Journal of Multidisciplinary Healthcare

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Physiotherapists Lack Knowledge in Mental Health:

A Survey of Knowledge and Attitudes of Physical
Therapists About Their Role in Mental Health

Madawi Alotaibi, Alanoud Alotaibi, Amani Alqahtani, Rand Alghonaim,

Samira Alzahrani, Tala Altamimi, Doaa Aljasser, Samiah Alqabbani & Afrah
Almuwais

To cite this article: Madawi Alotaibi, Alanoud Alotaibi, Amani Alqahtani, Rand Alghonaim,
Samira Alzahrani, Tala Altamimi, Doaa Aljasser, Samiah Alqabbani & Afrah Almuwais (2024)
Physiotherapists Lack Knowledge in Mental Health: A Survey of Knowledge and Attitudes of
Physical Therapists About Their Role in Mental Health, Journal of Multidisciplinary Healthcare, ,
2821-2830, DOI: 10.2147/JMDH.S461746

To link to this article: https://doi.org/10.2147/JMDH.S461746

© 2024 Alotaibi et al.

Published online: 12 Jun 2024.

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Open Access Full Text Article

ORIGINAL RESEARCH

Physiotherapists Lack Knowledge in Mental Health:

A Survey of Knowledge and Attitudes of Physical
Therapists About Their Role in Mental Health
Madawi Alotaibi 1 , Alanoud Alotaibi 1 , Amani Alqahtani 1 , Rand Alghonaim 1
, Samira Alzahrani 1 ,
Tala Altamimi 1 , Doaa Aljasser 2 , Samiah Alqabbani 1 , Afrah Almuwais 1
1
Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi
Arabia; 2Epidemiology and Biostatistics Section, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia

Correspondence: Afrah Almuwais, Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint
Abdulrahman University, P.O. Box 25058, Riyadh, 11466, Saudi Arabia, Email [email protected]

Purpose: As the number of mental illnesses increases, there is a need to manage it holistically within a multidisciplinary team. The
majority of patients with physical disabilities suffer from mental health problems, and physiotherapy can play a role in improving their
lifestyle. This study aimed to determine physiotherapists’ self-reported knowledge and attitudes regarding their role in treating patients
with mental health disorders.
Methods: This study adopted a descriptive, cross-sectional, and prospective observational survey design. The sample consisted of 208
physical therapists.
Results: The majority of the participants, (48%) had a positive attitude score, with (40%) having a neutral attitude and (12%) having
a negative attitude toward treating patients with mental health issues. Most respondents (86%) reported that they need more
information regarding patients with mental health disorders and physiotherapists’ management of their physical health issues.
Conclusion: Many physiotherapists lack knowledge and hold a neutral to negative attitude towards treating patients with mental
disorders. This highlights the need for more training to fill the gap in knowledge and guide physiotherapists to build upon their positive
attitude towards treating patients with mental disorders.
Keywords: physiotherapists, mental illness, mental health, psychosocial

Introduction
According to the World Health Organization (WHO),1 mental disorders are characterized by clinically significant disturbances in
an individual’s cognition, emotional regulation, or behavior. There are many different types of mental disorders, such as
schizophrenia spectrum disorders, major depression, and bipolar disorder.1 All of these are categorized as severe and persistent
mental illnesses (SPMI), which are associated with high levels of disability that affect personal, social, and occupational
functioning.1 Lower socio-economic status and unhealthy lifestyles also contribute to poor physical health.2 According to
WHO,1 in 2019, one in every eight people worldwide was living with a mental disorder, anxiety, or depression; in 2020, because
of the COVID-19 pandemic there has been a 26% and 28% increase respectively for anxiety and major depressive disorders.1
Likewise, the prevalence of mental disorders in Saudi Arabia increased throughout different phases of the pandemic.3
People who experience severe and persistent psychological problems, such as schizophrenia, bipolar disorder, and major
depressive disorder, report having poor physical health and a high prevalence of coexisting medical conditions (respiratory and
cardiovascular diseases, diabetes mellitus, and obesity, among others).4 Additionally, these patients also have a higher
likelihood of engaging in unhealthy behaviors like smoking, abusing drugs, poor physical activity, and maintaining
a sedentary lifestyle.4 Studies showed that patients with chronic pain report a wide range of experiences, indicating that

