Physiotherapy Management and Technology Use for Parkinson’s Disease: A Survey Among Greek Physiotherapists

Abstract

The purpose of this study is to investigate Greek physical therapists’ perceptions of therapeutic approaches, assessment tools, and the use of technology in the treatment of Parkinson’s disease. A cross-sectional survey was conducted using an online questionnaire consisting of 26 questions. The questionnaire was addressed to Greek physiotherapists who were registered with the Panhellenic Physical Therapy Association (PPTA) at the time of the survey and practiced their profession in Greece. A total of 203 physical therapists who met the inclusion criteria participated in the study. Out of all the participants, 65% had over 10 years of work experience and treated 1–9 patients with PD per year. Additionally, 84.7% of participants communicated with health scientists as part of the interdisciplinary collaboration, and 23.2% used assessment tools/scales frequently. New technologies were only used by 24.6% of participants despite a positive view of their benefits (70.9%). Physiotherapists who attended a lifelong educational program or adult neurological physiotherapy seminars or held a master’s or doctoral degree in physiotherapy used new technologies at higher rates of 64% and 68%, respectively. Finally, the use of new technologies was related to the acquisition of a master’s degree or lifelong training specialization.

1. Introduction

In recent decades, there has been a marked global increase in neurological disorders [1]. Parkinson’s disease (PD) is a rapidly progressing neurological disorder that has sparked significant interest in the scientific community for improving the management and treatment of its various motor and non-motor symptoms [2]. PD is a chronic neurodegenerative disorder of the Central Nervous System (CNS) caused by the loss of nerve cells in the brain’s basal ganglia responsible for dopamine production, which is crucial for regulating movement and coordination. This depletion of dopamine leads to a range of motor and non-motor symptoms, including bradykinesia (the slowness of movement), rigidity, tremors, postural instability, cognitive decline, and mood disorders such as depression and anxiety. PD is a progressive neurological condition; thus, the clinical symptoms of patients may worsen over time, significantly impacting the quality of life of patients and their caregivers [3,4].

In Europe, the number of Parkinson’s disease patients is estimated to exceed 1.2 million, and this figure is projected to double by 2030. Globally, the prevalence of the disease is increasing over time and is also expected to double in the next 20 years, reaching 2% in people over 60 years of age and 6% in people over 80 years old [5]. The burden of PD continues to escalate with an aging global population, making the effective management of this condition a critical area of research and clinical intervention [6]. In this context, physiotherapy has become an integral component of managing PD, aiming to improve physical function, reduce disability, and enhance quality of life. However, it is concerning that a significant portion of physiotherapists, particularly in Europe, report a lack of specialized training in PD management, which could negatively impact the quality of care provided [1,7]. More specifically, a study in the Netherlands by Ketelaar et al. [8] reported that 6 out of 10 patients were treated by physiotherapists who had no specialist training in the management of PD.

Physiotherapy plays a vital role in the multidisciplinary approach to PD, aiming to alleviate motor symptoms and improve functional capacity [8]. The basic components of physiotherapy management for patients with Parkinson’s disease include a thorough assessment, personalized intervention programs, and the application of evidence-based tools and techniques tailored to each patient’s unique needs. According to Keus et al. [9], recommended tools that are easy to use and have demonstrated reliability and validity include the Berg Balance Scale [10], the Timed Up and Go (TUG) test [11], the Ten-Meter Walk test [12], and the Five Times Sit-to-Stand test [13]. Each of these assessments evaluates different aspects: balance, gait, functional mobility, and physical capacity, respectively. Keus et al. [9] also stated that carefully selected and adequately utilized measurement tools assist physiotherapists in making a structured and objective identification of impairments, activity limitations, and participation restrictions that PD patients frequently face. These tools help set goals, develop appropriate treatment plans, and facilitate communication with other health professionals. The primary objectives of physiotherapy are to optimize mobility, prevent falls, reduce rigidity, and improve gait and posture to promote functional independence [8,14]. Several evidence-based physiotherapy protocols have been established, including motor training, strengthening exercises, balance training, and aerobic exercises that have been shown to improve overall functioning and daily living skills [2]. A holistic approach, which often includes manual therapy, posture correction, and progressive resistance exercises, is essential for managing rigidity and improving alignment [15]. This comprehensive method enhances patients’ ability to move efficiently and addresses the complex, multifaceted symptoms of Parkinson’s disease (PD) [14,16].

