuracy lies in Caregiving (59.50%) and Risk Factors (60.90%), where critical gaps exist, such as most participants not knowing mental exercise can’t prevent the disease and holding harmful caregiving beliefs, which highlights the need for targeted education on these aspects.
Fig. 2.
Domain specific knowledge of Alzheimer disease.
Alzheimer’s disease attitude
The survey assessing attitudes toward individuals with AD and related dementias (ADRD) revealed a mix of perceptions among participants across 20 items. While 38.70% agreed that it is rewarding to work with ADRD patients and 70.96% expressed fear of them. Comfort levels varied with 59.13% feeling at ease touching individuals with ADRD, contrasting 54.83% with the tendency to avoid agitated persons. Notably, 72.40% recognized that each person with ADRD has different needs, and 66.30% acknowledged the importance of understanding their personal history. Although 37.63% reported familiarity with ADRD, and 36.20% admitted a lack of knowledge. Additionally, 55.91% believed interactions with ADRD individuals could be enjoyable, and 58.42% viewed difficult behaviors. However, 49.82% felt current efforts could improve their lives, while 32.97% expressed frustration about their inability to help, underscoring the need for better support and caregivers training. These findings point positive attitudes and significant misconceptions, highlighting the necessity for targeted educational initiatives (Table 2).
Table 2.
Distribution of responses to dementia attitudes scale items among Syrian physical therapists (n = 279).
| DAS items | Disagree | Neutral | Agree |
|---|---|---|---|
| 1. It is rewarding to work with people who have ADRD. | 74 (26.52%) | 97 (34.76%) | 108 (38.70%) |
| 2. I am afraid of people with ADRD. | 198 (70.96%) | 49 (17.56%) | 32 (11.46%) |
| 3. People with ADRD can be creative. | 135 (48.38%) | 49 (17.56%) | 95 (34.05%) |
| 4. I feel confident around people with ADRD | 107 (38.35%) | 92 (32.97%) | 80 (28.67%) |
| 5. I am comfortable touching people with ADRD. | 31 (11.11%) | 83 (29.74%) | 165 (59.13%) |
| 6. I feel uncomfortable being around people with ADRD. | 206 (73.83%) | 31 (11.11%) | 42 (15.05%) |
| 7. Every person with ADRD has different needs. | 34 (12.18%) | 39 (13.97%) | 202 (72.40%) |
| 8. I am not very familiar with ADRD. | 101 (36.20%) | 73 (26.16%) | 105 (37.63%) |
| 9. I would avoid an agitated person with ADRD.a | 153 (54.83%) | 50 (17.92%) | 76 (27.24%) |
| 10. People with ADRD like having familiar things nearby. | 45 (16.12%) | 69 (24.73%) | 165 (59.13%) |
| 11. It is important to know the past history of people with ADRD. | 36 (12.90%) | 58 (20.78%) | 185 (66.30%) |
| 12. It is possible to enjoy interacting with people with ADRD. | 75 (26.88%) | 48 (17.20%) | 156 (55.91%) |
| 13. I feel relaxed around people with ADRD. | 78 (27.95%) | 89 (31.89%) | 112 (40.14%) |
| 14. People with ADRD can enjoy life. | 87 (31.18%) | 27 (9.67%) | 165 (59.13%) |
| 15. People with ADRD can feel when others are kind to them. | 63 (22.58%) | 23 (8.24%) | 193 (69.17%) |
| 16. I feel frustrated because I do not know how to help people with ADRD. | 92 (32.97%) | 59 (21.14%) | 128 (45.87%) |
| 17. I cannot imagine taking care of someone with ADRD.a | 147 (52.68%) | 39 (13.97%) | 93 (33.33%) |
| 18. I admire the coping skills of people with ADRD. | 78 (27.95%) | 95 (34.05%) | 106 (37.99%) |
| 19. We can do a lot now to improve the lives of people with ADRD. | 75 (26.88%) | 65 (23.29%) | 139 (49.82%) |
| 20. Difficult behaviors may be a form of communication for people with ADRD. | 66 (23.65%) | 50 (17.92%) | 163 (58.42%) |
