1. INTRODUCTION:

Physiotherapy is an excellent health care profession, which is growing its importance and expanding the scope of practice. Few people appreciate the expanse of knowledge and skills required to become a good physiotherapist. It is in fact a specialized job, treating individuals of all ages and genders with an extensive range of needs, helping people to improve their quality of life, advising clients in the management and prevention of diseases, as well as educating the public to help themselves.

This course addresses all aspects of working people with disabilities with special emphasis on the use of information technology to assist empowerment. Furthermore, physiotherapy has been described as a dynamic health care profession with established theoretical and widespread clinical application, which involves mainly physical approaches, in the preservation, development, and restoration of optimum physical function¹. Physiotherapists are primary health care professionals concerned with the assessment, diagnosis, treatment and prevention of the dysfunction and impairment of movement in individuals of all ages and within a wide range of contexts².

According to the World Confederation for Physical Therapy (WCPT, 2011), physiotherapy or physical therapy is a dynamic profession which provides services in multiple settings to individuals and communities within the scopes of promotion, prevention, treatment or intervention, habilitation and rehabilitation. Physiotherapy is concerned with developing, maintaining and restoring maximum movement potential throughout the lifespan of a person. Interaction between the physiotherapist, patient or client, other health care professionals, families, care givers and communities plays an integral part of physiotherapy. These interactions are crucial in the process of assessing movement and functional ability, identifying needs, and formulating goals specific to a client. Clear communication and mutual understanding are vital concepts to be practiced among the key members in caring for a patient or client. Through the combined efforts of each team member, the patient in care would surely reap the maximum amount of benefits from the health care service provided and in turn obtains good level of potential of regaining optimum function³.

Physiotherapy is still a growing profession in Malaysia. In the recent approval of The Allied Health Profession Act 2016, the Deputy Health Minister, Datuk Seri Hilmi Yahaya, stated that there is a lack of physiotherapists in the country with only some three thousand at present in the field⁴. Compared to our neigh bouring country Singapore, which has one physiotherapist for every six thousand people, Malaysia only has one for every seventeen thousand. It was also noted that it is even more appropriate now to have more physiotherapists as the country expects to have 15% senior citizens from the total population in the year 2030. This shows that the rate of physiotherapists working in Malaysia is still inadequate, and other health professions such as doctors and nurses are more highly recognized by the public because these professions had been around since a very long time. Since physiotherapy is still a growing profession, it can be assumed that the publics’ awareness of physiotherapy may be lacking, even among health professionals or future health professionals. Therefore, this study focused on health professional students to determine their current awareness and knowledge of physiotherapy.

In the field of today’s health care, issues related to health are ever increasing in complexity and challenges. The rise of chronic and complicating pathologies resulting in complex care situations demands more professionals to be involved. This emphasizes the need of interdisciplinary collaboration and interdisciplinary education (IPE), which has been on the rise, for the past decade⁵. Respecting and understanding roles of team members are some of the key characteristics which make up an effective interdisciplinary team⁶. Moreover, interdisciplinary interaction within the health care team is becoming more well-known as an effective strategy of enhancing the delivery of health care services⁷. Interdisciplinary teamwork can be achieved by acknowledging and appreciating the professional skills of other team members and understanding how their abilities may contribute to patient or client care.

In addition, interaction focused at an undergraduate level will improve the awareness of physiotherapy and ensure referral of a patient to physiotherapy when appropriate. By doing so, the future of health care delivery is more likely to improve. Mutual understanding and respect among various health professions not only enhance the delivery of health care but also unite the team as members work closely together with the sole purpose of providing optimum care for the patient. Besides that, health care professionals are on the frontline of raising awareness of physiotherapy among the general public. With increasing awareness of physiotherapy, the recognition of physiotherapy in the country would also heighten and physiotherapy services would be better known and valued. Inter professional education (IPE) provides a platform for students to share skills and knowledge between professions, and allows for a better understanding, shared values and respect for the roles of other health care professionals (Craddock et al., 2006).

This research aimed to provide data on the level of awareness and knowledge of physiotherapy among medical and health sciences students in a private university in Selangor. The results of this research were intended to assess the need to emphasize IPE in the curriculum of their study.

2. MATERIAL AND METHODS:

This research employed a cross-sectional study design to find out the level of awareness and knowledge of physiotherapy among medical and health sciences students at a private university in Selangor.