In recent years, international research interest has focused on using new technologies, including virtual reality platforms (VR), to manage Parkinson’s disease. Applications and gaming technologies like the Nintendo Wii or Xbox Kinect can additionally help improve patients’ motor and cognitive symptoms [17,18,19]. These technologies offer an interactive, engaging environment that promotes skill practice in a motivating, individualized manner, showing promising outcomes in improving symptomatology and functional performance in PD patients [15].

International guidelines emphasize the importance of evaluating physiotherapists’ knowledge and perceptions regarding the assessment tools and intervention methods they employ to effectively manage patients with Parkinson’s disease [2,7,9]. This evaluation could enhance our understanding of how physiotherapists perceive and apply the protocols used in the management of PD. Previous studies examined physical therapists’ perceptions and knowledge regarding managing PD patients in the Czech Republic [20], the Netherlands [8], and Sweden [21]. Although they have provided important information, their findings might not be generalizable in other countries with different healthcare systems and financial resources [22]. To our knowledge, there is currently no relevant research that discusses Parkinson’s disease management practices among Greek physiotherapists. This descriptive study utilizes an online questionnaire to gather the views and perceptions of Greek physiotherapists regarding their therapeutic approaches, assessment tools and techniques, and collaboration with other healthcare professionals involved in the treatment of Parkinson’s disease. Furthermore, this study explores their perspectives on the integration of technology in physiotherapy programs.

2. Materials and Methods

2.1. Participants

In this descriptive, closed-type survey study, the participants were Greek physiotherapists, with inclusion criteria including practicing their profession in Greece, holding a recognized Bachelor’s degree in physiotherapy from a public higher educational institute in Greece or a recognized foreign university, and being registered in the Panhellenic Physical Therapy Association (PPTA). The present study included 203 physiotherapists. However, there are no official data on the number of physiotherapists treating patients with Parkinson’s disease in Greece, and the required sample size may be smaller. According to the PPTA, 180 and 70 physiotherapists are registered in the scientific Clinical Interest Groups of Neurological and Geriatric Physiotherapy, respectively, but this does not exclude the possibility that more physiotherapists treat elderly and neurological patients.

2.2. Research Tool—Questionnaire

The online questionnaire was created using the “Microsoft Forms” software. An information and consent form was attached to the questionnaire structure to inform the participants about the context and purposes of the research. The questionnaire was developed using the international literature on physiotherapy treatment for patients with Parkinson’s disease [2,7,16,23]. It also considered studies that explore physiotherapists’ perceptions of Parkinson’s disease treatment [23] and the integration of technology in their treatment programs [21,24,25]. The questionnaire contained 26 questions, divided into three thematic parts as follows:

A.

Demographic data: gender, age, education, level of study, professional experience, and expertise.

B.

Data on the physiotherapy management of patients with PD in Greece: (a) the frequency and percentage of patients with PD treated by Greek physiotherapists, (b) the multidisciplinary collaboration, (c) the setting where physiotherapy sessions were practiced, (d) the use or non-use of assessment tools, (e) the goals of the physiotherapy program, and (f) the therapeutic techniques used.

C.

Data on the opinions and knowledge of Greek physiotherapists regarding the use of new technological applications: (a) their knowledge regarding new technologies, (b) the use or non-use of new technologies in therapeutic processes, (c) the combination of new technologies with the already existing therapeutic approaches, (d) the perceived obstacles regarding the use of new technology as a therapeutic application, (e) opinions regarding the results of the therapeutic process, and (f) the use or non-use of new technological applications.

