Beyond bones, joints and muscles: can physiotherapists have a role in identifying and supporting domestic violence victims?

Abstract

Purpose

Domestic violence (DV) is a pervasive global issue affecting people across all demographics. Physiotherapists, due to their close patient contact, may be ideally positioned to identify and support victims. However, their preparedness for this role is shown to fall short of needs via a study that aimed to determine physiotherapists’ knowledge, attitudes, and experiences with DV in Estonia, Greece, Cyprus, and Spain.

Methods

An online questionnaire via the LimeSurvey^® platform assessed the experiences of 167 physiotherapists across the four countries. The survey covered respondent demographics, training received on DV identification and referral procedures, self-reported confidence in identifying and referring DV victims, and the frequency of encountering suspected cases.

Results

The findings revealed a substantial gap between the legal mandates for healthcare professionals to address DV (as outlined in the Istanbul Convention and a 2024 EU Directive) and the preparedness of physiotherapists. Only 13.2% of respondents had received any DV training, and less than half felt confident making referrals to support services. However, there is an evident association between experience and awareness – physiotherapists with more years of experience, particularly those specialising in paediatrics or chronic conditions, are more likely to have encountered and reported suspected DV cases.

Conclusions

The study’s generalisability may be limited due to the sample size and the selection process (social media outreach and professional networks). Additionally, self-reported data can be prone to bias. Nonetheless, these findings highlight a critical need for integrating DV training modules into physiotherapy education curricula, both at the entry-level and throughout continuing education programs. The Online Professional Education for Physiotherapists and other healthcare professionals on DV (OPEP) project, in response to this gap, has developed a comprehensive online training resource specifically for physiotherapists on DV identification and referral protocols. This initiative aligns with the growing recognition of healthcare professionals’ role in combating DV and can play a vital role in supporting victims and survivors.

Keywords:

• Domestic violence
• physiotherapist
• physiotherapy

Acknowledgements

The European Commission’s support for production of this publication does not constitute endorsement of the contents, which reflects the views only of the authors, and the Commission cannot be held responsible for any use that may be made of the information that is contained herein. The authors wish to thank the anonymous respondents to the survey, and the following for their contribution to the study and project output materials: the Women’s Support and Information Centre, Estonia; the Mediterranean Institute of Gender Studies, Cyprus; M&M profuture training, Spain; and the Union of Women’s Associations of Heraklion Prefecture, Greece.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics statement

Prior to starting the study, ethical approval was obtained for the survey from the University of Tartu’s (Estonia) ethics review committee to confirm the study meets national and international guidelines for research on humans; approval by the ethics committee of the University of Tartu was granted under protocol number: 371/T-8, 21.11.2022.

Notes

1 Formal training on domestic violence has been a rarity across the EU at both entry- and continuing education levels. In some member states, this has begun to change, but when the project proposal was submitted in 2021, training on DV remained uncommon in the four partner countries, a gap that partners understood requires filling.

2 A sample size of 30 is generally considered to be a minimum threshold for statistical analyses. However, qualitative methods, such as the focus of this research design, may rely on smaller sample sizes (from as few as 10 participants) to gain detailed information from each participant.

3 The MOOC is offered through the University of Tartu for 1 ECTS unit, and can be shared with physiotherapy training centres upon request since it is transferable into the Moodle environment. The MOOC will be continuously offered by the Institute of Sport Sciences and Physiotherapy at the University of Tartu as well as Tartu Healthcare College after the end of the OPEP project. For further information: OPEP project (OPEP.eu).

Additional information

Funding

This publication was prepared in the framework of the project Online Professional Education for Physiotherapists and other healthcare professionals on Domestic Violence (1.02.2022 − 31.01.2025), funded by Erasmus+ Cooperation partnerships in vocational education (agreement number 2021-KA220-VET-07, project number 2021-1-EE01-KA220-VET-000029791).