Journal of Multidisciplinary Healthcare 2024:17 2821–2830 2821

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pain is only one aspect of their suffering and that patients are more impacted by the psychological discomfort that results from
having chronic pain, such as anxiety, loneliness, and agony.5,6
Craft & Perna7 revealed the relationship between exercise and depression, through physiological and psychological
mechanisms, including the endorphin and monoamine theories. Exercise, according to the endorphin theory, reduces
depression by increasing the release of endorphins afterward which are associated with a good mood and an improved
overall sense of well-being.7 According to the monoamine hypothesis, physical activity increases the availability of brain
neurotransmitters like serotonin, dopamine, and norepinephrine, which are reduced during depressive episodes.7 Exercise
may also exert its antidepressant benefits through improving self-efficacy.7 Self-efficacy refers to the confidence an
individual has in their ability to possess the essential skills required to accomplish a task and the assurance that the task
can be successfully completed with the intended results achieved.7
Individuals experiencing mental health disorders may enhance their quality of life through physical therapy, which
can boost their physical health, reduce psychosocial challenges, and complement primary treatments for their mental
condition.4 Evidence suggests that gains in muscle balance and flexibility are linked to improved safety and self-worth,
and better posture can lessen physical pain while enhancing mood, self-esteem, and body image.4 Strong evidence also
supports the idea that patients with mental illnesses like depression and anxiety benefit from a regular physical exercise
program.4 McGrath et al8 reported the physiotherapists’ frequency of contact with clients perceived to be experiencing
psychological distress, and clients contemplating or engaging in non-suicidal self-harm and suicidal behaviors. However,
due to a lack of mental health training, physiotherapists feel unprepared to treat patients who are experiencing poor
mental health.8,9 Moreover, physiotherapists are hesitant to address mental health issues like suicide due to fears of
inadvertently triggering unmanageable situations.8,9 This hesitation stems from concerns about the potential escalation of
difficulties beyond their capacity to effectively handle, leading to further complexities in their professional practice.8,9 In
a recent scoping review by Heywood et al,10 it was noted that physical therapists’ interactions with patients having
mental health conditions showed significant diversity. Notably, a disparity exists in the levels of confidence between
specialized physical therapists in mental health settings and those who identify knowledge deficiencies.10
As per Almirón et al,4 a reported 75.94% of physical therapists indicated their awareness of the therapeutic
applications of physiotherapy in addressing specific mental disorders, serving as a complement to both pharmacological
and psychological interventions.4 Lee et al11 found that the factors preventing people with mental disorders from
accessing physical therapy services include the lack of knowledge among mental health practitioners and individuals
with severe and chronic mental illness regarding physiotherapy and its connection to physical health in mental healthcare.
Additionally, extended waiting times; lack of integration between services; diagnostic overshadowing, where the physical
complaint is assumed to be the result of mental health; and a perceived lack of patient motivation or adherence leading to
early discharge from physiotherapy have all been identified as major barriers to accessing physical healthcare for those
with mental disorders.12 Furthermore, the stigma around mental health impedes access to healthcare services.13
Hemmings and Soundy12 conducted a study to gain insight into how people with mental health issues experienced
physical therapy care. They found that patients frequently reported feeling unheard and misunderstood, and physiothera­
pists partaking in focus groups felt that a lack of education and experience in mental health specialties was partly to
blame for the lack of consideration of psychosocial components of care.12
Determining the knowledge of physiotherapists about their role in treating patients with mental health issues can help
provide evidence about the importance of training physiotherapists in performing this critical role. This aligns with the
WHO’s “Comprehensive Mental Health Action Plan 2013–2030”, which aims to strengthen efficient leadership and
governance; provide comprehensive, integrated, and responsive community-based care; put promotion and prevention
strategies into place; and strengthen information systems, evidence, and research.1 Also, the vision statement of the
physical therapy profession, as articulated by the American Physical Therapy Association (APTA) “transforming society
by optimizing movement to improve the human experience” emphasizes that the healthcare system needs to evolve from
a medical to a biopsychosocial model.14 Recently, Furness et al15 reiterated the emphasis on educational requirements for
Australian physiotherapists, underscoring a strong demand for curriculum involving mental health conditions, the scope
of physiotherapy practice, and treatment approaches for individuals with mental health concerns.15 Given the lack of
studies investigating Saudi physiotherapists’ knowledge of their role in dealing with patients with mental illness, this

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study aims to determine the self-reported knowledge of physiotherapists regarding this role. It is hypothesized that
physical therapists have poor knowledge and negative attitudes regarding treating patients with mental disorders.