The target population of the study was medical and health sciences students from the Faculty of Medicine and Health Sciences (FMHS) at Universiti Tunku Abdul Rahman (UTAR) Sungai Long Campus. The sample size was calculated using power analysis and online sample size calculator based on total number of students from FMHS in UTAR Sungai Long Campus, excluding physiotherapy students. The total number of FMHS students excluding the physiotherapy students was 404. The sample size calculated was 198 participants, with margin of error 5% and confidence interval (CI) 95%. Medical and health sciences students were selected from FMHS in UTAR Sungai Long Campus. The method for sampling applied was non-probability sampling using convenient sampling technique. The inclusion criteria for the study: MBBS, TCM, and NS students in UTAR Sungai Long Campus, Male or female, Any age group, Any ethnicity, Willing to participate in the survey and the exclusion criteria for the study: Physiotherapy students, Refusal to participate in the survey, Subject who cannot comprehend/ complete the questionnaire.

The instrument utilized in this study is purely questionnaire-based. A self-developed questionnaire was adopted from researchers whom carried out similar studies⁸. The questionnaire consists of three sections, (Section A, B and C). Section A consists of demographic data of the students which included the age, gender, race, course and year of study. All data were kept confidential. Section B consists of eighteen close-ended questions relating to awareness about physiotherapy. Section C consists of nine close-ended questions relating to knowledge of physiotherapy, including a question to assess the students’ opinion on which strategies would be effective in increasing the knowledge of physiotherapy among health care students. A total of thirty-two items were included in the questionnaire. The questionnaire was sent for validation to five experts in the field to check the validity and reliability of the instrument used.

The data collected were coded and stored in Microsoft Excel Sheet. Statistical Package for the Social Sciences (SPSS) was the software utilized to analyze the data. The data was analyzed based on domains identified by the researcher. The domains identified were created based on the response of the participants in the study. Frequency and percentage analysis were done and the results were presented and tabulated in tables, bar graphs, and pie charts. Statistical tests including Mann-Whitney U test and chi-square test were used to compare the association of variables and outcomes.

3. RESULTS:

In this study, a total number of 208 questionnaires were distributed to MBBS, TCM, and NS students from FMHS at UTAR Sungai Long Campus. Only 198 questionnaires were completed and included for analysis. The other 10 questionnaires either had incomplete data; the subject did not meet the inclusion criteria for the study; the subject was not willing to participate; and misplaced forms. The overall response rate for the study was 95.19%.

3.1 Information about physiotherapy

3.1.1 Sources of information

Table 3.1: Sources of information

Source of information	Frequency (n)	(%)
Curriculum Career days/education fairs Campaigns/awareness programs Media Books Friends Family/relatives Educators Others	57	28.8
	85	42.9
	46	23.2
	71 56 107 65 87 5	35.9 28.3 54.0 32.8 43.9 2.5

Figure 3.1: Sources of information

The chart shows the most commonly cited source of information about physiotherapy was “Friends”, identified by 107 (54.0%) students. The second most commonly cited information source was “Educators”, identified by 87 (43.9%) respondents, and followed closely by “Career days/education fairs”, identified by 85 (42.9%) respondents. “Media” was identified by 71 respondents (35.9%), followed by “Family/relatives” (32.8%), “Curriculum” (28.8%), “Books” (28.3%), and “Campaigns/awareness programs” (23.2%). There were five (2.5%) respondents that cited “Others” as the source of information, which had mentioned obtaining information about physiotherapy from UTAR, during clinical postings, or through direct treatment by a physiotherapist.

Table 3.2: Association between factors and awareness on what physiotherapy is

Factors	p value
Age^A	1.000
Gender	0.320
Race	0.644
Course	0.311
Year of study	0.909
Education level	0.060
No. of information source	0.155

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-Square test. Significant value at p<0.05.

The association between the factors mentioned above and the respondents’ awareness on what physiotherapy is, is not statistically significant.

3.3 What best describes physiotherapy?

Table 3.3: What best describes physiotherapy?

Option	Frequency (n=198)	(%)
Physiotherapy involves invasive procedures in helping people regain function	53	26.8
Physiotherapy involves the prevention, diagnosis and therapeutic management of disorders relating to movement and health	129	65.2
Physiotherapy provides professional massage services	1	0.5
Physiotherapy is for injuries	1	0.5
Physiotherapy manipulates bones and joints to relieve pain	11	5.6
Don’t know	3	1.5

The table shows there were 129 out of 198 (65.2%) respondents who answered that “Physiotherapy involves the prevention, diagnosis and therapeutic management of disorders relating to movement and health” was what described physiotherapy best, followed by “Physiotherapy involves invasive procedures in helping people regain function” (26.8%), and “Physiotherapy manipulates bones and joints to relieve pain” (5.6%). Only one respondent selected “Physiotherapy provides professional massage services” and “Physiotherapy is for injuries” respectively.

Table 3.4: Association between factors and awareness level of physiotherapist work setting.