2.3. Evaluation by a Panel of Experts—Pilot Application

A three-member expert committee evaluated the questionnaire. The participation of this three-member committee was considered appropriate in terms of ensuring the validity of the questionnaire’s content [26]. The committee evaluated this survey in the areas of the completeness of content, the clarity of wording of questions, and commentary on the content and its usefulness in relation to the specific research topic. The pilot application of the questionnaire was communicated via a web link to a sample of 25 physiotherapists [27] for feasibility, readability, and face validity [28]. Piloting identified a few more required formatting changes and adjustments to enhance readability.

2.4. Questionnaire Dissemination—Data Collection

The questionnaire was distributed following the Ethics Committee’s approval via the “Microsoft Forms” web application. The choice of this application ensures the protection of the personal data of the participants in the survey [29]. Data collection took place after posting the link of the questionnaire on the website in February 2023 on social networking sites related to physiotherapists’ groups via an invitation of the PPTA by sending emails to professional physiotherapists working in rehabilitation centers in Greece.

The sampling process lasted for three months, concluding at the end of April 2023. Repeated invitations were sent out to maximize participation, given the challenges in recruiting participants due to the low engagement and scientific interest among Greek physiotherapists regarding neurological cases such as Parkinson’s disease.

2.5. Data Analysis and Statistical Analysis

The data obtained through the posted questionnaire were initially grouped using Microsoft Excel. The IBM SPSS 28.1 statistical program was then used for the statistical analysis of the results. Descriptive statistics tables were created, and X²—independence tests between variables were performed.

3. Results

In the present survey, 203 physiotherapists participated: 121 women, 81 men, and 1 person who identified under the option “Other”. All participants met the inclusion criteria and were included in the survey. A higher percentage of participants stated that they belonged to the age categories 30–39 years (32%) and 40–49 years (28.1%). Most of the participants obtained their degree in physiotherapy between 2000 and 2017, including 64.5% specifically from the Technological Institute of Athens and the University of West Attica. Regarding the years of working as a physiotherapist, there is a uniform distribution of percentages in the responses, but the highest percentages showed responses of more than 21 years for 25.6% of the sample and 16–20 for 20.7% of the sample. Also, most of the participants were self-employed (35%). Finally, a higher percentage of participants stated that they had not attended a lifelong learning program/seminar related to adult neurological physiotherapy (50.7%), did not hold a master’s or doctoral degree in physiotherapy (53.7%), and also did not hold a master’s or doctoral degree related to neurological physiotherapy (81.3%). The characteristics of the participants are presented in

Table 1. Participants’ characteristics.

Participants’ Characteristics
		Responses
		n	%
Gender	Female	121	59.6
	Male	81	39.9
	Other	1	0.5
Age	20–29 years	34	16.7
	30–39 years	65	32.0
	40–49 years	57	28.1
	50–59 years	40	19.7
	60+	7	3.4
Year of obtaining a degree in physiotherapy	Before 1977	1	0.5
	1978 to 1983	4	2.0
	1984 to 1999	50	24.6
	2000 to 2017	131	64.5
	After 2018	17	8.4
Graduation Institution	Technological Institute of Athens (University of West Attica)	91	44.8
	Technological Institute of Thessaloniki (International University of Greece)	41	20.2
	Technological Institute of Lamia (University of Thessaly)	34	16.7
	Technological Institute of Aegio (University of Patras)	13	6.4
	Universities from ForeignCountries	21	10.3
	Other	3	1.5
Years of work as a physiotherapist	1–5	35	17.2
	6–10	36	17.7
	11–15	38	18.7
	16–20	42	20.7
	Over 21	52	25.6
Employment status	Public sector employee	53	26.1
	Private sector employee	42	20.7
	Self-employed (owner of a physiotherapy center)	71	35.0
	Self-employed (in residential treatments—in private centers)	33	16.3
	Other	4	2.0
Lifelong training program or attendance of a seminar on neurological physiotherapy for adults?	Yes	100	49.3
	No	103	50.7
Master’s or doctoral degree in physiotherapy	Yes	94	46.3
	No	109	53.7
Master’s or doctoral degree in neurological physiotherapy	Yes	38	18.7
	Νο	165	81.3

.