Materials and Methods

Study Design
This study is a descriptive, cross-sectional, and prospective observational survey design. The Local Committee of
Scientific Research Ethics at Princess Nourah bint Abdulrahman University (PNU) granted ethical approval for this
study (IRB: HAP-01-R-059). The survey was adapted from Andrew et al.2 The original authors authorized the adaptation
of the instrument. The survey’s content validity was verified by experts to ensure it fits with the culture of our sample,
and its face validity was verified by physiotherapy students at PNU to ensure clarity. Additionally, reliability was
assessed using Cronbach’s alpha test.

Sampling
This study used convenient sampling methods to recruit practicing physical therapists of different ages and from different
regions of Saudi Arabia. The estimated population of physical therapists was obtained from the Saudi Commission for
Health Specialties. The sample size of 326 was estimated based on a population of 6000 physical therapists practicing in
KSA, with a 95% confidence interval and a margin of error of 5%. Sampling calculations were obtained from Open-
Source Statistics for Public Health. The inclusion criteria included being licensed in physiotherapy, practicing phy­
siotherapy in Saudi Arabia, and holding a bachelor’s degree or higher degrees. The exclusion criteria included being
a physiotherapy assistant or practicing without a license.

Procedure
After the participants confirmed their informed consent, they completed the five-part survey (Appendix 1). Part one
included questions about participants’ demographic information, such as age, gender, education, residential place of
practice, years of experience, employment status, practice setting, prior job experience in a mental health context,
caseload of individuals with mental illness, kind of referral, and psychology training were among the demographic
variables. Part two included questions about the participants’ knowledge of mental illness. There are four questions in the
knowledge portion. Each respondent’s total knowledge scores (ranging from 0 to 4) were computed; a right response
netted one point, while an incorrect response netted none. Based on Bloom’s cutoff,16 the overall knowledge scores were
divided into three levels: high, moderate, and poor. Part three included questions about participants’ attitudes toward
patients with mental illness. The attitude section consisted of three questions. The total attitude scores were calculated for
each respondent and categorized into three levels based on Bloom’s cutoff: a positive attitude (ranges 7–9), a neutral
attitude (ranges 5–6), and a negative attitude (ranges >5). Lastly, part four contained questions about their perception of
the gaps in their knowledge about patients with mental illness.

Data Collection and Analysis

The data were collected through an online survey between March 2023 and October 2023. The survey has been spread
through Google Forms and distributed through emails, social media applications, and physical distribution. All partici­
pants were informed about the study’s purposes and provided informed consent at the beginning of the online survey.
Data was kept confidential and used for study purposes only. The data obtained from the online survey was only accessed
by the researchers through their secure access.
Statistical analysis was carried out using JMP. Descriptive statistics were used to analyze all the variables that were
undertaken from the survey, in addition to the chi-square and ANOVA test used for the comparative questions. The
results of these analyses were presented using frequencies and percentages for categorical variables and mean and
standard deviations for continuous variables. All tests of associations were carried out at a significance level of 0.05 and
95% confidence interval. Sample size calculations were obtained from an online sample size calculator assuming 95%
confidence interval and 5% margin of error.

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Results
Two hundred and eight physiotherapists completed the survey, this sample acquired indicated an 85% of confidence
interval with a 5% margin of error. Of these, 61% were female (127 participants), and 39% were male (81 participants),
with a mean age of 31.5 years and a standard deviation of ±7.32 years. The majority of the responses were from
physiotherapists who had more than ten years of experience as a physical therapist 29%, had a bachelor’s degree 49%,
worked in the central region 64%, and worked mostly in a public hospital 40%. Their primary area of professional
practice was musculoskeletal physiotherapy 47%, and 74% worked in an outpatient setting. Other sociodemographic data
are shown in Table 1. Of the 208 participants, only 22% obtained a high knowledge score, while the majority 50% had
poor knowledge regarding mental health. The majority of the participants 48%had a positive attitude score, with 40%
having a neutral attitude and 12% having a negative attitude toward treating patients with mental health issues (Table 2).

