Saudi Cultural Missions Theses & Dissertations
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Item Restricted Patient Education and Compliance in Saudi Physiotherapy: A Qualitative Study of Barriers and Facilitating Strategies(Saudi Digital Library, 2025) Helmi, Mariam Mohamedwail A; Haloub, RadiIntroduction: Patient education has been regarded in the literature as a critical element in ensuring treatment compliance and healing in physiotherapy. In the case of Saudi Arabia, limited qualitative research has touched on how physiotherapists perceive and deliver education, and with what issues they are confronted. Earlier research has suggested that system-related, culture- based, and personal factors can influence patient education effectiveness. This study explores these themes from the perspective of practicing physiotherapists. Methodology: This study employed a qualitative design with semi-structured interviews of 11 physiotherapists who have experience in Saudi Arabia. Purposive sampling was applied in the recruitment of the participants. Data analysis was conducted using Braun and Clarke's thematic analysis with the objective of seeking out challenges and solutions to patient education delivery. Results: Eight themes emerged: (1) education facilitates compliance, (2) time pressures hinder education, (3) language differences lower understanding, (4) low health literacy and cognitive decline hinder multicultural learning, (5) cultural belief hinders openness, (6) emotional readiness influences information uptake, (7) family participation is facilitator and barrier, and (digital technology makes compliance and participation easier. Participants emphasized the necessity of tailored communication approaches, practice sensitive to culture, and family member involvement in education. Conclusion: There are challenges for Saudi Arabian physiotherapists in ensuring successful patient education. Time and language are systemic issues, but cultural processes and individual factors exist as well. Tailored education, use of digital platforms, and family involvement may enhance compliance. The study indicates the relevance of context-relevant approaches and sets the stage for institutional intervention and future research.9 0Item Restricted Effectiveness of pain neuroscience education in migraine management: a systematic review(Saudi Digital Library, 2025) Mukhaizn, Abdulaziz; Sriram, Sandhya; Kerry, Roger; Kerry, RogerAbstract Background Migraine is a leading cause of disability worldwide. Although pharmacological therapies are available, many patients remain symptomatic or discontinue treatment. Pain neuroscience education (PNE), which reframes pain as a multifactorial experience, has been proposed as a low-cost, scalable intervention. Its role in migraine care remains uncertain. Methods This systematic review was conducted according to PRISMA 2020 and registered in PROSPERO (CRD420251082539). Eligible studies were randomised controlled trials including adults with migraine, where PNE was delivered alone or in combination with physiotherapy, or usual primary care, compared with usual care or non-neuroscience education. The primary outcome was headache-related disability (MIDAS, HIT-6); secondary outcomes were headache frequency and intensity. Risk of bias (ROB) was assessed using the Joanna Briggs Institute (JBI) checklist and certainty of evidence with GRADEpro gdt. Narrative synthesis was performed due to heterogeneity. Results Five RCTs (n=416) were included. Short-term MIDAS results were inconsistent (very low certainty), whereas long-term outcomes favoured PNE, with high-certainty evidence that PNE more than doubled the likelihood of achieving ≥50% disability reduction at 12 months. HIT-6 improved across all groups, with between-group differences below the minimal clinically important difference (moderate certainty). Headache frequency showed mixed results: very low certainty short-term, low certainty long-term, but high-certainty benefit when analysed dichotomously. Headache intensity improved within groups, with moderate-certainty evidence supporting superior outcomes for PNE at several follow-ups. Conclusions PNE may reduce disability, headache frequency, and intensity in migraine, particularly when used in multimodal programmes. Evidence for standalone PNE is promising but limited to single trials. Standardised PNE content/dose, attention-matched comparators, and consistent outcome reporting (with MCIDs) are priorities for future trials.11 0Item Restricted Intra-Rater Reliability and Concurrent Validity of the 2-minute Step Test applied virtually to Healthy Adults: a Descriptive Study(Cardiff University, 2022) Alharbi, Ziyad Ahmed S; Jones, UnaBackground: Morbidity of cardiopulmonary diseases is heavily affected by cardiopulmonary fitness (CPF), which is correlated with physical activity and inversely correlated with all-case mortality. People with cardiopulmonary disorders often have lower CPF, due to pathological changes causing pulmonary symptoms, such as exercise intolerance. Assessment of CPF, before, during and after prescribed rehabilitation programmes is an important role of physiotherapists. This is often achieved by exercise testing using, for example, the 2-minute step test (2MST). 