Factors	p value
Age^A	0.023*
Gender	0.255
Race	0.204
Course (NS)	0.009*
Year of study	0.072
Education level	0.657
No. of information source	0.057

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05.

Table shows that there is a statistically significant association between factors such as age, course, year of study, and number of information source on the awareness level of physiotherapist work setting.

The mean (μ) age of students with adequate awareness of physiotherapy work setting was 21.27 with standard deviation (σ) of 0.151, while the mean age among students with inadequate awareness on physiotherapy work setting was 20.90 (σ 0.131). Therefore, the mean age of students with adequate awareness of physiotherapy work setting was higher compared to the mean age of students with inadequate awareness of physiotherapy work setting. The difference in the mean age between the two levels of awareness of physiotherapy work setting is statistically significant (p 0.023).

The awareness level of physiotherapy work setting was higher among students in NS course (66.7%) as compared to the awareness level of physiotherapy work setting among those in TCM (41.2%) and MBBS (30.4%). The difference in awareness level of physiotherapy work setting among the three groups is statistically significant (p 0.009).

Table 3.5: Association between factors and awareness level on role of physiotherapy in health care.

Factors	p value
Age^A	0.200
Gender	0.432
Race	0.338
Course	0.185
Year of study	0.711
Education level (Secondary school)	0.009*
No. of information source	0.406

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05.

Table 3.5 shows that there is a statistically significant association between the level of education and the awareness level on the role of physiotherapy in health care.

The awareness level on role of physiotherapy in health care was higher among students who came to know about physiotherapy at the secondary school level (84.6%) as compared to those who knew about physiotherapy at the pre-university level (71.7%), university level (64.7%), and primary school level (53.8%). The difference in awareness level on role of physiotherapy in health care among the four groups is statistically significant (p 0.009).

Table 3.6: Association between factors and awareness level of physiotherapy sub-specialties.

Factors	p value
Age^A	0.007*
Gender (Female)	0.021*
Race (Non-Chinese)	0.032*
Course (NS)	<0.001*
Year of study	0.130
Education level	0.191
No. of information source (6-8)	0.017*

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test.* Statistically significant results, significant value at p <0.05.

This shows that there is a statistically significant association between factors such as age, gender, race, course, and number of information source on the awareness level of physiotherapy sub-specialties

The mean (μ) age of students with adequate awareness of physiotherapy sub-specialties was 22.13 with standard deviation (σ) of0.295, while the mean age among students with low awareness of physiotherapy sub-specialties was 20.00 (σ 0.103). Therefore, the mean age of students with adequate awareness of physiotherapy sub-specialties was higher compared to the mean age of students with inadequate awareness of physiotherapy sub-specialties. The difference in the mean age between the two levels of awareness of physiotherapy sub-specialties is statistically significant (p 0.007).

The awareness level of physiotherapy sub-specialties was higher among females (6.6%) as compared to the awareness level of physiotherapy sub-specialties among males (0.0%). The difference in awareness level of physiotherapy sub-specialties between both groups is statistically significant (p 0.021).

The awareness level of physiotherapy sub-specialties was higher among non-Chinese (15.4%) as compared to the awareness level of physiotherapy sub-specialties among Chinese (3.2%). The difference in awareness level of physiotherapy sub-specialties between both groups is statistically significant (p 0.032).

The awareness level of physiotherapy sub-specialties was higher among students in NS course (22.2%) as compared to the awareness level of physiotherapy sub-specialties among those in MBBS (2.7%) and TCM (1.5%). The difference in awareness level of physiotherapy sub-specialties among the three groups is statistically significant (p <0.001). The null hypothesis was rejected.

The awareness level of physiotherapy sub-specialties was higher among students who had obtained information about physiotherapy from 6 to 8 sources (15.0%) as compared to the awareness level of physiotherapy sub-specialties among those who had 3 to 5 sources (4.5%) and 1 to 2 sources (1.1%). The difference in awareness level of physiotherapy sub-specialties among these three categories is statistically significant (p 0.017).

Table 3.7: Association between factors and awareness of physiotherapy home-based care.

Factors	p value
Age^A	0.589
Gender	0.266
Race	0.866
Course	0.814
Year of study	0.276
Level of education	0.988
Source of information	0.665

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. Significant value at p <0.05.

The association between the factors mentioned above and the respondents’ awareness of physiotherapy home-based care is not statistically significant.

Table 3.8: Association between factors and awareness of physiotherapy benefits.

Factors	p value
Age^A	0.061
Gender	0.182
Race	0.771
Course	0.752
Year of study	0.170
Education level	0.057
No. of information source	0.832

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. Significant value at p<0.05.

The association between the factors mentioned above and the respondents’ awareness of physiotherapy benefits is not statistically significant.

Table 3.9: Association between factors and knowledge level of impairments can be treated by physiotherapists.