Table 1 Demographic Data

Demographic N %

Gender
Female 127 61%
Male 81 39%

Years of experience as a physiotherapist

Less than 2 years 51 25%
2–5 years 52 25%
5 −10 years 44 21%
More than 10 years 61 29%

Highest educational level

Bachelor 101 49%
Master degree 52 25%
Doctor of physical therapy 38 18%
Doctoral degree (PhD) 17 8%

In which region do you work

Central region 132 64%
Eastern region 26 13%
Northern region 11 5%
Western region 29 14%
Southern region 10 5%

What is your main practice setting

Home setting 6 3%
Inpatient setting 39 19%
Non-clinical 9 4%
Outpatient setting 154 74%

Current primary area of professional practice

Cardiovascular rehabilitation 4 2%
Gerontology 3 1%
ICU 2 1%
Musculoskeletal 98 47%
Neurological 36 17%
Nin Clinical 4 2%
Pediatrics 19 9%
Sport injuries 18 8%
Women’s health 7 3%
Other 17 8%

(Continued)

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Table 1 (Continued).

Demographic N %

Primary workplace
Private clinic 42 20%
Public hospital 83 40%
Rehabilitation center 19 9%
Specialized center 6 3%
University hospital 15 7%
Other 43 21%

Do you have previous experience working in a mental health setting?

Yes 30 14%
No 120 58%
Limited experience 58 28%

What proportion of your caseload includes people with mental illness?

All cases 10 5%
Approximately half 28 13%
Do not know 18 9%
Less than one quarter 106 51%
More than half 14 7%
None 32 15%

The people with mental illness in your clinical practice were

Incidental cases 50 24%
Not applicable 48 23%
Referred case – general practitioner 84 40%
Referred case – mental health professional 26 13%

Did you receive any psychology courses as a part of your academic study?
Yes 148 71%
No 46 22%
I am not sure 14 7%
Note: Reprinted with permission from Andrew E, Briffa K, Waters F, Lee S, Fary R. Physiotherapists’ views about
providing physiotherapy services to people with severe and persistent mental illness: a mixed methods study. J
Physiother. 2019;65(4):222–229.2. https://creativecommons.org/licenses/by-nc-nd/4.0/.2

Table 2 Bloom’s Knowledge

and Attitude Scores
N %

Knowledge:
High 46 22%
Moderate 58 28%
Poor 104 50%

Attitude:
Positive 99 48%
Neutral 84 40%
Negative 25 12%
Note: Reprinted with permission
from Andrew E, Briffa K, Waters F,
Lee S, Fary R. Physiotherapists’ views
about providing physiotherapy ser­
vices to people with severe and per­
sistent mental illness: a mixed
methods study. J Physiother. 2019;65
(4):222–229.2. https://creativecom
mons.org/licenses/by-nc-nd/4.0/.2

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PT Knowledge of People with Mental Disorders

Differences in knowledge scores among different demographic characteristics were assessed using the Chi-square test and
ANOVA (Table 3). The results showed that the knowledge scores were high among middle-aged therapists (30.5±7.54), and
physiotherapists with less than two years of experience showed a high knowledge score in 43% of cases, while those with over ten
years demonstrated a low score in 39% of instances (p-value = 0.001*). Furthermore, 30% physiotherapists who lived in the

Table 3 The Impact of Demographic Data on the Knowledge and Attitude Score
Variable Knowledge Attitude

High Moderate low P-value Positive Neutral Negative P-value

Age (mean ± SD) 30.5±7.54 31.7±6.60 31.9 ±7.62 0.0554 30.5±6.3 32.6±7.8 31.9±8.6 0.1501

Gender (n%) 0.0150 0.1478

Female 33 (26%) 37 (29%) 57 (45%) 67 (53%) 45 (35%) 15 (18%)
Male 13 (16%) 21 (26%) 47 (58%) 32 (40%) 39 (48%) 10 (12%)

Years of experience as a physiotherapist (n%) 0.0001* 0.3628

Less than 2 years 22 (43%) 9(34%) 20 (39%) 30 (59%) 15 (29%) 6(112%)
2–5 years 2(4%) 19 (36%) 31 (60%) 27 (52%) 20 (39%) 5(10%)
5 −10 years 11 (25%) 15 (34%) 18 (41%) 19 (36%) 21 (48%) 7(16%)
More than 10 years 11 (18%) 15 (18%) 35 (39%) 26 (43%) 28 (46%) 7(12%)

