An Influences the Level of Physiotherapy Services Utilized by Saudi Arabian Physiotherapist
 
Bshayer Yahya Asiri1*, Maha Ali Alqahtani2
1 Physiotherapist at Prince Sultan Military Medical City Riyadh, KSA
Email: Bshayer.asiri1@gmail.com
2 Physiotherapist at Prince Sultan Military Medical City Riyadh, KSA
Abstract - Background: The aim of this analysis is to examine physicians' perspectives on physiotherapy in Saudi Arabia (SA), including their views, experiences, and attitudes, and to determine variables may influence the amount of physiotherapy services used. Methods: Researchers used a cross-sectional design. All nationalities and genders of practicing or academically affiliated physicians in South Arabia were eligible to participate. Results: The inclusion criteria were satisfied by 150 responders in total. The respondents had a slightly adverse outlook on physiotherapy, yet their thoughts & experiences pointed to several significant problems. For instance, half of them said physiotherapists didn't do a good job of getting the word out about the services they offer, and nearly two-thirds of them confessed to not knowing enough about the field. Physicians listed a lack of physiotherapist competence in patient evaluation & therapy as the most probable factor influencing physiotherapy service utilisation (55.3%), followed by physicians' ignorance of physiotherapy service types (41.3%) and physicians' & physiotherapists' inability to work together (36%). Conclusion: Physiotherapy services were not as widely used in South Arabia due to a number of causes. Academics & clinicians in the field of physiotherapy should work to improve doctors' perceptions of the profession by raising their level of knowledge about the services offered by physiotherapists.
Keywords- Physiotherapy, Physicians, Healthcare, Services, Patients
INTRODUCTION
Physiotherapy is an essential part of interdisciplinary healthcare because of the many benefits it provides in the treatment & recovery from a wide range of medical issues (Puckree et al. 2011). Improving patient outcomes, especially in secondary & tertiary care settings, in Saudi Arabia relies heavily on doctors utilising physiotherapy services. However, the extent to which these services are integrated into patient care varies widely, influenced by multiple factors including physician knowledge, perceptions of physiotherapy's effectiveness, and the structural dynamics of the healthcare system.
The level of physiotherapy service utilization among Saudi Arabian physicians is shaped by a complex interplay of professional, cultural, and institutional factors. These include the physicians' understanding of the scope of physiotherapy, their confidence in the competencies of physiotherapists, and the availability and accessibility of physiotherapy services within different healthcare sectors (Lee K, Sheppard et al. 1998). Additionally, collaboration between physicians and physiotherapists, as well as hospital policies regarding physiotherapy, play a significant role in determining how often and how effectively these services are utilized.
There are still obstacles for physiotherapy to overcome, such as the healthcare system's failure to acknowledge it as an essential service, despite the rise of evidence-based physiotherapy & rising demand for physiotherapy services (Alshehri MA et al. 2017). Physiotherapists play an essential role in rehabilitation, but doctors who don't understand their importance may put off or even reject patients who may benefit from their services. Accordingly, it can directly affect the level of physiotherapy service utilisation in any nation. According to Alghadir A. et al. (2015), physiotherapists in Saudi Arabia encounter a number of obstacles, such as an absence of postgraduate physiotherapy programs at Saudi institutions and a general unwillingness to adopt evidence-based practice. Further, physiotherapists are unable to participate in basic health care clinics, & patients in South Arabia cannot contact them directly; instead, they must have a reference from a doctor in order to have a physiotherapy session (Al-Abbad HM et al. 2016). In addition, research carried out by Al-Eisa et al. revealed that 75% of doctors in South Arabia either did not refer patients to physiotherapy clinics at all or recommended them very infrequently. The level of physiotherapy service use may have been affected by this. It is crucial to offer patients rehabilitation therapies like physiotherapy at the earliest opportunity.in order to give each patient the best possible treatment. Some have hypothesised that alternative healthcare providers could be able to help physiotherapy patients if the general population and their affiliated healthcare experts didn't know how important their work is. Consequently, physiotherapy in South Arabia needs a solution to all these problems, and must work to make that happen. This study aims to evaluate doctors' perspectives on physiotherapy, learn about doctors' thoughts & feelings about physiotherapy services, and find out what factors might influence doctors' beliefs about how much physiotherapy patients use in South Arabia.