Factors	p value
Age^A	0.001*
Gender	0.756
Race	0.135
Course	0.161
Year of study (3)	0.017*
Education level	0.994
No. of information source (6-8)	0.028*

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05

This shows that there is a statistically significant association between factors such as age, year of study and number of information source on the knowledge level of impairments can be treated by physiotherapists.

The mean (μ) age of students with adequate knowledge of impairments can be treated by physiotherapist was 21.31 with standard deviation (σ) of 0.130, while the mean age among students with inadequate knowledge of impairments can be treated by physiotherapist was 20.67 (σ 0.149). Therefore, the mean age of students with adequate knowledge of impairments can be treated by physiotherapists was higher than the mean age of students with inadequate knowledge of impairments can be treated by physiotherapists. The difference in the mean age between the two levels of knowledge of impairments can be treated by physiotherapist is statistically significant (p 0.001).

The knowledge level of impairments can be treated by physiotherapists was higher among Year 3 students (65.3%) as compared to Year 2 (61.1%), and Year 1 (37.0%). Year 4 had 60.9%. The difference in knowledge level of impairments can be treated by physiotherapist among the four groups is statistically significant (p 0.017).

The knowledge level of impairments can be treated by physiotherapists was higher among students who had obtained information about physiotherapy from 6 to 8 sources (85.0%) as compared to the knowledge level of impairments can be treated by physiotherapists among those who had 3 to 5 sources (55.1%) and 1 to 2 sources (52.8%). The difference in knowledge level of impairments can be treated by physiotherapists among these three categories is statistically significant (p 0.028).

Table 3.10 Association between factors and knowledge level of examination procedures conducted by physiotherapists.

Factors	p value
Age^A	<0.001*
Gender	0.922
Race	0.778
Course (TCM)	0.006*
Year of study (4)	<0.001*
Education level	0.300
No. of information source (6-8)	0.004*

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05.

This shows that there is a statistically significant association between factors such as age, course, year of study and number of information source on the knowledge level of examination procedures conducted by physiotherapists.

The mean (μ) age of students with adequate knowledge of examination procedures conducted by physiotherapists was 21.49 with standard deviation (σ) of 0.165, while the mean age among students with inadequate knowledge of examination procedures conducted by physiotherapists was 20.70 (σ 0.116). Therefore, the mean age of students with adequate knowledge of examination procedures conducted by physiotherapists was higher than the mean age among students with inadequate knowledge of examination procedures conducted by physiotherapists. The difference in the mean age between the two levels of knowledge on examination procedures conducted by physiotherapists is statistically significant (p <0.001).

The knowledge level of examination procedures conducted by physiotherapists was higher among TCM students (57.4%) as compared to those in NS course (44.4%) and MBBS (33.0%). The difference in knowledge level of examination procedures conducted by physiotherapists among the three courses is statistically significant (p 0.006).

The knowledge level of examination procedures conducted by physiotherapists was higher among Year 4 students (69.6%) as compared to the knowledge level of examination procedures conducted by physiotherapists among those in Year 3 (52.0%), Year 2 (33.3%), and Year 1 (23.9%). The difference in knowledge level of examination procedures conducted by physiotherapists among the four groups is statistically significant (p <0.001).

The knowledge level of examination procedures conducted by physiotherapists was higher among students who had obtained information about physiotherapy from 6 to 8 sources (65.0%) as compared to the knowledge level of examination procedures conducted by physiotherapists among those who had 3 to 5 sources (49.4%) and 1 to 2 sources (30.3%). The difference in knowledge level of examination procedures conducted by physiotherapists among these three categories is statistically significant (p 0.004).

Table 3.11: Association between factors and knowledge level of conditions can be treated by physiotherapists.

Factors	p value
Age^A	0.006*
Gender	0.612
Race	0.856
Course (NS)	0.027*
Year of study (3)	0.017*
Education level	0.266
No. of information source	0.267

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05.

This shows that there is a statistically significant association between factors such as age, course and year of study on the knowledge level of conditions can be treated by physiotherapists.

The mean (μ) age of students with adequate knowledge of conditions can be treated by physiotherapists was 21.67 with standard deviation (σ) of 0.181, while the mean age among students with inadequate knowledge of conditions can be treated by physiotherapists was 20.97 (σ 0.108). Therefore, the mean age of students with adequate knowledge of conditions can be treated by physiotherapists was higher than the mean age among students with inadequate knowledge of conditions can be treated by physiotherapists. The difference in the mean age between the two levels of knowledge of conditions can be treated by physiotherapists is statistically significant (p <0.006).