Highest educational level (n%) 0.2568 0.1185

Bachelor 20 (20%) 26 (24%) 55 (54%) 45 (45%) 41 (41%) 15 (15%)
Master degree 10 (19%) 12 (23%) 30,589%) 19 (37%) 27 (52%) 6(12%)
Doctor of physical therapy 11 (29%) 13 (34%) 14 (37%) 25 (66%) 10 (26%) 3(8%)
Doctoral degree (PhD) 4(29%) 7(41%) 5(29%) 10 (59%) 6(35%) 1(6%)

In which region do you work (n%) 0.0309* 0.1415

Central region 31 (24%) 40 (30%) 61 (46%) 66 (50%) 52 (39%) 14 (11%)
Eastern region 2(8%) 9(34%) 15 (58%) 13 (50%) 7(27%) 6(23%)
Northern region 1(9%) 0 10 (90%) 4(36%) 5(46%) 2(18%)
Western region 9(31%) 6(21%) 14 (48%) 9(31%) 17 (59%) 3(10%)
Southern region 3(30%) 3(30%) 4(40%) 7(70%) 3(30%) 0

What is your main practice setting (n%) 0.5913 0.4432

Home setting 2(33%) 0 4(67%) 3 (50%) 2 (33%) 1 (17%)
Inpatient setting 7(18%) 11 (28%) 21 (54%) 14 (36%) 22 (56%) 3(8%)
Non-clinical 2(22%) 3(33%) 4(44%) 4 (44%) 3 (33%) 2 (22%)
Outpatient setting 35 (23%) 44 (29%) 75 (49%) 78 (50%) 57 (37%) 19 (12%)

Do you have previous experience working in 0.4093 0.3142

a mental health setting (n%)
Yes 4(13%) 8(27%) 18 (60%) 17 (57%) 11 (37%) 1 (7%)
No 29 (24%) 37 (31%) 54 (45%) 53 (44%) 48 (40%) 19 (16%)
Limited experience 13 (22%) 13 (22%) 32 (55%) 29 (50%) 25 (43%) 4 (7%)

What proportion of your caseload includes 0.0935 0.0143*

people with mental illness (n%)
All cases 1(10%) 2(20%) 7(70%) 3 (30%) 5 (50%) 2 (20%)
Approximately half 9(32%) 7(25%) 12 (32%) 19 (68%) 8 (29%) 1 (4%)
Do not know 3(17%) 10 (55%) 5(28%) 10 (56%) 7 (39%) 1 (6%)
Less than one quarter 27 (26%) 30 (46%) 49 (28%) 56 (53%) 38 (36%) 12 (11%)
More than half 2(14%) 3(21%) 9(64%) 2 (14%) 10 (71%) 2 (14%)
None 4(13%) 6(19%) 22 (69%) 9 (28%) 16 (50%) 7 (22%)

(Continued)

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Table 3 (Continued).

Variable Knowledge Attitude

High Moderate low P-value Positive Neutral Negative P-value

The people with mental illness in your 0.0989 0.40698

clinical practice were (n%)
Incidental cases 12 (24%) 18 (36%) 20 (40%) 28 (56%) 19 (38%) 3 (6%)
Not applicable 11 (23%) 12 (25%) 225 (52%) 23 (48%) 17 (35%) 8 (17%)
Referred case – general practitioner 21 (25%) 24 (29%) 39 (46%) 23 (45%) 34 (40%) 12 (14%)
Referred case – mental health professional 2 (8%) 4 (77%) 20 (15%) 10 (39%) 14 (54%) 2 (8%)

Did you receive any psychology courses as 0.0017* 0.0135

a part of your academic study (n%)
Yes 41 (28%) 37 (25%) 70 (47%) 72 (49%) 57 (39%) 19 (13%)
No 5 (11%) 12 (20%) 29 (60%) 20 (44%) 20 (43%) 6 (13%)
I am not sure 0 9 (64%) 5 (35%) 7 (50%) 7 (50%) 0

Notes: *significant p-value < 0.05. Reprinted with permission from Andrew E, Briffa K, Waters F, Lee S, Fary R. Physiotherapists’ views about providing physiotherapy services to
people with severe and persistent mental illness: a mixed methods study. J Physiother. 2019;65(4):222–229.2. https://creativecommons.org/licenses/by-nc-nd/4.0/.2

central region showed a moderate knowledge score, while 46% displayed a low score (p-value = 0.0309*). Among physiothera­
pists who underwent psychological course training, 28% achieved a high knowledge score, whereas 47% scored lower
(p-value= 0.0017*).
Although they were insignificant, the results showed that the knowledge scores of females and more experienced
therapists with a bachelor’s degree (p-value = 0.2568) and musculoskeletal subspecialty who worked in an outpatient
department (OPD) of a public hospital (p-value = 0.5913) were higher than the scores of other therapists.