Most participants stated that they treated 1–9 patients with Parkinson’s disease approximately per year (76.8%); the frequency of sessions was twice a week (54.7%), and they believed that physiotherapeutic intervention was most effective at the onset of symptoms (63.1%). A statistically significant difference was observed between the number of patients treated each year and the number of physiotherapists that attended lifelong educational seminars or programs (Pearson Chi-Square = 15.590, df = 2, p < 0.001). Specifically, physiotherapists who participated in lifelong educational programs treated more patients per year compared to those who did not (

Table 2. Comparison between the number of patients treated each year and the number of physiotherapists that attended lifelong educational seminars or programs.

			Q8. Have You Attended a Lifelong Learning Program or Seminar Regarding Adult Neurological Physical Therapy?		Total
			Yes	No
Q11. Approximately how many patients with Parkinson’s disease do you treat per year?	1–9	Count	65	91	156
		%	41.7%	58.3%	100.0%
	10–19	Count	22	8	30
		%	73.3%	26.7%	100.0%
	Over 20	Count	13	4	17
		%	76.5%	23.5%	100.0%
Total		Count	100	103	203
		%	49.3%	50.7%	100.0%

).

Similarly, a statistically significant difference was also observed between the number of patients treated each year and the number of physiotherapists who (a) held a master’s or doctoral degree in physical therapy (Pearson Chi-Square = 8.168, df = 2, p = 0.017), and (b) held a master’s or doctoral degree in neurological physical therapy (Pearson Chi-Square = 17.165, df = 2, p < 0.001).

Furthermore, a significant difference was found among the responses for the locations where the rehabilitation program of such patients took place (Pearson Chi-Square = 298,753, df = 5, p < 0.001). Most of the responses were received for home sessions (

Table 3. Location of rehabilitation programs—percentages/frequencies.

Location of Rehabilitation Programmes
		Responses
		n	Percentage	Percentage of Cases
Rehabilitation Program	At home	135	46.2%	67.2%
	Rehabilitation centers	29	9.9%	14.4%
	Physiotherapy centers	95	32.5%	47.3%
	Nursing homes	25	8.6%	12.4%
	Facilities of Parkinson’s associations	3	1.0%	1.5%
	Other	5	1.7%	2.5%
Total		292	100.0%	145.3%

).

Meanwhile, it also became evident that the participants always (37.4%) communicated with healthcare professionals to formulate their rehabilitation program (Figure 1), and they often (23.2%) used assessment tools/scales to evaluate patients with PD (Figure 2). The most frequently used tools/scales were the Timed Up and Go test (13%), the Activities of Daily Living assessment scale (11.2%), the Berg Balance Scale (10.5%), the 10 m Walk Test (8.8%) and the 5 Times Sit-to-Stand test (7.7%).

A statistically significant difference was observed between the use of assessment tools and the number of physiotherapists who attended lifelong educational seminars or programs (Pearson Chi-Square = 23.082, df = 5, p < 0.001). Of the physical therapists who always, mostly always, often, and sometimes used evaluation tools/scales to evaluate patients with PD, a greater percentage attended a lifelong educational program/seminar concerning adult neurological physical therapy (70.6%, 58.3%, 53.2%, and 51.4%, respectively). The results are presented in

Table 4. Comparison between the use of assessment tools and the number of physiotherapists who attended lifelong educational seminars or programs.

			Q8. Have You Attended a Lifelong Learning Program or Seminar Regarding Adult Neurological Physical Therapy?		Total
			Yes	No
Q16. Do you use assessment tools/scales to assess patients with PD?	Always	Count	24	10	34
		%	70.6%	29.4%	100.0%
	Almost always	Count	21	15	36
		%	58.3%	41.7%	100.0%
	Often	Count	25	22	47
		%	53.2%	46.8%	100.0%
	Sometimes	Count	18	17	35
		%	51.4%	48.6%	100.0%
	Rarely	Count	9	19	28
		%	32.1%	67.9%	100.0%
	Never	Count	3	20	23
		%	13.0%	87.0%	100.0%
Total		Count	100	103	203
		%	49.3%	50.7%	100.0%

and Figure 3.