LITERATURE REVIEW
Abdulelah M Aldhahir et al. (2022) Patients with heart failure (HF) benefit greatly from a multidisciplinary approach to care that includes physiotherapists, known as cardiopulmonary rehabilitation (CR). No research has investigated physical therapists' perspectives on providing CR or the factors that might influence referral. Therefore, the aim of analysis to physical therapists' perspectives on providing cardiac rehabilitation (CR) programs to patients and to identify potential variables and obstacles that influence referral choices. All PTs in Saudi Arabia were surveyed using a cross-sectional online poll that ran from February 19, 2022, until June 27, 2022. Using descriptive statistics, we were able to characterise the respondents. For categorical data, the reporting tools employed were frequencies & percentages. The online poll was filled up by 553 PTs, 289 of whom were male (52.30%) and 264 of them were female (47.70%). Among them, 334 (or 60.4% of the total) were in agreement that CR would lessen shortness of breath in HF patients, and 360 (or 65.1% of the total) were in agreement that CR would increase patients' physical fitness. When asked whether CR would help HF patients with palpitations & exhaustion, 321 PTs (or 58% of the total) gave their enthusiastic approval. Among 553 physical therapists, 349 (or 63.1% of the total) were in full agreement that CR would enhance patients' capacity to carry out their everyday tasks. Out of the total number of responders, 499 (or 90%) wanted CR programs to be delivered under the supervision of a hospital. In addition to physical activity, 455 people (or 82.30% of the total) viewed stress management as a crucial aspect of CR programs. "Fatigue related to disease" (42% of the time) was the patient-related factor that had the greatest impact on referral decisions. According to 59.90% of those who made referrals, the absence of CR centres is the biggest obstacle. For HF patients, PTs saw CR as an effective treatment option. From the opinion of the physical therapists, a major obstacle to CR referral was the absence of a supervised hospital-based program that included stress management in addition to the exercise component.
Arwa Alnaqbi et al. (2021) Physiotherapy is available to service customers in two main methods globally. There are a number of advantages to direct access over indirect access, which needs a recommendation from a primary care physician. These include faster treatment times, more cost-effective treatment overall, and a higher chance of avoiding acute disorders from becoming chronic illnesses. The United Arab Emirates is one of numerous countries that restricts access to physiotherapists, despite the many advantages they provide. Finding out how well-versed physiotherapists in the UAE are on the topic of direct access and whether or not their demographic characteristics colour their understanding of the word is the primary goals of this research. In addition, the physiotherapists who took part in the study wanted to know what they thought were the advantages and disadvantages of direct access. The researchers used a cross-sectional observational study. This study used an updated version of the survey questionnaire that Bury & Stokes created in 2013. There were six parts to the survey, and each one used a Likert scale with closed-ended questions. Two hundred & 64 physical therapists completed the survey after receiving it via email. The last step was to use MANOVA to see if any demographic factors had an effect on the respondents' opinions. While over 30% of participants were totally oblivious to the concept of direct access, 70% were aware of it. Physiotherapists of a younger generation were more likely to support the approach, whereas those of a more senior generation were more worried about the obstacles. Professional autonomy, evidence-based practice, & limited scope of practice for physiotherapists were the primary obstacles mentioned, along with the little support from physicians & policymakers. Among the demographic criteria that affected direct access, physiotherapists under the age of 23 were the most vocal advocates for the policy. Considering the advantages of direct access, including better professional standing, cost savings, patient happiness, & increased efficiency, more efforts are required to adopt it in the UAE. Possible means of doing this, according to this research, include mentoring, professional autonomy, and leadership support.
Abdulmohsen Hassan Al Ghamdi et al. (2019) The purpose of this study is to analyse the physical therapy scope of practice in Saudi Arabia & detail the factors that healthcare providers have identified as facilitating and impeding patients' ability to receive physical therapy treatments. Using a cross-sectional questionnaire, 90 physical therapists from 6 hospitals in Riyadh, Jeddah, & Dammam were surveyed. The survey was given out either in person or over email. We created this survey to find out what healthcare providers think are the biggest obstacles to patients having direct access to physical therapy services. Out of 90 physical therapists, 70 participated in the current study, for a response rate of 77.7 percent. With a bachelor's degree being the highest level of education held by 68.6% of the participants, the majority of the participants (41.4%) were between the ages of 21 & 30. According to the data, 51.4% of those who took the survey were female. Nearly 25% of those who took part in the study had 6–10 years of clinical experience. An overwhelming majority of the participants, or 88.6%, were employed by the local hospital. Providing physical therapy services in Saudi Arabia is challenging due to the reasons listed in the questionnaire, the majority of which are geographical accessibility, availability, price, & acceptance of services. Geographic accessibility, availability, price, & acceptance of treatments are some of the perceived challenges to delivering physical therapy in Saudi Arabia that this study describes. Physical therapy treatments in Saudi Arabia may be even more accessible if lawmakers & third party payment system adopted the highlighted obstacles as a guide.