PT Attitudes Toward People with Mental Disorders

The Chi-square analysis did not reveal any significant differences (p>0.05) in relation to the demographic data except,
physiotherapists with less than a quarter proportion of their caseload inclusive of people with mental illness, 53%
displayed a positive attitude, 30% were neutral, and 11% showed a negative attitude (p-value=0.0143) (Table 3).

PTs’ Perceived Knowledge Gap Regarding Their Role in Mental Health

Part four of the study contained two questions aimed at determining whether physiotherapists needed more education or
knowledge, and which types of information might be helpful for physiotherapists in managing the physical health needs
of people with mental illness. The vast majority of respondents 86% agreed that they needed more training or
information, and when they were asked what kind of information they would like to receive, most of them identified
general mental health illnesses, physical health issues frequently linked to mental illness, and management of physical
health issues in patients with mental illness. Most respondents, in general, agreed that they needed more education and
practice on a wide range of information. At the end of the survey, an open-ended question was asked to determine
whether the participants had any opinion about physiotherapists’ involvement in managing mental illness. Most of the
answers (45.9%) followed two themes: (1) the need for more training and courses regarding mental disorders and
physical therapy and (2) the need for collaboration between the physical therapist and psychologist/psychiatrist.

Discussion
Despite the lack of research on physiotherapists’ knowledge about their role in treating patients with mental illness in
Saudi Arabia, determining their knowledge can assist in providing evidence of the necessity of training physiotherapists
to perform this crucial role. This study aimed to investigate physiotherapists’ knowledge of their role in treating mental
illnesses and their attitudes toward patients with mental disorders.

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PT Knowledge About Their Role in Mental Health

Our findings in this study imply that participants’ knowledge about mental health and their role in people with mental disorders was
inadequate; only 22% of the participants had higher knowledge scores, which is consistent with findings of Hooblau et al,17 as
participants in a focus group stated that they did not feel equipped to handle people living with a mental illness due to the insufficient
knowledge they had gained at an undergraduate level. Similarly, Almirón et al4 reported that 61.50% of physiotherapists showed
a lack of knowledge about the physical conditions affecting patients with mental disorders and that 55.61% requested more
information and training on the subject. Furthermore, in a systematic review by Vancampfort et al,18 which found that in current Sub-
Saharan African mental health policies, only 2 out of 22 screened plans made reference to the importance of considering
physiotherapy within multidisciplinary treatment, indicating that mental health care providers have limited knowledge of the
advantages of physiotherapy in mental health treatment. Vancampfort et al18 attributed this neglect to policymakers, training
institutes, and other mental health care professionals’ lack of knowledge about the benefits of physiotherapy in mental health care.
This lack of awareness among physiotherapists might be related to the misconception of mental health spectrum which
extends beyond just the realm of mental disorders, as highlighted in the exchange between McGrath et al19 and Heywood
et al.20 Where McGrath et al, sheds light on the intersection between physical therapy and mental well-being, emphasizing that
mental health encompasses a broader spectrum of factors beyond diagnosable mental disorders, including emotional well-
being, resilience, and overall psychological functioning. Dillon et al21 revealed the multifaceted nature of mental health and
the influence of psychosocial factors, such as distress and coping mechanisms, on individuals’ experiences of chronic pain.
McGrath et al22 advocate for integrating mental health screening and interventions into physiotherapy practice to provide
comprehensive care to patients with both physical and psychological needs. Tatta23 suggests that physiotherapists can play
a more active role in addressing mental health concerns, not only managing physical symptoms but also providing support and
interventions to improve mental well-being. This highlights the importance of recognizing the broader concept of mental
health and the role of physiotherapists, in addressing the interconnectedness of physical and mental well-being. This also
aligns with results of this current study regarding physiotherapists’ need for more education about mental health and their role
in addressing psychological well-being alongside physical symptoms in healthcare settings.