Factors associated with physical therapist’ knowledge and awareness regarding alzheimer’s disease
The analysis evaluated various characteristics influencing attitudes toward ADRD, revealing that age and gender did not significantly affect perceptions, with p-values of 0.118 and 0.08 for the ADKS and 0.141 and 0.126 for the DAS, respectively. However, education level showed notable variation, particularly in the DAS, where those with a college education demonstrated significant differences (p = 0.044). Prior experience with dementia therapy positively influenced attitudes, as evidenced by significant differences in mean ranks (p = 0.018 for ADKS and p = 0.041 for DAS). In contrast, the number of years of therapy experience did not yield significant results for ADKS (p = 0.08) or DAS (p = 0.165). Notably, experience specifically with dementia therapy indicated a significant positive influence on attitudes (p = 0.028 for ADKS), while the DAS showed no significant results (p = 0.236). These findings underscore the importance of prior experience and education in shaping attitudes toward ADRD. It is noteworthy that while several factors were statistically significant (p < 0.05), the associated effect sizes (r ranging from 0.07 to 0.10, η² from 0.019 to 0.029) were generally small according to conventional benchmarks. This indicates that these factors have a statistically detectable influence, they account for a relatively small proportion of the variance in knowledge and attitude scores. The weak correlation between ADKS and DAS scores was confirmed (p = 0.25, p = 0.003) (Table 3).
Table 3.
Factors associated with physical therapist’ knowledge and awareness regarding alzheimer’s disease.
| Items | Characteristics | ADKS | DAS | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mean | U | Z | p-value | Effect Size (r/η²) | Mean | U | Z | p-value | Effect Size (r/η²) | Cohen’s d | ||
| Age (Kruskal-Wallis) | 20 | 157.31 | 7602 | 1.275 | 0.118a | η² = 0.022 | 181.52 | 8928 | 1.153 | 0.141a | η² = 0.021 | 2.23 |
| 30 | 160.31 | 198.95 | ||||||||||
| 40 | 167.31 | 151.62 | ||||||||||
| 50 | 241.1 | 233.65 | ||||||||||
| Gender (Mann-Whitney) | Male | 173.21 | 18,313 | 1.386 | 0.08a | r = 0.08 | 138.69 | 17,475 | 1.643 | 0.126a | r = 0.10 | 0.30 |
| Female | 214.31 | 189.76 | ||||||||||
| Education level (Kruskal-Wallis) | College | 182.97 | 0.135β | η² = 0.019 | 0.044*β | η² = 0.029 | 1.20 | |||||
| Bachelor | 142.58 | r = 0.07 | ||||||||||
| Master | 173.36 | |||||||||||
| Doctor | 223.23 | |||||||||||
| Prior experience with therapy dementia (Mann-Whitney) | No | 173.21 | 10,602 | 1.275 | 0.018*a | 178.52 | 9978 | 1.153 | 0.041*a | 2.21 | ||
| Yes | 214.31 | r = 0.08 | ||||||||||
| Therapy experience (year) (Spearman’s ρ) | 235.21 | - | - | 0.08a | p = 0.10 | 238.79 | - | - | 0.165a | p = 0.08 | 0.62 | |
| Experience with tdementia herapy (year) (Spearman’s ρ) | 276.86 | - | - | 0.028*a | p = 0.13 | 186.63 | - | - | 0.236a | p = 0.07 | 0.31 | |
| ADKS-DAS Correlation (Spearman’s ρ) | - | - | - | 0.0003 | p = 0.25 | - | - | - | - | - | - | |
* Significant at P value < 0.05. a Mann-Whitney U-test for gender. β Kruskal-Wallis test for education.
Note: The effect size for Mann-Whitney U is r. For Kruskal-Wallis, it is eta-squared (η²). For correlations, it is Spearman’s ρ.
Discussion
This study provides a crucial first look into the knowledge, awareness, and attitudes of PTs in Syria regarding AD. The findings reveal a landscape of moderate knowledge associated with significant attitudinal challenges, reflecting a complex interplay between educational gaps, clinical experience, and the broader socio-cultural and healthcare context of Syria.