Ghadah Algudairi et al. (2018) One important indicator of healthcare systems' efficacy & efficiency is the degree to which patients report high levels of satisfaction, or PS. The researchers in this study set out to determine what factors and features are connected with PS and outpatient PT care in Saudi Arabia. In 2017, 400 patients who had PT were asked to take part in this research. The MedRisk Patient Satisfaction with Physical Therapy Care Scale (MRPS) was utilised to evaluate PS. The majority of the 358 respondents (77%), who were female, had an average age of 38.1 (SD 12.7) years. According to the MRPS, the average global satisfaction score for all respondents was3.56, indicating good happiness, and at least 76% of those who underwent PT reported feeling better afterward. In Saudi Arabia, PT is still in its infancy but already plays a significant role in healthcare. In order to find ways to enhance and give people access to high-quality healthcare, PS is essential.
Ágnes SIMON-UGRON et al. (2017) There is ongoing discussion about expanding patient access to physical therapy services on a global & national scale. Health insurance companies & patients alike may reap the benefits of direct access to physical therapists if it meant shorter wait times & lower overall expenses. The researchers set out to determine how following physical therapy guidelines affected healthcare spending and utilisation in the future by reviewing the available evidence. The data was retrieved from Value in Health (2011–2016) & PubMed search was conducted on January 15, 2017. Both singular and plural forms of the keywords "physical therapy," "physiotherapy," and "utilisation" were employed. Value in Health (15 results) & Medline (PubMed) (41) were the initial databases searched. Consequently, 56 outcomes were recognised. Only 22 papers made it into our review after we applied the inclusion criteria and removed duplicates. In summary. Health care expenses decreased in areas where physiotherapy was often utilised, however this was not the case globally.
Einas S. Al-Eisa et al., (2016). The efficacy of physiotherapy in reducing patients' impairment and reliance on others has been well-documented over many years. Nevertheless, its acknowledgement is still lacking in health care systems that incorporate several disciplines. A larger reduction in hospital patient load is possible if doctors are aware of the ways physical therapists may aid in patient care and avoid problems. The researchers in this study set out to learn how Saudi Arabian doctors see physiotherapy and what they think about it. This research asked one hundred fifteen members of the SCFHS from different hospitals throughout five areas of Saudi Arabia to take part. The participants represented a wide range of specialities, countries, designations, and years of experience in the healthcare industry. Data was gathered using a 22-item questionnaire that covered topics such as the demographics of the doctors, their educational backgrounds, and their understanding of physiotherapy. Data from 280 respondents was utilised for analysis after the inclusion & exclusion criteria were applied. Among those who took the survey, 75% claimed to have a basic understanding of physiotherapy; 11% said they frequently sent patients to physiotherapy departments, and 14% said it happened sometimes. This is the first research that we are aware of in Saudi Arabia that aims to assess doctors' understanding of physiotherapy. This study's findings emphasise the significance of regularly updating doctors with EBT by holding seminars & workshops on the efficacy of physiotherapy in a variety of conditions. Physical therapists have a duty to improve the way their peers in the medical field see their work.
METHODS
The research used a convenience sample & cross-sectional descriptive design. All nationalities and sexes of practicing or academically affiliated physicians in South Arabia were eligible to participate. Because their involvement would compromise the reliability of the study results, undergraduates & interns were not included. Furthermore, medical experts who were not doctors were not included either. An online poll conducted on a secure Google website was used to gather the data. There was complete anonymity because no one other than the writers had access to the data. On the first page of the survey, you might find the permission form, the study's goals, and a brief overview. The research committee of Majmaah University's Physical Therapy Department at the Faculty of Applied Medical Sciences in the Kingdom of Saudi Arabia gave its approval to the study. This study used a structured survey that was based on prior research with similar aims in order to examine cultural effects on the Saudi healthcare system. The survey ran from December 2020 to February 2021, at which time it was accessible online for participation. The survey was disseminated using WhatsApp in addition to Facebook & Twitter.
