The aim of this study was to determine the knowledge, attitude and practice of physiotherapists towards promotion of non-treatment physical activity for better health in patient management.
It was observed that about two thirds of the respondents had a high knowledge of physical activity promotion. Almost all the respondents had very good attitude (role perception and confidence) towards physical activity promotion. However, only one third of the respondents counselled more than 10 patients in a month. It was also observed that 60.7% of the respondents identified insufficient consultation time as a barrier to the promotion of active lifestyle among patients. Almost all the respondents identified brief counselling integrated into regular consultations as the most feasible means of physical activity promotion in patient management. Most of the respondents considered themselves as more physically active than other Nigerians of the same age and gender. More than half of the respondents were not aware of physical activity recommendation guidelines in other countries while almost all of them felt that physical activity recommendation guideline is necessary in Nigeria. The main limitation of this study was the relative small sample size.
The observation that two thirds of the surveyed physiotherapists in Nigeria had high knowledge of physical activity promotion yet most of them counselled less than 10 patients in a month implies that Nigerian physiotherapists at present operate mainly in the tertiary prevention capacity. A similar study by Shirley et al. observed that more than half of the surveyed Australian physiotherapists (54%) counselled 10 or more patients to lead a more physically active lifestyle (beyond therapeutic exercises) in a month. They also observed that physical therapists who gave patients more physical activity life style advice appeared to have greater knowledge about physical activity promotion. This means that 18% more physiotherapists in Australia practice physical activity promotion in patient management than those in Nigeria. The reason may be that there are fewer physiotherapists in Nigeria with large number of patients to manage than in Australia. As such they will be constrained by time to counsel their patients on having a more physically active lifestyle. Therefore, it is not surprising that 60.7% of the surveyed physiotherapists in Nigeria identified insufficient consultation time as a barrier to the promotion of physically active lifestyle among patients.
There was no significant association between the attitude of the surveyed physiotherapists towards physical activity promotion in patient management and their counselling practice. This means that the good attitude of almost all surveyed physiotherapists in Nigeria towards physical activity promotion had no influence on their counselling practice to patients. This also may be attributed to lack of time as few physiotherapists are available for large number of patients. Shirley et al. reported that almost all the surveyed Australian physiotherapists had very good role perception and confidence in promoting physical activity to patients and this influenced their practice of it. In 3 states in USA, about 54% of physical therapists believed that it was part of their role to be involved in promotion of health and fitness
. Buffart et al. reported that 98% of physicians that participated in their study believed that physical activity promotion was part of the physician’s role but fewer physicians felt confident in giving specific physical activity advice to patients. Leijon et al. reported that among the various health care professionals in Sweden, physical therapists provided the highest number of physical activity referrals and physicians provided the lowest. This difference may be due to the fact that physiotherapists have extensive training on exercise prescription for both primary and tertiary prevention of diseases and disabilities.
There was a significant association between low practice of physical activity promotion in patient management and insufficient consultation time. This suggests that low practice of physical activity promotion in patient management observed in this study is mainly due to insufficient consultation time. Bull et al. and van der Ploeg et al. reported that lack of time was a major barrier to physical activity promotion in the clinical setting.
The finding that almost all the surveyed physiotherapists in this study identified brief counselling integrated into regular consultations as the most feasible means of physical activity promotion in patient management may also be due to insufficient consultation time. Shirley et al. reported that physical therapists indicated that separate, one-on-one consultations are less feasible for physical activity promotion but incorporating non-treatment physical activity advice into normal consultations is deemed feasible by almost all. However, van der Ploeg et al. and van der Ploeg et al. reported that a physical activity counsellor can effectively improve patients’ daily physical activity levels in a series of one-on-one counselling sessions.
There was a significant association between practice of physical activity promotion in patient management and years of working experience of the respondents suggesting that those who had 1–5 years’ work experience counselled more patients. The reason for this may be that a larger number of the surveyed physiotherapists were in this group.
There was also a significant association between practice of physical activity promotion in patient management and the relative physical activity levels of the surveyed physiotherapists. This means that the physiotherapists in Nigeria who considered themselves much more physically active than other Nigerians of the same age and gender counselled more patients on the importance of adopting a more physically active lifestyle.
Although majority of the physiotherapists in Nigeria (97%) saw the necessity for physical activity recommendation guideline in Nigeria only 43% were aware of physical activity recommendation guideline in other countries. Shirley et al. reported that only one third of the surveyed physical therapists were aware of the national physical activity guidelines.
The questionnaire used in collecting data in this study was not pretested and validated for the Nigerian environment. This is viewed as a limitation, although the contents in the questionnaire was well understood by the respondents and matched the work environment in Nigeria.
The sampling technique also proved to be a limitation because physiotherapists from only fourteen states of the country participated in the study. The selected states were those that had relatively higher number of currently practicing physiotherapists and represented almost all the 6 geopolitical zones of Nigeria. We could therefore infer that the results were representative of the physiotherapists in the country.