PT Attitudes About Their Role in Mental Health

The study findings reveal that most of the participants held neutral to negative attitudes 52% toward treating patients with
mental illnesses. Driver et al24 conducted a systematic review of 15 studies focusing on the knowledge, behaviors,
attitudes, and beliefs of physiotherapists toward applying psychosocial interventions in practice; they concluded that
physiotherapists’ attitudes and beliefs were mainly positive.
As found in the results, female physiotherapists working in the central region predominantly exhibited positive attitudes.
This might be attributed to the high percentage of population living in the central region compared to other regions, leading to
more exposure to patients with mental health, which might be identified as a factor that could enhance healthcare providers’
attitudes toward them. This agrees with findings of Prasanna et al25 where physiotherapists’ attitudes toward patients with
mental disorders were neutral and explained that their attitudes may be influenced by the low exposure to such cases in their
practice. These findings align with those of Lennon et al,26 who discovered that physiotherapists in Ireland were generally
supportive of patients with comorbid psychological issues and acknowledged the need to address such concerns. Similarly, the
results of Hooblau et al’s17 study mirror our findings, demonstrating that public sector physiotherapists in KwaZulu-Natal
exhibited good attitudes towards managing people living with mental illness and mental health. Moreover, and aligning with
our findings, Lucas and Parker’s27 results showed that in outpatient and community rehabilitation settings, physiotherapists
dealt with anxiety in patients with multiple sclerosis and believed they could help when it manifested.
This study showed that positive attitudes were seen among physiotherapists with less than two years of experience.
This aligns with a study conducted by Ghuloum et al28 revealed that recent graduates who were in contact with patients
with mental illness tended to have a more positive attitude towards them. Additionally, the study suggests that attitudes of
healthcare providers may evolve with experience and education.
One of the key findings of our survey was that most physiotherapists felt a need for more education and training to
manage the physical health problems of people with mental illness. This finding suggests that there is a gap in the

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education and training of physiotherapists in Saudi Arabia that needs to be addressed to provide high-quality care to
patients with mental illness. Several previous studies have emphasized the importance of healthcare professionals having
adequate education, training, and support to manage the physical health problems of patients with mental illness.
Dandridge et al29 conducted a survey of physiotherapy students’ experiences and attitudes toward treating individuals
with mental illness and found that students felt that they needed more education and training in this area. Similarly, Lucas
and Parker27 conducted a mixed-methods study on the perceived role of physiotherapists in managing anxiety in patients
with relapsing-remitting multiple sclerosis and found that physiotherapists’ perceived role in managing anxiety was
limited due to a lack of training and experience. The findings of the current study are consistent with those of these
previous studies and highlight the need for more emphasis on the education and training of healthcare professionals,
including physiotherapists, in managing the physical health problems of patients with mental illness.

Implications to PT Practice
The findings of this study emphasize the need for healthcare professionals to have adequate education and training (both in
undergraduate and graduate studies and at the professional level) to manage the physical health problems of patients with
mental illness, the prevalence of which has greatly increased following the COVID-19 epidemic.3 The study encourages
academia to incorporate more courses and training related to mental illness and connect them to clinical practice. The courses
need to address mental illnesses and the role of physiotherapists in treating them, including how to effectively manage the
physical health problems of patients with mental illness. Furthermore, the study emphasizes the need for the government to
promote mental wellness and psychological interventions nationwide to minimize the impact of the stigma associated with
mental illness in Saudi Arabia, which makes it more difficult for patients to access appropriate care.13,30

Limitations
Some limitations of the study should be noted. The first limitation is the small sample size, as only two-thirds of the
calculated sample was obtained. This can be explained by the sample selection method, which was a convenience
sample. For the same reason, another limitation is the over-representation of the central region. It was challenging to
obtain more responses from the other regions, given that the study was conducted in the central region.

Conclusion
There is a lack of knowledge and a positive attitude toward treating patients with mental disorders, which highlights the
need for more training to fill the gap in knowledge and guide and build upon the positive attitude of physiotherapists
toward treating patients with mental disorders. Further research is needed to identify the specific areas where phy­
siotherapists require more education and training and to develop effective training programs that can improve their
knowledge and skills in managing the physical health problems of patients with mental illness.

Acknowledgments
The authors acknowledge the support provided through the Princess Nourah Bint Abdulrahman University Researchers
Supporting Project (No.PNURSP2024R535), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Disclosure
The authors report no conflicts of interest in this work.

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