Ten people participated in a pilot test to make sure the survey was easy to understand & accurate. After calculating Cronbach's alpha, the internal consistency was found to be 0.698. Attitudes towards physiotherapy services (0.887), opinions & experiences towards physiotherapy services (0.678), and variables associated to the level of usage of physiotherapy services (0.529) were the most reliably rated survey sections. Data was collected & analysed with the use of IBM SPSS version 19.0, which is developed and owned by IBM Corp. in Armonk, NY, USA. Analysis and reporting were based on the frequencies & percentages of the participants' answers to each question.
RESULTS
The study included 175 participants; however, 25 were not included since they belonged to different healthcare specialities. Information on the 150 participants whose responses were considered for the study is laid forth, Almost all of the respondents (86%) were Saudi nationals, and the vast majority (76%) were either employed by the Saudi Ministry of Health(40%), the commercial health sector(13.4%), or some other branch of the Saudi government (26.6%). Almost half of the respondents (42% to be exact) had less than five years of experience, and just 20% worked in an academic environment. Plus, 28 percent had 6–10 years of experience, 22.6% had 11–15 years, and just 3.4% had 16–20 years, with an additional 4% having 21 years of experience or more.
Survey of opinions on various aspects of physiotherapy services, with responses categorized into five levels: "Strongly disagree," "Disagree," "Neutral," "Agree," and "Strongly agree." The percentages and raw numbers of respondents for each category are given for different statements. The function of physiotherapy services in secondary care is crucial large majority of respondents (81.3%) agree or strongly agree that physiotherapy services are vital in secondary care, with 46.7% strongly agreeing. Very few respondents are neutral (4%), and only 14.7% strongly disagree. No prior knowledge of human anatomy is held by physiotherapists Half of the respondents (50%) strongly disagree with this statement, indicating that most believe physiotherapists do have experience with human anatomy. However, 32% either disagree or strongly disagree, while only 12.7% agree or strongly agree with the statement. Physiotherapists should be available to patients directly, without the need for a referral Opinions are somewhat divided here. A significant portion (52.7%) either strongly disagree or disagree, suggesting some skepticism about patients having direct access to physiotherapists. Meanwhile, 23.3% agree or strongly agree, with 24% remaining neutral. Physical therapists have the authority to recommend exercise & rehabilitation regimens to their patients majority (48.6%) agree or strongly agree that physiotherapists can independently prescribe rehabilitation or exercise programs, although 21.4% are neutral. However, 30% of respondents disagree or strongly disagree, indicating a split opinion. Patients can have faith in physiotherapists because of their extensive training and experience a substantial portion (50.6%) agree or strongly agree that physiotherapists are well-qualified and trustworthy, though 22.7% are neutral. However, 26.7% of respondents either strongly disagree or disagree with this statement. Physiotherapists are skilled at reevaluating patients when more testing is required responses are fairly distributed, with 45.3% agreeing or strongly agreeing, and 28% neutral. A smaller group (26.7%) disagrees or strongly disagrees, suggesting varied confidence in this aspect of physiotherapy. Some surgical procedures should be able to have physiotherapists present responses are mixed, with a significant portion (38.6%) agreeing or strongly agreeing, while 32% disagree or strongly disagree. A notable 29.4% remain neutral on this issue, indicating uncertainty or lack of strong opinion.
Some important difficulties were highlighted by the physicians' responses when asked about their views and experiences with physiotherapy. A total of 63.4% of respondents had brought up the need for physiotherapy interventions in the workplace, and 57.4% had experience working with rehabilitation teams or physiotherapists themselves. Nearly all participants (90%) felt comfortable referring patients to physiotherapists, and nearly as many (61.4%) had discussed patient treatment with a physiotherapist. Physiotherapists, according to half of those who took the survey, fail to do a good job of getting the word out about the services they provide. Almost two-thirds of those who took the survey felt they lacked sufficient knowledge regarding physiotherapy services, while over three-quarters would have like to have more information.