Additionally, a statistically significant difference was observed between the use of assessment tools and the number of physiotherapists (a) that held a master’s or doctoral degree in physical therapy (Pearson Chi-Square = 19.855, df = 5, p =0.001) and (b) that held a master’s or doctoral degree in neurological physical therapy (Pearson Chi-Square = 21.021, df = 5, p < 0.001).

Statistically significant differences were identified in the responses regarding the therapeutic goals established for managing the physiotherapy program. (Pearson Chi-Square = 182,918, df = 7, p < 0.001). More responses were received to maintain postural control and balance. The results are presented in

Table 5. Therapeutic goals—percentages/frequencies.

Therapeutic Goals—Percentages/Frequencies
		Responses
		n	Percentage	Percentage of Cases
Therapeutic goals	Improving physical fitness	110	12.1%	54.2%
	Maintaining control of posture and balance	183	20.2%	90.1%
	Dyskinesia reduction	117	12.9%	57.6%
	Gait functionality—Reduction in freezing episodes	159	17.5%	78.3%
	Prevention of falls	132	14.6%	65.0%
	Reduction in stiffness (muscles, joints)	130	14.3%	64.0%
	Pain reduction	66	7.3%	32.5%
	Other	9	1.0%	4.4%
Total		906	100.0%	446.3%

.

The majority of participants in this present study (75.4%) stated that they did not apply new technologies in their therapeutic programs for patients with PD. Furthermore, a statistically significant difference was identified in the responses regarding the choice of new technologies such as telerehabilitation, smartwatches, and the Nintendo Wii for the 24.6% of physiotherapists who utilized them (Pearson Chi-Square = 47,463, df = 4, p < 0.001). The findings are shown in

Table 6. Technological applications—percentages/frequencies.

Technological Applications
		Responses
		n	Percentage	Percentage of Cases
Technological Applications	Tele-rehabilitation for neurological patients at home	6	5.6%	7.9%
	Virtual reality (Nintendo Wii, Xbox Kinect, etc.)	40	37.0%	52.6%
	Artificial intelligence applications and robotic systems	8	7.4%	10.5%
	Use of a smartwatch	37	34.3%	48.7%
	Other	17	15.7%	22.4%
Total		108	100.0%	142.1%

.

A statistically significant difference was observed between the use of modern technological applications and the number of physiotherapists that attended lifelong educational seminars or programs (Pearson Chi-Square = 5.766, df = 1, p = 0.016). More specifically, physiotherapists who attended a lifelong education program/seminar on adult neurological physiotherapy used advanced technological applications, while physiotherapists who have not attended relevant programs used them at a smaller percentage (

Table 7. Comparison between the use of modern technological applications and the number of physiotherapists who attended lifelong educational seminars or programs.

			Q8. Have You Attended a Lifelong Learning Program or Seminar Regarding Adult Neurological Physical Therapy?		Total
			Yes	No
Q20. Do you use newer technological applications in your therapeutic program, e.g., telerehabilitation, Smartwatch, Nintendo Wii?	Yes	Count	32	18	50
		%	64.0%	36.0%	100.0%
	No	Count	68	85	153
		%	44.4%	55.6%	100.0%
Total		Count	100	103	203
		%	49.3%	50.7%	100.0%

).

Similarly, a statistically significant difference was observed between the use of modern technological applications and the number of physiotherapists (a) that held a master’s or doctoral degree in physical therapy (Pearson Chi-Square = 12.558, df = 1, p < 0.001) and (b) that held a master’s or doctoral degree in neurological physical therapy (Pearson Chi-Square = 10.181, df = 1 p= 0.001).