2MST is valid and reliable when conducted in person. In conditions such as those imposed by the COVID-19 pandemic, teleassessment can help physiotherapists to continue to monitor CPF remotely, therefore, the reliability and validity of 2MST conducted remotely, currently unknown, is important. Study aims: To determine intra-rater reliability and concurrent validity of remotely administered 2MST in healthy people. Methods: an observational study comprising three remotely administered 2MST separated by 15-minute rest intervals, followed, within a week, by a face-to-face 2MST. Remote 2MSTs were supervised by the researcher via a web-based videoconferencing tool. Achieved steps were used to estimate reliability. Scores from the second remote and face-to-face assessments were used to assess validity. Results: In a sample of ten healthy participants, eight males, mean age 25.6 (22 – 30) years, intra-rater reliability of remote 2MST was excellent (ICC = 0.924), and there was strong correlation between remote and face-to-face tests (Pearson’s r = 0.865; p < 0.01). Agreement between remote and face-to-face tests was relatively low (mean difference -1.8 steps) with wide limits of agreement (-17.92 – 14.32). Conclusions: The findings suggest that 2MST administered remotely, when used on healthy adults, with excellent relative reliability and high levels of validity. However, due to lower absolute agreement between the tests cannot be used interchangeably. further studies could overcome the limitations of this study and confirm its legitimacy.41 0Item Restricted An Exploration of the Acceptance of Telerehabilitation in Saudi Arabia: Physiotherapists' and Patients' Perspectives(University of Nottingham, 2024-01-29) Alanazi, Ahmed; Wharrad, HeatherBackground: Providing long-term treatment and monitoring for patients, especially those with neurological conditions, requires resources which are not always available. Consequently, finding innovative solutions that can ease the financial and physical burden of chronic conditions is essential. Telerehabilitation offers a potential solution to this challenge, and it was widely used during the COVID-19 pandemic, when face-to-face rehabilitation services could not be provided. However, despite its clinical effectiveness, previous studies suggest that its application may be impeded by users’ concerns, and an inadequate understanding of the practical implications of the discipline. The number of people with chronic disabilities in the Kingdom of Saudi Arabia (KSA) exceeds one million, and these patients require regular sessions with physiotherapists; however, accessing rehabilitation services can be difficult and costly, especially for those in rural or remote areas. Although telerehabilitation was used in the Saudi healthcare system before the pandemic, no formal framework to support its implementation exists and the potential barriers to its wider adoption in the country have not been clearly identified. As a result, this study explores the acceptance of telerehabilitation among physiotherapists and patients with neurological conditions in KSA and proposes a potential strategy for its nationwide implementation which takes account of the country’s large geographic area and its socio-religious context. Methods: This study adopts a pragmatic philosophical paradigm and employs the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) models to identify the factors which influence Saudi physiotherapists’ and patients’ acceptance of telerehabilitation. It also utilises Q methodology to gather and analyse the data, introducing a novel online approach to data collection in response to the limits on face-to-face engagement as a result of the pandemic. Results and discussion: The physiotherapist participants viewed telerehabilitation as beneficial, particularly for patients in rural or isolated areas, but they expressed concerns about data security, and the lack of training and technical support. The use of Q methodology enabled them to be categorised into three attitude-based groups: Advocates, who supported telerehabilitation for its cost-effectiveness; Pragmatists, who were open to healthcare technology but emphasised the need for better