The knowledge level of conditions can be treated by physiotherapists was higher among NS students (22.2%) as compared to those in MBBS (10.7%) and TCM (2.9%) course. The difference in knowledge level of conditions can be treated by physiotherapists among the three courses is statistically significant (p 0.027).

The knowledge level of conditions can be treated by physiotherapists was higher among Year 3 students (16%) as compared to the knowledge level of conditions can be treated by physiotherapists among those in Year 2 (5.6%) and Year 1 (0.0%). Students in Year 4 had about 13%. The difference in knowledge level of conditions can be treated by physiotherapists among the four groups is statistically significant (p 0.017).

Table 3.12: Association between factors and knowledge of techniques conducted by physiotherapists.

Factors	p value
Age^A	<0.001*
Gender	0.868
Race	0.559
Course (NS)	0.006*
Year of study (4)	0.006*
Education level	0.806
No. of information source	0.102

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05.

This shows that there is a statistically significant association between factors such as age, course and year of study on the knowledge of techniques conducted by physiotherapists.

The mean (μ) age of students with adequate knowledge of techniques conducted by physiotherapists was 21.33 with standard deviation (σ) of 0.128, while the mean age among students with inadequate knowledge of techniques conducted by physiotherapists was 20.57 (σ 0.148). Therefore, the mean age of students with adequate knowledge of techniques conducted by physiotherapists was higher than the mean age among students with inadequate knowledge on techniques conducted by physiotherapists. The difference in the mean age between the two levels of knowledge of techniques conducted by physiotherapists is statistically significant (p <0.001).

The knowledge level of techniques conducted by physiotherapists was higher among NS students (94.4%) as compared to the knowledge level of techniques conducted by physiotherapists among those in TCM (63.2%) and MBBS (55.4%) course. The difference in knowledge level of techniques conducted by physiotherapists among the three courses is statistically significant (p 0.006).

The knowledge level of techniques conducted by physiotherapists was higher among Year 4 students (87.0%) as compared to the knowledge level of techniques conducted by physiotherapists among those in Year 3 (66.7%), Year 2 (57.4%) and Year 1 (45.7%). The difference in knowledge level of techniques conducted by physiotherapists among the four groups is statistically significant (p 0.006).

Table 3.13: Association between factors and knowledge level of physiotherapy modalities.

Factors	p value
Age^A	0.744
Gender	0.645
Race (Non-Chinese)	<0.001*
Course (NS)	0.006*
Year of study	0.243
Education	0.731
No. of information source	0.169

^AContinuous variable compared using Mann-Whitney U test. Others are categorical variables compared using Chi-square test. *Statistically significant results, significant value at p <0.05.

The knowledge level of physiotherapy modalities was higher among non-Chinese (15.4%) as compared to the knowledge level of physiotherapy modalities among Chinese (1.1%). The difference in knowledge level of physiotherapy modalities between both groups is statistically significant (p <0.001).

The knowledge level of physiotherapy modalities was higher among NS students (11.1%) as compared to knowledge level of physiotherapy modalities among students in TCM (2.9%) and MBBS (0.0%) course. The difference in knowledge level of physiotherapy modalities among the three courses is statistically significant (p 0.006).

Figure 3.2: Which strategies do you think is effective in increasing physiotherapy knowledge among health care students?

Table 3.14: Which strategies do you think is effective in increasing physiotherapy knowledge among health care students?

Option	Frequency (n)	(%)
Classroom lecture	62	31.3
Interactive workshop (roleplay)	155	78.3
Case studies	73	36.9
Others	9	4.5

The pie chart shows majority of the respondents (78.3%) reported that interactive workshop including role play is an effective strategy in increasing physiotherapy knowledge among health care students, followed by case studies (36.9%) and classroom lecture (31.3%). The remaining 4.5% gave their opinion by suggesting the following: providing free physiotherapy service/treatment; using online articles and games as a medium; through physiotherapy club activities and more publicity on it; collaboration between UTAR nursing and physiotherapy students during clinical postings in the hospital; experiencing being a physiotherapist for a few days; lectures and practical sessions; more publicty on physiotherapy.

4. DISCUSSION:

Looking at the data, most of the students reported that they were exposed to physiotherapy during the secondary school level, followed by pre-university level. This shows that the awareness of physiotherapy among secondary school and pre-university students were higher compared to primary school students. The likely reason for this could be a lack of education about the physiotherapy profession in classroom teachings of primary school students. It can be assumed that lesser number of students was exposed to physiotherapy at the university level because majority of them had heard about physiotherapy before they entered university. Besides that, students who came to know about physiotherapy during secondary school had shown significantly better awareness on the role of physiotherapy in health care. This suggests that the information about physiotherapy role in health care could be obtained during their secondary school level, where most of them came to know about physiotherapy.