Potential variables that might influence the level of physiotherapy service use by physicians in South Arabia, according to their beliefs. There are three possible answers in this table: "Yes," "No," and "Unsure." The answers pertain to different aspects of how physiotherapy services are perceived and utilised. Physiotherapy treatments had the opposite effect of improving my patients' health. A small percentage of participants (22.7%) hold the belief that physical therapy treatments really made their patients' health conditions worse. While 34 percent are uncertain, 43.3% strongly disagree, meaning they do not perceive any negative effects from physical treatment. Concerns regarding the competency of physiotherapists are raised by the fact that a large percentage of respondents (55.3%) believe that physiotherapists do not possess the requisite knowledge and abilities to evaluate and treat patients. But twenty-seven percent disagree and twenty-four percent aren't sure. Among those who have taken the survey, 41.3% confess to knowing very little about the variety of physiotherapy treatments that are possible. However, 36% feel knowledgeable, and 22.7% are unsure, highlighting varying levels of awareness among respondents. There is no cooperation between me and the physiotherapist Responses are evenly split between "Yes" and "No," each with 36%, indicating that cooperation between the respondents and physiotherapists is inconsistent. Additionally, 28% are unsure, suggesting some ambiguity or variability in collaborative practices. Hospital policy prohibits the use of physiotherapy services in certain conditions a significant proportion of respondents (38.7%) say that hospital policy does not prohibit the use of physiotherapy in certain conditions, while 29.3% believe it does. However, 32% are unsure, indicating uncertainty or lack of clarity about hospital policies regarding physiotherapy.
DISCUSSION
The present research set out to answer three questions: (1) how doctors in SA feel about physiotherapy services, (2) what they think and have experienced with these services, and (3) what factors could influence how much doctors believe their patients should use these services. According to the research, doctors don't think much of the physiotherapy field. On top of that, the investigation uncovered a few major issues that might have dampened the level of physiotherapy treatment use.
The present study found that physicians’ attitudes towards physiotherapy services in SA substantial majority of respondents (81.3%) agree or strongly agree that physiotherapy services have a vital role in secondary care, underscoring the recognized importance of these services. Despite this acknowledgment, there is a significant concern about the skills and knowledge of physiotherapists, with 55.3% agreeing that physiotherapists lack the necessary expertise to assess and treat patients. This concern is further highlighted by the fact that 50% of respondents strongly disagree with the notion that physiotherapists lack experience in human anatomy, suggesting that while there is recognition of their general knowledge, doubts remain about their specific competencies. The data indicates a high level of confidence in referring patients to physiotherapists, with 90% of respondents affirming their confidence in doing so. However, collaboration between healthcare providers and physiotherapists appears inconsistent, with 36% reporting a lack of cooperation. Furthermore, 38.6% of respondents have not communicated with a physiotherapist regarding patient care, suggesting potential barriers to interdisciplinary communication. The data reveals mixed perceptions regarding the impact of physiotherapy on patient outcomes. While 43.3% believe that the health status of their patients did not worsen when physiotherapy interventions were used, a notable 34% are unsure, and 22.7% believe it did worsen. This uncertainty might reflect the broader concerns about the skills and knowledge of physiotherapists. Additionally, 29.3% believe that hospital policies prohibit the use of physiotherapy services in certain conditions, with a significant portion (32%) unsure, suggesting ambiguity or lack of clarity in hospital policies. The survey indicates that while 68% of respondents feel they have enough information about physiotherapy services, 70% express a desire to know more. This suggests an ongoing need for education and awareness programs to address knowledge gaps and enhance the understanding of physiotherapy's role and benefits.
When it came to respiratory physiotherapy in SA, however, other research (e.g., Al Mohammedali, O'Dwyer, & Broderick) indicated that doctors preferred it. Of those who took the survey, 92.5% said physiotherapists were an important element of the ICU team and 82.5% said they have the expertise to collaborate with respiratory care teams. According to another study by Odunaiya et al., who looked at how obstetricians and gynaecologists felt about physiotherapists being a part of their patients' care, the majority of the doctors surveyed had a positive impression of the field. So, for instance, 97% of people think that physiotherapists can't be replaced by medication and instructions, and 95.5% think that physiotherapists don't hurt patients. Physicians' prior interactions with physiotherapists, the quality of those exchanges, and other contextual & cultural variables may all play a role in shaping doctors' perspectives on the field. Those who had used physiotherapy services in the past were more likely to have a good impression of the field than those who had never used them before (Puckree et al., 2010). In order to change the way medical professionals feel about physiotherapy, it is crucial to recognise these variables.