However, the participants also believed that combining therapeutic approaches with the simultaneous use of technological applications benefits the progress of the physiotherapy rehabilitation program for patients with PD (70, 9%). Among the factors that prevented them from using modern technology in their approach, more responses were given based on the lack of appropriate facilities, equipment, and available financial resources. A statistically significant difference was identified in the responses regarding the facilitating factors for using new technologies (Pearson Chi-Square = 222,353, df = 6, p < 0.001). A higher percentage of responses were obtained regarding facilitating the use of technology in the therapeutic approach to patients with PD: 24% related to the training of therapists in new technologies, 21.7% mentioned workshops with the presentation of new scientific data, and 20.3% mentioned state-sponsored applications for the use of technologies adapted to patients with PD (

Table 8. Facilitating factors for the use of new technologies—percentages/frequencies.

Facilitating Factors for the Use of New Technologies
		Responses
		N	Percentage	Percentage of Cases
Facilitating factors for the use of new technologies	Awareness of associations of patients with PD regarding the use of technology in treatment programs	112	19.8%	55.2%
	Workshops with the presentation of new scientific data on the use of new technologies in the field of rehabilitating patients with PD	123	21.7%	60.6%
	State-sponsored applications for the use of technologies adapted to patients with PD	115	20.3%	56.7%
	The training of therapists in new technologies	136	24.0%	67.0%
	The creation of a clear legislative framework for the use of newer technologies in rehabilitation	65	11.5%	32.0%
	Other	10	1.8%	4.9%
	None of the above	5	0.9%	2.5%
Total		566	100.0%	278.8%

).

Finally, the participants expressed that incorporating technology into the rehabilitation program for patients with Parkinson’s disease (PD) could be beneficial for gradually reducing the symptoms of the disease, with 70.4% agreeing on its effectiveness. Additionally, 92.6% indicated they would consider including technological applications in their physical therapy programs for PD patients, provided that these technologies are easily accessible.

4. Discussion

The findings from the current study provide valuable insights into the perspectives and practices of physiotherapists regarding the management of Parkinson’s disease (PD) and the integration of technology in their therapeutic approaches. A key finding indicates that physiotherapists in Greece commonly utilize assessment tools within their clinical practice. However, those who have participated in continuing education programs or possess a postgraduate degree are more likely to use these tools regularly compared to those without such qualifications. Additionally, most participants do not incorporate modern technology into their treatment programs. In contrast, therapists with postgraduate training utilize newer technological applications at a higher rate than those without such training. Despite this, they acknowledge the benefits that patients with Parkinson’s disease can gain from integrating these technologies into their treatment plans. The overwhelming majority indicated that they would consider including technological applications in their physical therapy programs for PD patients, provided that these technologies are easily accessible.

Most of the participants responded that they treated between 1 and 9 patients with Parkinson’s disease each year. This is significantly lower than the findings reported in the study by Conradsson et al. [22], where the majority of participating physiotherapists in Sweden treated between 10 and 20 patients with Parkinson’s disease annually. However, in that study, physiotherapists with advanced scientific training and specialized knowledge in neurological physiotherapy were more likely to treat patients with Parkinson’s disease, highlighting the importance of ongoing specialized training for physical therapists in Greece. These findings align with the European Physiotherapy guidelines [9], Canadian Guidelines for Parkinson’s Disease [23], and the National Institute for Health Care Excellence Guidelines for Parkinson’s Disease [30]. They emphasize that healthcare professionals involved in treating patients with Parkinson’s disease must have the necessary scientific training to manage the condition [2,9,23,30].

According to the European Physiotherapy Guideline for Parkinson’s Disease [9], physiotherapy interventions can be conducted in various settings, including the patient’s home, community gyms, primary healthcare clinics, rehabilitation centers, nursing homes, and hospitals, as reported in the present study. Physiotherapists need to recognize the factors that influence the location of the services they provide, including the treatment objectives, as well as the preferences and abilities of the patient. For example, if the intervention aims to improve a patient’s ability to perform daily functional tasks, it is preferable to conduct therapy in the home, where these activities can be practiced in the patient’s natural environment [23]. Furthermore, the views of Greek physiotherapists appear to align with the international literature, which indicates that the best time to begin a rehabilitation program for patients with Parkinson’s disease is during the early stages of the condition when patients are still functionally independent [9,23]. This finding underscores the importance of incorporating evidence-based practices into the routine clinical work of physical therapists who treat these patients [2,9,23,30].

