Do Physiotherapists in Nigeria Accept and Adopt Tele-rehabilitation: A Mixed-method Study

Abstract

Background Recent exponential increase in adoption of tele-rehabilitation among physiotherapists in developed countries has highlighted its effectiveness in complementing conventional physical contact physiotherapy. However, many low-and middle-income countries have limited evidence on acceptance and adoption of tele-rehabilitation.Method This was a mixed method design of quantitative and qualitative study, aimed at investigating acceptance and adoption of tele-rehabilitation among Physiotherapists in Nigeria. Respondents comprised 331 physiotherapists working in Nigeria and registered with the Medical Rehabilitation Therapists (Registration) Board of Nigeria (MRTB). Quantitative approach involved completion of a 33-item structured questionnaire shared as Google Forms on respondents’ WhatsApp and emails. Qualitative aspect involved in-depth interview with 12 physiotherapists at the clinics, using a 10-item semi-structured interview guide, and recorded with a voice recorder. Quantitative data was analyzed using descriptive and inferential statistics at p < 0.05 Alpha level. Qualitative data was analyzed using thematic content analysis.Results Respondents comprised 172 males and 159 females. Their mean age and years of experience were 33.42 ± 8.95 and 8.86 ± 8.037 years respectively. Pre-lockdown, only 62 (18.7%) respondents offered tele-physiotherapy. During the lockdown, 114 (34.4%) offered tele-physiotherapy. Smartphone apps were used by the majority155 (46.8%). 57 (17.2%) respondents were confident that tele-rehabilitation can complement conventional physiotherapy, while 72 (21.8%) kept offering post-lockdown. Use of digital technology was highest for patient education 97 (29.3%), especially for education in musculoskeletal conditions, 85 (25.7%). There were significant associations between pre-lockdown duties (p-value = 0.036), post-lockdown duties (p- value = 0.005), use of digital health technology (p-value = 0.001) with respondents’ age. Significant associations also existed between respondents’ years of practice and each of post-lockdown duties (p-value = 0.017) and use of digital health technology (p-value = 0.001). Qualitative approach revealed that facilitators to adoption and acceptance of tele-rehabilitation included patient education, training of physiotherapists, developing and implementing evidence based guidelines, and affordability and availability of tele-health software and hardware systems. Barriers were lack of or limited technological infrastructures, finances, hospital management support, and knowledge of ICT.Conclusions Physiotherapists in Nigeria demonstrated moderate acceptance but low adoption of tele-rehabilitation. Training of physiotherapists in tele-rehabilitation is recommended. The MRTB and policy makers should provide enabling technological environment for tele-rehabilitation in Nigeria.