A number of critical concerns were raised by the doctors' perspectives and personal experiences with physiotherapy treatments. Nearly all South Arabian doctors (92.6% confidence) said they would recommend patients to physiotherapists, yet half of those doctors said physiotherapists didn't do a good job of getting the word out about their services. On top of that, 55.5% of people felt they lacked adequate knowledge on physiotherapy options. This is in line with the findings of Karthikeyan and Jones (2015) in Papua New Guinea, where only 44.1% of healthcare workers think that physiotherapists raise awareness of the field and only 31.7% think they have enough knowledge about the subject. Physiotherapy services in South Arabia were better understood by 83.3% of doctors in the present research. In SA, 75.2% of doctors felt they needed more education about the function of physiotherapy in respiratory treatment, which is in agreement with what Al Mohammedali, O'Dwyer, and Broderick found in 2017. According to the study's authors, physiotherapists were recommended to patients with respiratory issues more frequently by specialists than by general practitioners. Nearly all of the healthcare providers surveyed by Karthikeyan and Jones (2015) in Papua New Guinea(96.6%) expressed interest in learning more about physiotherapy, and nearly all of them(95.9%) acknowledged the need for further education in the field.
Physiotherapy treatments may be readily accessed by patients in the United Kingdom & United States through patient self-referral, eliminating the need for referrals from physicians (WCPT 2017). Whereas in South Arabia, physiotherapists are required by law to obtain a doctor's reference before they may treat a patient. Numerous studies have shown that the referral rate to physiotherapists in South Arabia is low, despite the fact that nearly all doctors (92.6%) felt confidence in referring their patients to them. Al Mohammedali, O'Dwyer, and Broderick found that out of all the doctors in South Arabia who were asked about respiratory rehabilitation, just 40.8% said they always recommended patients to physiotherapists, while 59.2% said they either never referred patients or referred them very seldom. In a separate research, Al-Eisa et al. discovered that around half of the doctors in SA15 did not send their patients to physiotherapists and another quarter of the doctors seldom sent their patients to physiotherapists. The low referral rate to physiotherapy clinics in SA is an essential issue that has to be rectified, and these two research tackled that problem. Kutty, Gebremichael, and Vargehese1 discovered that nearly all Ethiopian doctors reported referring patients to physiotherapists for treatments, suggesting that a high referral rate to physiotherapy clinics may exist. According to this research, musculoskeletal illnesses accounted for 39.8% of all referrals, while neurological issues accounted for 49.8%. Furthermore, (Abdulmohsen Hassan Al Ghamdi et. al 2019) discovered that physiotherapy services were highly utilised in Nigeria. Nearly all doctors (94% reported referring patients to physiotherapists) fell into this category. Dissimilarities in health and education system functions, policies, and regulations, along with other variables like the degree to which doctors communicate and collaborate with physiotherapists, may account for the contradictory findings in certain nations.
CONCLUSION
The results of this study demonstrated that doctors in Saudi Arabia had negative views of physiotherapists & highlighted many important variables that could have affected the level of physiotherapy service utilisation. Academics & clinicians in the field of physiotherapy should work towards improving doctors' perceptions of the profession and its services by raising their level of knowledge & challenging their unfavourable attitudes. Additionally, physiotherapists in South Arabia have a duty to provide up-to-date information about their field to other medical professionals and the public at large. Furthermore, doctors should acknowledge the value of physiotherapy services and make use of them when necessary to enhance patient care. The challenges that physiotherapists and doctors have while trying to work together & communicate should be the subject of future studies.
REFERENCES
  1. Puckree T, Harinarain R, Ramdath P, et al.: Knowledge, perceptions and attitudes of final year medical, occupational therapy and sport science students regarding physiotherapy, in KwaZulu Natal. SAJPA, 2011, 67: 19–26.