The European Guidelines for PD recommend collaboration among multidisciplinary team members to ensure optimal service delivery in rehabilitation settings [9]. Furthermore, research emphasizes the importance of collaboration between physiotherapists and other specialties in rehabilitating various conditions [21,31]. In the present study, fewer than half of the participants reported consistently communicating with the multidisciplinary team to develop their patients’ rehabilitation plans. These findings may indicate that the service setting affects the collaboration between health providers, such as rehabilitation centers, where physiotherapists can communicate more easily with physicians [22].

Most participants frequently use tools/scales such as the Timed Up and Go test, the Activities of Daily Living assessment scale, the Berg Balance Scale, the 10 m Walk Test, and the 5 Times Sit-to-Stand test in their clinical practice. This is consistent with the findings of Conradsson et al. [32], who suggested that Swedish physiotherapists are more likely to use the Timed Up and Go (TUG) test, whereas the Berg Balance Scale and the 10-m Walk Test are used less frequently.

Importantly, these assessment tools are included in the European Clinical Guidelines for Parkinson’s Disease [9] and are recommended for evaluating the dysfunctions and activity limitations experienced by these patients. Physiotherapists who participate in lifelong education programs or hold postgraduate or doctoral degrees are more likely to consistently use assessment tools and scales when managing patients with Parkinson’s disease. These professionals with postgraduate training utilize assessment tools more frequently, showing a direct link between ongoing education and the enhanced use of these tools in clinical practice [33,34,35,36]. Considering the importance of adequate assessment in managing PD, the healthcare system should offer relevant training for physical therapists treating these patients [37,38,39].

Concerning the therapeutic goals of the rehabilitation program for patients with PD, most respondents mentioned (a) maintaining postural control, (b) balance, and (c) functional gait as key components in designing physiotherapy programs. Static and dynamic balance training was the most popular physiotherapy approach for patients with PD. The above findings align with the European and Canadian guidelines for Parkinson’s disease [9,23] and the international literature [16,21,22], which recommend equivalent physiotherapy interventions for neurological patients.

The findings of this study provide valuable insight into the integration of new technologies in the physiotherapy management of Parkinson’s disease among Greek physiotherapists. For Parkinson’s disease care, increasing benefits from technological advancements such as wearable devices, virtual reality (VR), robotic-assisted therapy, and telehealth have been discovered, and this study offers an important perspective on whether these innovations are being adopted in clinical practice in Greece. Previous research has highlighted the promise of these technologies in improving motor function, balance, and overall quality of life for PD patients [14,40,41,42]. However, the adoption of these tools in clinical practice remains low, as evidenced in our study. Our findings align with those of Bezuidenhout et al. [21], who found that out of 139 physiotherapists surveyed in Sweden, 103 did not offer tele-rehabilitation services to patients with neurological disorders. According to the above research, the limited use of tele-rehabilitation may be due to the limited ability of patients to use such new technology as well as the resources provided by the healthcare system. Although many physiotherapists do not use newer technologies, most of them recognize the benefits that patients with Parkinson’s disease can gain from incorporating these technologies into their treatment programs. The opinion of Greek physiotherapists is in agreement with recent systematic reviews, which have highlighted the positive impact of tele-rehabilitation [25,43] and virtual reality [18] on balance, gait, and quality of life in patients with PD. Additionally, physiotherapists who have participated in lifelong education programs or hold a master’s or doctoral degree utilize newer technology applications at a higher percentage than those who have not engaged in relevant programs. These findings may indicate insufficient training in new technologies at the undergraduate level, suggesting that university curricula should address these issues.