patient understanding of the uses of telerehabilitation; and Hesitants, who were uncertain and concerned about missing important clinical information. The patients with MS had varied perspectives, appreciating potential benefits, such as cost savings, but expressing concerns about data security and highlighting the lack of support from family and friends as a potential barrier. These patients were also categorised into three groups: Supporters, who recognised telerehabilitation's benefits but had concerns about a lack of suitable space at home and would prefer to be treated by a physiotherapist of the same gender; Rationalists, who accepted telerehabilitation's potential benefits but who thought more resources were required in order to accept it; and Resisters, who questioned its effectiveness over face-to-face rehabilitation. Barriers to telerehabilitation acceptance included the lack of facilitating conditions, such as training, guidelines, and equipment, individual differences such as age, gender knowledge, digital literacy, and medical conditions, and social influence, such as lack of support and encouragement from physiotherapists and family and friends to use telerehabilitation. These findings informed the development of a logic model for a strategy to implement telerehabilitation in KSA, which considers religious and cultural beliefs in KSA, and addresses the barriers identified above. The model sets out the desired outcomes, necessary inputs, and activities for physiotherapists, patients and healthcare services. It also lists the short-term, medium-term, and long-term outputs, the assumptions on which the model is based, and the external factors which might affect its implementation, including the rapid rate of social change in KSA. Conclusion: This study fills a gap in the literature by examining users' perceptions of telerehabilitation in KSA and identifying the barriers to its acceptance among two key stakeholders groups. The logic model contributes to society by outlining a strategy for the implementation of telerehabilitation in KSA, and, potentially, in other countries which share its cultural and religious values. The study also contributes to Q methodology by demonstrating an innovative method for online data collection and evaluating its effectiveness. In addition, the use of Q methodology in combination with the TAM and UTAUT models provides a methodology to assess user acceptance of healthcare technologies which could be used in other contexts. As such, the findings of this study are of immediate value to policy makers and healthcare providers in KSA, but they also have wider implications. Future research in the Saudi context should focus on the feasibility of the proposed strategy, including cost-benefit analyses and practical trials, and exploring perceptions in other rehabilitation fields, such as occupational and speech therapy.92 0Item Restricted PHYSIOTHERAPISTS’ AND MOTHERS’ LIVED EXPERIENCES OF FAMILY-CENTRED CARE FOR CHILDREN WITH PHYSICAL DISABILITIES IN SAUDI ARABIA: AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS(Saudi Digital Library, 2023) Jamal, Abeer; Clouston, Teena; Hodges, AmieIntroduction Family-centred care (FCC) is an approach for determining the best pediatric healthcare services for children and families. As families are an important part of a child's identity, healthcare providers must consider family dynamics, needs, and wishes when treating and supporting children. FCC has been explored worldwide; however, there is little knowledge about it in Saudi Arabia. Accordingly, this study examined the lived experiences of physiotherapists and mothers regarding FCC for children with physical disabilities in Saudi Arabia. Methodology Interpretative Phenomenological Analysis (IPA) was chosen to demonstrate how participants interpret a lived experience and make meaning of their personal and social reality. A face-to-face interview with open-ended questions was conducted with 8 participants (4 physiotherapists and 4 mothers of children with disabilities). Interviews were conducted in English and Arabic and lasted from 30 minutes to an hour and a half. A four-step analysis was carried out, following Smith et al. 