Based on the analysis, friends, educators, and career days/education fairs were the highest rated sources of information about physiotherapy among medical and health sciences students in this study. This emphasizes that other than friends or peer groups, educators play a major role in influencing the students’ knowledge of physiotherapy as well. Educators were also cited as a more common source of information about physiotherapy as compared with media. This indicates that teachers and lecturers in educational institutions had been sharing information about physiotherapy to the students. Although the media can reach young people easily with messages, educators may be better placed to deliver information about physiotherapy. These findings may also suggest that physiotherapy awareness among the students is more commonly spread through word-of-mouth. Majority of the students had obtained information regarding physiotherapy from at least five sources of information. The study found that students who had higher number of information sources obtained about physiotherapy shown better level of awareness and knowledge of physiotherapy. This may be due to more exposure or education about physiotherapy through many different information sources, thus a better level of understanding about physiotherapy.

Other than high number of information sources, factors such as age, gender, race, course and year of study had also shown significant association on the students’ level of awareness and knowledge about physiotherapy. In general, a trend was observed from the findings of study, which showed that older age, female gender, non-Chinese race, Year 3 and Year 4 students from nursing and TCM course had presented better awareness and knowledge regarding physiotherapy.

Increased awareness and knowledge of physiotherapy among those of slightly older age and higher year of study could be due to the experiences gained by these students during their course of study or during clinical attachments. Additionaly, the reason nursing and TCM students had better awareness and knowledge of physiotherapy compared to MBBS students may be because of a higher interest level of nursing and TCM students in knowing about physiotherapy, in other words, knowing about the roles of health care professions other than their own. This can be reinforced by a study conducted in Malaysia, which found that medical students had the least favourable attitude towards interdisciplinary collaboration and team work compared to other health care professions⁹. Moreover, the findings of the same study had also revealed that many of the medical students view the role of nurses and therapists as mainly to provide support for doctors. This perception of medical students towards physiotherapy may be a barrier towards acquiring knowledge about physiotherapy, as they tend to view other health care students as their inferior. The findings that show female participants being more familiar with physiotherapy were similar to findings in a study conducted in United Kingdom that compared between genders and the perception of physiotherapy¹⁰. The comparison made between Chinese and non-Chinese race, although statistically significant, may be affected due to the low number of non-Chinese participants in the study.

Although 98.5% of the students reported that they knew what physiotherapy is, there is a general lack of awareness about the work settings of physiotherapists, sub-specialties in physiotherapy, whether or not physiotherapists prescribe drugs, role of physiotherapists in x-ray recommendation, and physiotherapy referral. Most of the students were aware of the role of physiotherapy in health care, and the cost and benefits of physiotherapy.

Concerning awareness of physiotherapist work setting, many of the students had inadequate awareness. The awareness of physiotherapists working in ICU/NICU/CCU is low (16.2%), this may due to a lack of awareness of the role of physiotherapists in the ICU setting. Also, many did not acknowledge schools, special education schools, corporation/business setting, as workplaces for physiotherapists. Again, the reason for this could be due to the lack of awareness of the role of physiotherapy in health promotion in these settings. Although only 30.3% of the students responded that home-visit is a work setting for physiotherapists, 75.3% of the students had gave a positive response when specifically asked if physiotherapists provide home-based care. A possible reason for this outcome could be that some students had unintentionally missed the option of home-visit in question on physiotherapist work setting.

Very few students had adequate awareness regarding physiotherapy sub-specialties. Among those who reported that they were aware of the sub-specialties in physiotherapy, most of them knew about orthopedics, sports physiotherapy and neurology. The reason for this could be a lack of familiarity about the diverse scopes in physiotherapy. Similar obervations were made in a survey study conducted to assess the awareness of various aspects of physiotherapy among medical residents¹¹.

Many of the students were unclear on whether physiotherapists can prescribe drugs to patients. This may be due to a lack of understanding on the job scope of physiotherapists. Hence, there is a need to clarify the role of physiotherapists in drug prescription.

More than 50% of the students reported that a physician referral before taking physiotherapy treatment is required only sometimes. This reveals that the students were not very much aware about the referral system of physiotherapy in Malaysia. Only 28.3% had reported that a physician referral is always required before receiving physiotherapy services. Out of that, only 32 out of 112 current MBBS students who participated in the study knew that a physican referral is always required before taking physiotherapy treatment. There is a need to educate the medical students about physiotherapy referral in Malaysia to cultivate a practice of referring patients for physiotherapy when appropriate during their clinical practice in the future.

