Musculoskeletal imaging authority, levels of training, attitude, competence, and utilisation among clinical physiotherapists in Nigeria: a cross-sectional survey.

BACKGROUND: Direct-access physiotherapy practice has led to a global review of the use of differential-diagnostic modalities such as musculoskeletal imaging (MI) in physiotherapy. OBJECTIVE: To explore the MI authority, levels of training, attitude, utilisation, and competence among clinical physiotherapists in Nigeria. METHODS: This national cross-sectional study analysed a voluntary response sample of 400 Nigerian physiotherapists that completed the online version of the Physiotherapist's Musculoskeletal Imaging Profiling Questionnaire (PMIPQ), using descriptive statistics, Spearman's correlation, Mann-Whitney U, Kruskal-Wallis, and Friedman's ANOVA tests. RESULTS: Of the 400 participants, 93.2% believed that physiotherapists should use MI in clinical practice. However, only 79.8% reported having MI authority in their practice settings. The participants' median (interquartile range) levels of training =10 (24) and competence =16 (24) were moderate. Nonetheless, levels of training (χ2 [15] = 1285.899, p = 0.001), and competence (χ2 [15] = 1310.769, p < 0.001) differed across MI procedures. The level of training and competence in x-ray referral and utilisation was significantly higher than magnetic resonance imaging, computed tomography scan, ultrasonography, scintigraphy, and dual-energy x-ray absorptiometry, in that order (p < 0.05). There was a significant positive correlation between the levels of training and competence (rho =0.61, p < 0.001). The participants had a positive attitude =32 (32) and occasionally used MI in clinical practice =21 (28). CONCLUSION: Majority of the respondents believed they had MI authority although there was no explicit affirmation of MI authority in the Nigerian Physiotherapy Practice Act. Participants had a positive attitude towards MI. However, levels of MI training, competence, and utilisation were moderate. Our findings have legislative and curriculum implications.

Experiences of physiotherapists involved in front-line management of patients with COVID-19 in Nigeria: a qualitative study.

OBJECTIVES: Evidence-based guidelines recommend physiotherapy for respiratory treatment and physical rehabilitation of patients with COVID-19. It is unclear to what extent physiotherapy services are used in the front-line management of COVID-19 in Nigeria. This study aimed to explore the experiences of front-line physiotherapists managing patients with COVID-19 in Nigeria. DESIGN: Qualitative interview-based study. SETTING: ICU and hospital COVID-19 wards, COVID-isolation and treatment centres in Nigeria, between August 2020 and January 2021. PARTICIPANTS: Eight out of 20 physiotherapists managing patients with COVID-19 in the front line were recruited using purposive and snowball sampling. METHODS: Qualitative in-depth semistructured telephone interviews of all consenting physiotherapists managing patients with COVID-19 in the front line in Nigeria were conducted and transcribed verbatim. Transcripts were thematically analysed. RESULTS: Eight front-line physiotherapists (three neurological physiotherapists, two orthopaedic physiotherapists, one cardiopulmonary physiotherapist, one sports physiotherapist and one rotational physiotherapist) provided consent and data for this study. Four themes and 13 subthemes were generated illustrating discriminatory experiences of front-line physiotherapists, particularly from COVID-19 team leads; lack of multidisciplinary teamwork within COVID-19 teams; wide ranging stigmatisation from extended family members, colleagues, friends and the general public; material and psychosocial personal losses; lack of system support and suboptimal utilisation of physiotherapy in the management of COVID-19 in Nigeria. Personal agency, sense of professionalism, previous experience managing highly infectious diseases and being a cardiopulmonary physiotherapist were the factors that made the front-line physiotherapists to become involved in managing patients with COVID-19. However, discriminatory experiences made some of these physiotherapists to stop being involved in the management of patients with COVID-19 in the front line. Most front-line physiotherapists were not cardiopulmonary physiotherapists which may have influenced their level of expertise, multidisciplinary involvement and patient outcomes. CONCLUSIONS: There is suboptimal involvement and support for physiotherapists, particularly cardiopulmonary physiotherapists treating patients with COVID-19 in the front line in Nigeria.