's guidelines (2009). As IPA is idiographic, each interview was analysed individually, and then the process was repeated. To compare experiences, a cross-case analysis was done. Findings The mothers' and physiotherapists' experiences revealed five themes: ‘current status of FCC within Saudi Arabia’, ‘roles of care and family dynamics in Saudi’, ‘communication as the cornerstone to FCC’, ‘the provision of support’, and ‘culture as a barrier to father’s involvement’. FCC was unfamiliar to participants yet seen as different care. Saudi culture altered the division of caring roles, father engagement, and burden of care, which sometimes hindered family involvement and FCC provision. Communication, support, and information helped participants understand their children's conditions and rehabilitation, which improved their involvement in their children’s care. Conclusion The study has provided new knowledge and understanding of FCC. The principles of FCC aligned with the Islamic values of Saudi culture, where some were reflected in the physiotherapist's clinical practice, but they were not explicitly recognised under a particular concept. Participants' experiences were heavily influenced by Saudi culture, which affects FCC provision and requires customising FCC to meet Saudi families' needs.46 0Item Restricted Joint Hypermobility: a survey of knowledge and current practices among Saudi paediatric physiotherapists(Saudi Digital Library, 2023-12-01) Rehbeeni, Omamah; Simmonds, JaneBackground: Physiotherapists play a crucial role in the management of children with joint hypermobility (JH) and symptomatic joint hypermobility (SJH). Therefore, this study aimed to assess knowledge of these conditions among paediatric physiotherapists in Saudi Arabia and to review current practices in terms of the assessment and management of children with JH and SJH. Methods: A cross-sectional study design utilising a previously validated questionnaire was conducted. The questionnaire was distributed online among eligible Saudi paediatric physiotherapists via the Saudi Physical Therapy Association and convenience sampling. The study was between June to July 2023. Results: A total of 69 responses were collected, 28 of which completed the questionnaire. Most participants (79%) had received no undergraduate training in joint hypermobility and related conditions, while 59% of the respondents with postgraduate education had received no training. The mean score of total knowledge about JH and its associated conditions and features was 18.24 out of 41. A significant association was found between the knowledge score and postgraduate training (p < 0.006). Assessment tools for diagnosing JH and related conditions were used by one-third or less of the respondents. Only 32% of respondents were confident with their assessment of this condition, and only 52% of them were confident with their treatment. Conclusion: There is a knowledge gap about JH and SJH among Saudi paediatric physiotherapists. Education and training were shown to improve knowledge scores. Therefore, it is important to address the gap and improve confidence levels through evidence-based education and training.47 0Item Restricted Psychological Interventions within Physiotherapy: A Qualitative Exploration of the Perspectives of Paediatric Physiotherapists in the Kingdom of Saudi Arabia(Saudi Digital Library, 2023-12-01) Hakami, Wafaa; Coomer, AnnetteBackground: Paediatric physiotherapists treat children with disabilities to improve their quality of life. According to GASTAT (2017) disability survey in the Kingdom of Saudi Arabia (KSA), 11.16% of Saudi children aged 5-19 years old have disabilities. Children with physical disabilities may struggle psychologically and socially, so the biopsychosocial model can be implemented in physiotherapy as a holistic approach. Physiotherapists implement Psychologically Informed Physiotherapy (PIP) to integrate the biopsychosocial model into physiotherapy practice (Porter, 2016; Smart, 2023; Gervais-Hupe et al., 2022). Gray et al. (2021) found that many physiotherapists had positive attitudes and beliefs about PIP, but there is a need for further development. Methods: A qualitative study using epistemological philosophies was conducted to explore the research aims and objectives. Paediatric physiotherapists in the Kingdom of Saudi Arabia were invited to focus groups. Qualitative data were transcribed and analysed using hybrid thematic analysis. Data collection took place between June and July 2023. Findings: Ten participants in four focus groups, with three to two participants in each group. Thematic analysis identified three themes: knowledge, implementation, and future needs. The knowledge included exploring the history of academic education, post-professional education, and the basis of knowledge. Implementation briefly mentioned conditions and then explored interventions, strategies, and techniques. Purposes were also included in the implementation theme. The third theme was future learning and training needs recommendations and suggestions. Conclusion: This study was the first to explore and provide valuable insights into paediatric physiotherapists’ perspectives of knowledge of psychology, psychological interventions and PIP in KSA.43 0