Majority of the students were aware of the role of physiotherapy in health care. However, there were some students who think that the role of physiotherapy is to treat communication disorders and hearing deficits, which is actually within the scope of speech therapy. Some students also think that evaluating the psychological status of a patient is also the role of physiotherapy in health care. This is a misconception because a person’s psychological status can be evaluated thoroughly through therapy sessions conducted by a clinical psychologist, not a physiotherapist. Also, there were students who think that physiotherapists provide emotional support in stressful situations. This is not a major role of physiotherapy in health care services, but a role to be played through counselling sessions by a professional counsellor in the health care team. Few students even think that the role of physiotherapy in health care is for coordinating funding resources, which is actually a duty to be carried out by a health service manager. These findings suggest that the students need to have a clearer and more distinct definition of the roles of members in the health care team, in order for interdisciplinary collaboration to take place smoothly in the future.

Apart from that, the findings also reveal that a fair number of students were familiar about the study duration of bachelor of physiotherapy course in Malaysia, impairments can be treated by physiotherapists and the techniques conducted by physiotherapists. However, there was a great lack of knowledge in areas of physiotherapy including, cases and conditions managed by physiotherapists, examination procedures conducted by physiotherapists and modalities used in physiotherapy.

The result of the study shows that more than half of the students know that the duration of study for the Bachelor of Physiotherapy course in Malaysia was 4 years. This could be due to information about physiotherapy obtained through career days or education fairs, where people would enquire or get to know about duration of courses.

As seen, majority knew that physiotherapists evaluate and assess impairments such as strength, balance, posture, coordination and range of motion. Only a few knew that physiotherapists are able to assess breathing pattern, lung function, and incontinence. This could be due to lack of awareness about cardiopulmonary physiotherapy and physiotherapy in women’s health.

Moreover, the findings show that a high number of students do not have adequate knowledge on the cases seen by physiotherapists (87.9%) and the conditions that can be treated by physiotherapists (90.9%). Many knew about the cases and conditions related to musculoskeletal physiotherapy, but the knowledge of other cases and conditions can be managed by physiotherapists were lacking. This can be seen in the lack of knowledge on cases such as developmental pediatric disorders, cardiopulmonary related cases, and women’s health conditions, resulting in a lack of knowledge on conditions relating to these scopes of physiotherapy such as pelvic floor disorders, cerebral palsy, chronic obstructive pulmonary disease and asthma. This may be due to unfamiliarity of the students concerning scopes of physiotherapy other than musculoskeletal and sports physiotherapy. Hence, there is an urgent need to educate the students regarding the scopes of physiotherapy and the conditions managed by physiotherapists to develop a better understanding of the various specialties in physiotherapy. This is important in inter-professionalism and for the benefit of the patient’sreceving health care services in the future.

The findings reveal more than half of the students had inadequate knowledge on the examination procedures conducted by physiotherapists. Again, students were most familiar with the examination of special tests for musculoskeletal system. The low percentage of participants who knew about respiratory assessment shows that there may be a lack of awareness about cardiorespiratory physiotherapy. This can be seen also in the student’s knowledge of physiotherapy techniques. Although more than 50% of the students had adequate knowledge of physiotherapy techniques, they were less familiar with cardiopulmonary techniques used in physiotherapy such as performing suction and manual techniques, and prescribing airway clearance techniques. The lack of knowledge on cardiopulmonary physiotherapy can be reflected also in the lack of knowledge about modalities used in this area such as incentive spirometer, flutter and jet nebulizer.

The result shows that a high number of students (98%) do not have adequate knowledge of physiotherapy modalities. Among the fifty students who reported that they know about physiotherapy modalities, most of them knew of the TENS machine, followed by modalites like NMES, therapeutic ultrasound, and cryotherapy. This may be due to the common use of these modalities in pain relief. Other than that, many were not aware of the various modalities used by physiotherapists. As health care students, it is good to gain basic knowledge on the uses and effects of therapeutic modalities so that various health care professions are able to work together and include the expertise of physiotherapy along with the expertise of different health professions in an inter-collaborative patient-approach.

This study had also assessed the preference of physiotherapy among medical and health sciences students. It was found that majority of the students would most prefer physiotherapy only when the condition is a chronic. For acute conditions, majority had preferred no intervention, while the rate of preference for physiotherapy rose from 15.7% in acute conditions to 28.3% for sub-acute conditions. As for fitness, most students would prefer going to a fitness trainer first, followed by a physician, and then only a physiotherapist. This reveals that the students may not be very much aware about the role of physiotherapists in fitness education. Also, not many of the students think that no one can substitute the role of physiotherapists. They perceived that other professionals such as chiropractors and doctors can substitute the services provided by physiotherapists. This shows that the role of each professional has not been well-defined among the students. They were not able to accurately distinguish or draw a clear line between the professional abilities of working professionals, leading to the mindset of thinking that one can substitute the services provided by the other.