The assessment of knowledge among PTs revealed significant gaps across several domains. Notably, 70.60% of participants correctly identified difficulty handling money as an early symptom of AD. While this is a recognized early clinical sign, which aligns with a broader regional pattern observed in Mediterranean countries1,3. A study assessing AD knowledge among a multi-national cohort, including participants from Mediterranean regions like Greece, also reported variable recognition of financial difficulty as an early symptom, suggesting a common area for improved awareness across similar healthcare landscapes18.
The misunderstanding of financial symptoms has profound implications beyond clinical recognition that directly intersects with critical legal and ethical dimensions of patient care. The onset of financial impairment is a key trigger for legal interventions to protect individuals with AD19. This study showed the fact that nearly 30% of PTs did not recognize this early symptom underscores a potential gap in their role within the multidisciplinary care team.
Furthermore, 55.91% mistakenly believed that tremors are common in AD. This misunderstanding could lead to misdiagnosis and inadequate patient support, echoing concerns raised in similar research that emphasizes the necessity for comprehensive education on symptoms to enhance AD recognition and management20. Furthermore, 20.78% of participants believed that mental exercise could prevent AD, despite 66.30% acknowledging high cholesterol as a risk factor, indicating a lack of understanding of the multifactorial nature of the disease. This aligns with findings from studies in other regions that highlight the need for targeted educational programs on risk factors21,22.
Syrian PTs demonstrated strong proficiency in domains like Treatment (95.2%) and Disease Course (88.5%), indicating a solid understanding of therapeutic approaches and disease progression. However, critical deficiencies were apparent in areas fundamental to early intervention and holistic care23. Similarly, the variable recognition of financial difficulty as an early symptom (70.60% correct) aligns with findings from a multi-national Mediterranean study15,24.
The onset of financial impairment is a key trigger for legal protections, such as guardianship, to prevent exploitation19. The fact that nearly 30% of PTs lack this underscores a potential gap within the role of multidisciplinary team, particularly in settings like Syria where formal legal safeguards may be underutilized.
However, a point of contrast emerges in the domain of caregiving. The Syrian PTs demonstrated a notably low accuracy in caregiving principles (59.5%), which is more pronounced than reported in some Western studies. In Syria and similar contexts, caregiving often remains perceived primarily as a familial responsibility, with less formal emphasis on evidence-based caregiver strategies within professional healthcare training.
On a positive note, 72.40% of participants recognized that each person with ADRD has unique needs, and 66.30% acknowledged the importance of understanding personal history. This awareness is vital for delivering person-centered care, which is essential for enhancing patient outcomes. Moreover, the survey revealed that 32.97% of participants expressed frustration regarding their inability to assist individuals with ADRD effectively. This highlights a significant gap in support and training for PTs, underscoring the necessity for ongoing professional development and access to resources that empower therapists in their roles.
These knowledge gaps are not isolated to Syria but reflect a broader, cross-cultural challenge faced by healthcare professionals (HCPs) in various regions. A recent systematic review examining the views of HCPs on AD cross-culturally highlights that dilemma such as symptom misidentification, uncertainties in risk factor knowledge, and challenges in caregiving strategies are pervasive25. This point out that HCPs in low- and middle-income countries (LMICs) and post-conflict regions often work with limited specialized training and institutional support, leading to inconsistencies in AD management that showed our findings3. The particularly low accuracy in Caregiving principles among Syrian PTs, which is more pronounced than some Western studies18–21, may be attributed to the fact that in many high-income countries, dementia caregiving is systematically integrated into professional curricula. In contrast, in Syria and similar contexts, caregiving is often perceived primarily as a familial responsibility, with less formal emphasis on evidence-based strategies within professional training15,26.