  2. Lee K, Sheppard L: An investigation into medical students’ knowledge and perception of physiotherapy services. Aust J Physiother, 1998, 44: 239–245. [Medline] [CrossRef]
  3. Alshehri MA, Alalawi A, Alhasan H, et al.: Physiotherapists’ behaviour, attitudes, awareness, knowledge and barriers in relation to evidence-based practice implementation in Saudi Arabia: a cross-sectional study. Int J Evid-Based Healthc, 2017, 15: 127–141. [Medline] [CrossRef]
  4. Alghadir A, Zafar H, Iqbal ZA, et al.: Physical therapy education in Saudi Arabia. J Phys Ther Sci, 2015, 27: 1621–1623. [Medline] [CrossRef]
  5. Al-Abbad HM, Al-Haidary HM: The perception of physical therapy leaders in Saudi Arabia regarding physical therapy scope of practice in primary health care. J Phys Ther Sci, 2016, 28: 112–117. [Medline] [CrossRef]
  6. Al-Eisa, E. S., Al-Hoqail, H., Al-Rushud, A. S., Al-Harthi, A., Al-Mass, B., Al-Harbi, B. M., ... & Iqbal, Z. A. (2016). Awareness, perceptions and beliefs about physiotherapy held by physicians working in Saudi Arabia: a cross-sectional study. Journal of physical therapy science, 28(12), 3435-3439.
  7. Alnaqbi, A., Shousha, T., AlKetbi, H., & Hegazy, F. A. (2021). Physiotherapists’ perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study. PloS one, 16(6), e0253155.
  8. Al Ghamdi, A. H., Al Shehri, A. S., Ramirez, O. C., Shamshi, S., & Khan, S. (2019). Perceived barriers among healthcare professionals for access to physical therapy service in Saudi Arabia. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 29(01), 26-38.
  9. Algudairi, G., Al-Eisa, E. S., Alghadir, A. H., & Iqbal, Z. A. (2018). Patient satisfaction with outpatient physical therapy in Saudi Arabia. BMC health services research, 18, 1-8.
  10. Al Mohammedali, Z., O’Dwyer, T. K., & Broderick, J. M. (2016). The emerging role of respiratory physiotherapy: A profile of the attitudes of nurses and physicians in Saudi Arabia. Annals of thoracic medicine, 11(4), 243-248.
  11. Aldhahir, A. M., Alhotye, M., Alqahtani, J. S., AlDraiwiesh, I. A., Alghamdi, S. M., Alsulayyim, A. S., ... & Alwafi, H. (2022). Physiotherapists’ attitudes, and barriers of delivering cardiopulmonary rehabilitation for patients with heart failure in Saudi Arabia: a cross-sectional study. Journal of Multidisciplinary Healthcare, 2353-2361.
  12. SIMON-UGRON, Á. (2017). UTILIZATION OF PHYSIOTHERAPY SERVICES IN THE WORD. Studia Universitatis Babeș-Bolyai Educatio Artis Gymnasticae, 95-108.
  13. Al Mohammedali Z, O’Dwyer TK, Broderick JM: The emerging role of respiratory physiotherapy: a profile of the attitudes of nurses and physicians in Saudi Arabia. Ann Thorac Med, 2016, 11: 243–248. [Medline] [CrossRef]
  14. Odunaiya NA, Ilesanmi T, Fawole AO, et al.: Attitude and practices of obstetricians and gynecologists towards involvement of physiotherapists in management of obstetric and gynecologic conditions. Int J Womens Health, 2013, 5: 109–114. [Medline]
  15. Karthikeyan P, Jones A: Knowledge of physiotherapy services among hospital-based health care professionals in Papua New Guinea. P N G Med J, 2015, 58: 55–60.
  16. World Confederation for Physical Therapy (WCPT): http://www.wcpt.org/node/25749/cds (Accessed Jul. 6, 2017)
  17. World Confederation for Physical Therapy (WCPT): http://www.wcpt.org/node/25369/cds (Accessed Jul. 6, 2017)
  18. Ogiwara S, Inoue K, Hyuga H: The physiotherapist-doctor relationship: an Ishikawa physiotherapists’ perspective. J Phys Ther Sci, 2005, 17: 87–92. [CrossRef]
  19. Hulme JB, Bach BW, Lewis JW: Communication between physicians and physical therapists. Phys Ther, 1988, 68: 26–31. [Medline] [CrossRef]
  20. Abdulmohsen Hassan Al Ghamdi, Abdullah Saleh Al Shehri, Oscar C. Ramirez, Sharick Shamshi, Shabana Khan, Perceived Barriers Among Healthcare Professionals For Access To Physical Therapy Service In Saudi Arabia, 2019;29:1:26-38.