From the data collected, it was found that 93.9% (n=186) of the medical and health sciences students would like to know more about physiotherapy. This shows that majority of the students are open and willing to receive more information about physiotherapy, and have a positive attitude about physiotherapy. Most of the students reported that they are interested in knowing more about therapeutic exercises, pain relief, and relaxation. Students are keen on self-help techniques that would be useful for them in situations which require these aspects.

The focus of this research study is to determine the level of awareness and knowledge among medical and health sciences students from Universiti Tunku Abdul Rahman. In summary, the researcher can make inference based on the findings of the study that the level of awareness and knowledge of physiotherapy among undergraduate students of other health care professions is still inadequate, appropriate measures should be taken to improve their knowledge. It is highly recommended to emphasize inter-professional education and carry out measures to increase the awareness and knowledge of physiotherapy among these future health care professionals. Through the data collected, majority of the students reported that interactive workshop including role play would be an effective strategy in increasing physiotherapy knowledge among health care students, followed by case studies and classroom lecture. This suggests that the students would prefer an interactive style of learning rather than the traditional classroom teaching. Some students had given their opinion and suggested the following: providing free physiotherapy service/treatment; using online articles and games as a medium; through physiotherapy club activities and more publicity on it; collaboration between UTAR nursing and physiotherapy students during clinical postings in the hospital; experiencing being a physiotherapist for a few days; lectures and practical sessions; more publicty on physiotherapy. These strategies should be taken into consideration when planning to implement inter-professional education in the curriculum of their study.

5. CONCLUSION:

This study concludes that even though 98.5% of the students reported that they knew what physiotherapy is, there is still a lack of awareness and knowledge of physiotherapy among medical and health sciences undergraduate students. The summary of the findings of the study shows that the scope of physiotherapy is still not very well understood among medical and health sciences students. Other than musculoskeletal and sports physiotherapy, the awareness of other scopes in physiotherapy such as cardiopulmonary physiotherapy and physiotherapy in women’s health were not satisfactory.

Hence, appropriate strategies must be implemented to enhance the knowledge about physiotherapy among medical and health sciences students. This can be done through the emphasis of inter-professional education during their undergraduate program of study. Besides that, relevant authorities and those in the field of physiotherapy should be more pro-active in raising the awareness and recognition of the growing physiotherapy profession in Malaysia, for the advancement of quality health care services in the country.

6. LIMITATIONS:

All studies have limitations. In this study, there were some characteristics of research design and methodology which may have influenced or impacted the findings from this research.

Firstly, the design of the current research was cross-sectional, which means that the data were gathered and collected at one specific point in time only. It is only a snap-shot of the present situation, which may provide differing results if the study was conducted at another time-frame.

Besides that, the results of the study may not be generalizable beyond the specific population from which the sample was drawn due to a unique sample size of 198 participants from one university. The data cannot represent medical and health sciences students from other universities in Malaysia.

In addition, convenient sampling was the method of sampling used in this study. Majority of the samples were taken from students in Year 1 to Year 3 as they were easily available in the university campus whereas most of the Year 4 and Year 5 students were at their clinical posting sites. This may cause bias in respondents and may affect the accuracy and consistency of the findings.

Furthermore, majority of the students were from the Chinese race therefore it was difficult to evenly recruit partcipants from different races. As a result, it was hard to make good comparisons on the level of awareness and knowledge of physiotherapy among different races.

Moreover, the instrumentation used in the study was a questionnaire structured with close-ended questions. The disadvantages or limitations in using close-ended questions is that it does not give information about whether or not the respondent actually understood the question being asked. Misinterpretation of a question can also go unnoticed. Other than that, the options given in the question may suggest ideas that the respondents would not otherwise have or may even confuse the respondents if they feel there were too many options given. All these may result in bias of the particpant’s response in the survey. Also, self-reported data may contain some potential source of bias such as recall bias.

7. RECOMMENDATIONS:

In future, the study should be conducted with a larger sample size in different colleges and universities so that the data can be generalized to all medical and health sciences students in all institutions in Malaysia. Other than that, further studies regarding the awareness of physiotherapy can be carried out within different populations such as primary and secondary school students, general public etc. as there is still a lack of research done concerning this area in Malaysia. The researcher also recommends the study to be conducted among current working health professionals, such as medical doctors who have the responsibility to refer patients for physiotherapy. As suggested, "A physician must understand the principles and methods that physiotherapist’s use¹². With this understanding, a physician can appropriately include therapy services and comprehensive diagnostic and treatment planning”.

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Received on 30.10.2018 Modified on 18.11.2018

Research J. Pharm. and Tech. 2019; 12(4): 1695-1706.

DOI: 10.5958/0974-360X.2019.00283.X