According to this study, the factors inhibiting the use of new technologies include inadequate facilities and equipment, limited financial resources, and the unwillingness of patients to adopt modern technology. Additionally, a lack of familiarity with new technologies and uncertainty regarding their costs, as well as unclear legislation and concerns about the security of personal data management, also pose challenges. Similarly, according to Erol et al. [44] cited the suitability of the facilities, staff expertise, and financial resources required as important factors for using virtual reality in physiotherapy intervention. According to Schwartzman et al. [45], therapists’ reluctance to use such technology may be due to the lack of appropriate required training, equipment, and financial costs that virtual reality and relevant applications necessitate. Given the barriers to technology adoption, there is a clear need for focused policy interventions, such as increased funding for health technology, professional development programs for physiotherapists, and collaborations between healthcare institutions and technology providers. Moreover, fostering a culture of innovation within physiotherapy may encourage practitioners to be more open to integrating new technologies into their practice [44,45,46,47]. Educational initiatives that emphasize these technologies’ efficacy and practical use could also promote their acceptance among physiotherapists. The implications discussed above align with the factors that facilitate the use of technology, as mentioned by participants. These factors include the training and continuing education of therapists in new technologies, government subsidies for applications, providing information to patients with Parkinson’s disease, and establishing a clear legal framework for the use of newer technologies in rehabilitation [44,48].

At the same time, a high proportion of physiotherapists in this study believe that the addition of technology to the rehabilitation program of patients with PD can be beneficial in the progressive reduction in symptoms that characterize the disease. Finally, most of the participants stated that they would include technological applications in the development of their physiotherapy program if they had easier access to them. These findings seem to align with the views of the physiotherapists in the study by Bezuidenhout et al. [21], who cited the accessibility of physiotherapists to new technologies, which is an important factor in improving the management of symptoms of patients with Parkinson’s disease. Utilizing new technologies has the potential to significantly improve the precision and effectiveness of treatment plans for patients with Parkinson’s disease. For instance, wearable devices can enable real-time monitoring and adjustments to therapeutic exercises, while virtual reality (VR) can offer immersive rehabilitation experiences that enhance motor skills and cognitive function more engagingly [14,18,49,50]. Adopting these technologies more widely could help alleviate the burden on healthcare systems by providing more accessible and efficient care options [44]. Therefore, physiotherapists in Greece must stay updated on technological advancements to deliver high-quality services, with the primary goal of benefiting and satisfying their patients. This aligns with the European Physiotherapy Guidelines [9], which emphasize continuing professional education and the acquisition of new knowledge as essential for ensuring professional development and enhancing the quality of care provided to patients with Parkinson’s Disease [7].

Ultimately, it is noteworthy that a limitation of this study could be the use of the online questionnaire, which requires the ability to use and access modern communication technologies [29]. At the same time, the geographical distribution of participants/students in the study was not recorded. Additionally, an important limitation was the small sample size out of a total of 9238 physiotherapists licensed to practice in Greece. However, there are no official data in Greece on the exact number of physiotherapists whose main scientific occupation is neurological or geriatric physiotherapy.

In future studies, it would be beneficial to investigate further the perspectives of physiotherapists concerning the barriers they encounter in communication with other professionals, the utilization of assessment tools, and the adoption of modern technology across various countries. In Greece, it is essential to document these perspectives in both mainland and remote regions, as the barriers may differ. Additionally, documenting the primary areas of clinical practice for physiotherapists in Greece would be advantageous. This information could support the execution of targeted research across various scientific domains of physiotherapy.

5. Conclusions

In this novel study, Greek physiotherapists’ perceptions and knowledge regarding managing patients with Parkinson’s disease were investigated for the first time. The findings emphasize the significance of lifelong learning, neurological specialization, and the lack of training in new technologies for physiotherapists in Greece. A policy framework and the provision of resources are needed to improve the incorporation of new technologies into clinical practice. Moreover, the findings from this study can act as a springboard for additional research on the physiotherapy treatment of PD in Greece.