PHYSIOTHERAPY AWARENESS IN MEDICAL AND NON MEDICAL POPULATION : A SOCIAL MEDIA SURVEY

Background: Physiotherapy is one of the oldest branches of healthcare profession which is concerned with holistically rehabilitating the patient. In recent years, the field has evolved rapidly providing evidence based quality health services. Inspite of people awailing physiotherapy services its awareness to a certain extent appears to be less. The purpose of this study was to find level of awareness of Physiotherapy among medical professionals and general population.

Physiotherapy is the one of the oldest profession in healthcare practiced since 460Bc by great physicians such as Hippocrates and Galen.Events such as First World War, Polio-outbreak, increasing disabilities lead to rapid progression and modernization of physiotherapy from 18th century [1].Due to continuous efforts, research and development of various techniques over the years, it has gained recognition and appraisal with its evidence based practice.Often asked, what is physical therapy and what does a phys-iotherapist do, it is difficult to restrict its definition in few words since the profession is holistic in approach.According to World Confederation of Physical Therapy, "Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation.This encompasses physical, psychological, emotional, and social wellbeing.Physical therapy involves the interac-Devanshi Doshi, Mariya Jiandani, Rucha Gadgil, Neha Shetty.PHYSIOTHERAPY AWARENESS IN MEDICAL AND NON MEDICAL POPULATION: A SOCIAL MEDIA SURVEY.
tion between the physical therapist, patients/ clients, other health professionals, families, care givers and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists" [2].with support from WHO [3].It is been more than seven decades since the inception of physiotherapy in India and primarily in Mumbai.In spite of its recent advances and excellent results in delivering quality healthcare, awareness of physiotherapy remains a big question in India not only among general population but also other health care professionals including medical professionals.
It is indeed shocking to learn that they have inadequate knowledge when most of the time they are the first point of referral for therapy.Hence a need to conduct the survey among medical and non-medical professionals to know the awareness, system dysfunctions treated by physiotherapist and role of physiotherapy in lifestyle disease.It is believed that early referral and recognition by medical practitioner and awareness in general masses leads to better optimization and deliverance of physiotherapy services which appears to be underutilized at present.

MATERIALS AND METHODS
It was an observational study.The survey was conducted online using social media in the form of questionnaire which had open ended and closed ended questions.The questionnaire was submitted using Google forms to all using a link shared via social media, (Whatsapp, Facebook, Gmail) for a period of one week.Two separate questionnaires were designed (using same subsections) and validated for general population and health care practitioners (HCP).The questionnaire for general population had simple language to avoid use of medical terminologies.Overview regarding Physiotherapy: The questionnaire ended by asking people's perception/ view/comments regarding field of physiotherapy.47%(n=49) for HCP and 42% (n=65) for general population responded with common themes being that "it's an excellent field which sadly in India is underestimated and not respected as much as it should be.There are many illnesses for which physiotherapy is the only solution and it is very effective in mobilizing the patient"."It's an emerging field in India with lot of scope which needs to be paid more attention, misconceptions should be cleared regarding the field and more multi-specialties need to be open"."Physiotherapy combined with medicine is the best thing to rescue patients from injury or to prevent disability".There was a common consensus to improve awareness about the field of physiotherapy through various modes of communication.
Graph 3: Awareness about physiotherapy exercise protocol in managing life-style related disorders.

DISCUSSION
The survey helped to understand existing awareness of physiotherapy among health care and non health care professionals.Awareness about Physiotherapy and its referral indicated 90% of HCP and 78% of general population knew about Physiotherapy.A similar survey conducted in institute in the year 2002 revealed that 75% (n=100) of general population (non-medicos) and 100 % (n=100) of group 2 comprising of medical population were aware about Physiotherapy.Also, 18% had approached for physiotherapy treatment by direct contact, while majority of population 82% came through medical referral.
Our results were consistent with a study done by Apurva Shimpi (2014) a cross sectional survey to study awareness and perspective among referring doctors in colleges of Mumbai and Pune which found that a significant number of doctors (69.9%) were acquainted with the physiotherapist working with them.They also found that a majority of doctors from their study (95.5%) referred people for physiotherapy [3].However a study done by Dhiraj et al in rural area regarding awareness of Physiotherapy among medical practitioners practicing in rural setup showed that doctors practicing in rural areas were unaware about physiotherapy services and importance of the same [4].A review by Anila Paul in the year 2015 on awareness of Physiotherapy across the globe included studies conducted from 1979 till 2015 were included lead to the conclusion that there is less awareness regarding the field even in countries with high HDI [5].Hence measures to improve awareness are urgently required.Medical professionals play an important role in referral of patients for physiotherapy besides direct contact.Hence awareness of role of physiotherapy in various disease and dysfunctions is of paramount importance.Though there is adequate awareness about physiotherapy in musculoskeletal, sports and neurological dysfunction, it is limited to field of cardiovascular and pulmonary dysfunction i.e. cardiac and pulmonary rehabilitation, physiotherapy post plastic surgery and women's health or following pregnancy and gynecological and obstetric disorders and oncology.Lack of acknowledgement by them will indeed affect the patients who are unknown to the potential of the field in improving their quality of life.The scenario has not changed much since the survey done by Swati et al (unpublished data) in 2002 where 43% patients were referred for orthopedic conditions, 34% for neurological disorders, 5% for gynecology and cardio-vascular and pulmonary conditions and 4% for pediatrics.More than a decade and importance of physiotherapy in these fields still remain underutilized.
A study by Dr Deepa Abhichandani (published in the year 2015)"Awareness of various aspects of Physiotherapy among medical residents in India" had the similar results.The study concluded that physiotherapists should guide medical residents regarding physiotherapy and its various specialties, extensive knowledge of physiotherapy evaluation and management especially of community based rehabilitation and industrial health physiotherapy should be taught [6].
Physiotherapy through the medium of exercise as key factor and patient education plays a major a role in lifestyle modification and prevention of metabolic disorders and cardiac risk factors; however the awareness about the same was poor in both healthcare professionals and general population.Physiotherapy adds life to years and though in existence in India for more than six decades still remains underutilized.More work needs to be done in spreading awareness in various diseases and dysfunctions where a physiotherapist is an integral part of health care team in improving quality of life of patients.and clinical rounds if conducted can increase the recognition of the field [7].
On similar lines, one can conduct interactive interdepartmental workshops in medical colleges, hospitals and clinics about the field of physiotherapy especially among medical professionals.In such workshops, people should be explained about the fundamentals of the field, duties of a physiotherapist, evaluation and assessment done by a therapist, the science and evidence supporting each treatment programs and how it helps to prevent injuries and disabilities.Implementation of such measures can provide a great aid in increasing acquaintance of doctors to the field of physiotherapy, thereby improving referral for the same.