The attitudes uncovered in this study further emphasize the need for supportive frameworks. While a strong majority of PTs recognized the need for individualized care (72.4%), a strikingly high proportion expressed fear of people with AD (70.96%). This significant fear and discomfort in managing agitated patients (54.83% would avoid them) align with the cross-cultural review, which identifies emotional distress and a lack of confidence as common dilemmas among HCPs, especially when faced with the behavioral and psychological symptoms of dementia without adequate training or mentorship14. This contrast between a theoretical understanding of person-centered care and a practical fear of providing a critical dilemma that can directly impact the quality of therapeutic interactions and patient outcomes15.
Our analysis of influencing factors offers a pathway for intervention. The significant positive correlation between prior dementia experience and both improved knowledge (p = 0.018) and more positive attitudes (p = 0.041) is a cornerstone finding. This aligns perfectly with global evidence that clinical exposure is one of the most effective ways to reduce stigma and improve competency14–16. Similarly, the influence of higher education levels (p = 0.044 for DAS) underscores the fundamental role of structured academic training. These findings suggest that the knowledge-attitude gap in Syrian PTs is not immutable and can be addressed through targeted educational and clinical reforms.
This similarity suggests that the intervention of increasing clinical rotations in dementia care is a universally beneficial strategy, applicable to the Syrian context despite its unique challenges.
Factors influencing knowledge and attitudes
The analysis revealed several key factors influencing knowledge and attitudes toward AD. Notably, education level emerged as a significant predictor, with those holding higher degrees demonstrating improved knowledge and attitudes, particularly reflected in their DAS scores (p = 0.044). This finding underscores the importance of enhancing educational curricula in physiotherapy programs to address neurodegenerative diseases comprehensively. Additionally, prior experience with dementia therapy significantly correlated with ADKS, reinforcing the notion that practical and hands-on exposure enhances understanding and fosters positive attitudes. This aligns with existing literature indicating that clinical experience can mitigate stigma and improve caregiving efficacy27.
The findings underscore the need for targeted AD training in Syrian physiotherapy education, prioritizing risk factors, early symptoms, and person-centered care strategies. Additionally, integrating ADKS and DAS assessments into continuing education programs could help monitor knowledge and attitude shifts over time.
At a policy level, advocating for AD-specific curricula in Syrian medical universities and hospital training programs is essential. Given the study’s demonstration that dementia therapy experience correlates with better outcomes, creating clinical rotation programs for PTs in memory care units may enhance competence.
Limitations and future directions
This study has limitations including the use of convenience sampling from university-affiliated centers may limit the generalizability of findings to PTs in private practice or rural areas. Future research should employ stratified sampling to capture Syria’s diverse geographic and practice settings, especially in conflict-affected areas where healthcare access is uniquely challenged. Furthermore, as highlighted by the cross-cultural review28, qualitative investigations are essential to deeply explore the cultural, religious, and systemic factors shaping these attitudes such as how societal views on aging and dementia in the Arab world influence professional perspectives1. Comparing these profiles across different HCPs (e.g., physicians, nurses) in Syria would clarify whether the identified gaps are specific to physiotherapy or represent a systemic issue within the national healthcare framework.
Conclusion
This study illuminates the specific knowledge and attitude profile of Syrian PTs toward AD, situating it within a recognized cross-cultural context where HCPs face common dilemmas exacerbated by resource constraints. The results underscore an urgent need to bridge the gap between theoretical knowledge and practical, empathetic care delivery. Address identified gaps through integrate AD specific modules on symptoms, risk factors, and person-centered care.
Mandate clinical rotations in dementia care units. Future research should evaluate these interventions’ impact on PTs competence, and training programs is essential for enhancing the quality of care provided to individuals with AD. By fostering a better understanding of the disease and promoting positive attitudes, PTs can significantly improve patient outcomes and support families facing the challenges of AD. Future research should focus on developing and evaluating these educational interventions to measure their impact on the knowledge and confidence of PTs in managing AD.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors thank all participants for the support.
Author contributions
R.A., J.A.design the research. R.A., M.U. collected the data. J.A. analyzed the data. RA drafted the manuscript. RA, JA, J.A. revised the manuscript. All authors contributed to the article and approved the submitted version.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Consent for publication
Informed consent was obtained from all patients and/or their family members.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.