CONCLUSION
Though majority of healthcare professionals and general population are aware of physiotherapy, its role in field of cardiovascular, pulmonary, oncology, obstetrics and gynecology and plastic surgery is little known and remains underutilized.There is a felt need by both health care professionals and general population to create more specific understanding and promote utilization of services to promote quality of life.

RESULTGraph 1 :Graph 2 :
They were framed to inquire respondent's 1) Knowledge of Physiotherapy If Physiotherapy services received and got relieved from the same, 3) Awareness about Physiotherapy in various system dysfunctions, 4) Awareness about role of supervised exercise protocols in controlling lifestyle related disorders.Questions were open ended and close ended with a yes/no response pattern.Results were calculated directly by Google spreadsheet in terms of frequency distribution and descriptive statistics.103healthcare practitioners(MBBS, Dentists, BHMS, Surgeons, medical Students) filled the questionnaire and 153 non-medical professionals(housewives, managers, chartered accountants, engineers, students from other fields etc) submitted their response.More than 90% (n=103) of medical professionals and 78% (n=153) of non-medical professionals knew about physiotherapy.(Graph 1) Awareness regarding what is physiotherapy.Devanshi Doshi, Mariya Jiandani, Rucha Gadgil, Neha Shetty.PHYSIOTHERAPY AWARENESS IN MEDICAL AND NON MEDICAL POPULATION: A SOCIAL MEDIA SURVEY.Population who received Physiotherapy: 77% (n=78) of healthcare professionals or their family members had received Physiotherapy treatment, out of which 76%(n=63) of them got relief by the same.74% (n=114) of general population had received Physiotherapy treatment, out of which 65% (n=83) obtained relief.Awareness about specialties in Physiotherapy: There was a varied response showing more awareness in musculoskeletal, sports and neurological dysfunctions.Among HCP, 93.2% (n=96)were aware whereas 86.2%(n=132) general population were aware about the role of physiotherapy in musculoskeletal disorders.97.1% (n=100) of HCP and 90.2% (n=138) of general population knew about physiotherapy in sports.Among other specialties, 85.4% (n=88) of HCP and 69.9% (n=107) of general population had a knowledge about role of Physiotherapy in neurological disorders, 79% (n=80) of HCP and 74% (n=111) general population were familiar to Physiotherapy given post-surgery.In the field of cardiac, pulmonary &vascular conditions the percentage was however less with figure of 68% (n=70) & 69.9% (n=72) and 44.4% (n=68) & 37.3% (n=57) respectively for HCP and general population.In physiotherapy services for elderly though 79.6% (n=82) of HCP knew, it was only 50.3% (n=77) among general population.Some fields like plastic surgery, oncology, gynecology and obstetrics fared poorly on awareness; the percentage dropped significantly to 50.5% (n=52) and 54.5% (n=56) and 54.4% (n=56) respectively in HCP to 32.7% (n=50), 37.3% (n= 56) in general population.(Graph 2) Awareness about role of Physiotherapy in lifestyle-related disorders: In diseases such as diabetes mellitus and hypertension, on enquiry whether physiotherapy contributes to management and prevention of diseases like diabetes 70% (n=72)of HCP& 69% (n= 71) general population agreed that supervised exercise protocols helps in controlling them.In case of hypertension, 47.7% (n=73) HCP & 61.1 % (n=94) general population were aware of role of physiotherapy.67%(n=69) of HCP and 54.2% (n=83) of general population believed that physiotherapy exercise programs helps in managing dyslipidemia, 83% (n=85) of HCP and 71.2% (n=109) of general population for obesity and 73% (n=76) of HCP for metabolic disorders.(Graph 3) Awareness about the role of physiotherapy in various branches.