Attitudes and Beliefs of Physical Therapists in Saudi Arabia Regarding Direct Access and Scope of Practice


Physical therapist
Scope of practice
Direct access
Saudi Arabia


How to Cite

Alosaimi S, Alamri R, Alghamdi M. Attitudes and Beliefs of Physical Therapists in Saudi Arabia Regarding Direct Access and Scope of Practice. Integr J Med Sci [Internet]. 2022 Apr. 13 [cited 2023 Sep. 22];9. Available from:


Purpose: This study aimed to understand better what practicing physical therapists know and believe about direct access (DA) and scope of practice (SOP) for physical therapy in Saudi Arabia (SA). Methods: A pilot study was first performed to ensure the clarity of the questions. Then, a cross-sectional survey was sent through emails, and social media platforms included three main sections: demographics, opinions, and beliefs questions. Results: A total of 150 respondents met the inclusion criteria. About 55.3% of the participants reported never or rarely using an SOP document as a reference for knowing their practice. Moreover, nearly 48% learned about the SOP through an informal discussion. Only 24.7% of the participants correctly identified which practice setting DA is permitted. Most participants felt confident or strongly confident of their abilities to assess (67.3%) and treat (72%) patients without physicians’ referral. Around 84% of the participants agreed or strongly agreed that DA should be expanded to include all healthcare settings. Conclusion: We found that physical therapists are confident about their ability to treat and assess patients without physicians’ referrals. There is uncertainty about where DA is permitted in SA.


Da Costa BR, Vieira ER. Stretching to reduce work-related musculoskeletal disorders: A systematic review. J Rehabil Med. 2008 May;40(5):321-8.

Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, et al. Musculoskeletal health conditions represent a global threat to healthy aging: A report for the 2015 world health organization world report on ageing and health. Gerontologist. 2016 Apr;56 Suppl 2:S243-55.

World report on ageing and health World Health Organization. 2015. [Accessed 2022 Apr 12]. Available from:

Musculoskeletal conditions | World Health Organization. 2019. [Accessed 2022 Apr 12]. Available from:

Robert G, Stevens A. Should general practitioners refer patients directly to physical therapists? Br J Gen Pract. 1997 May;47(418):314-8.

Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: A systematic review. Phys Ther. 2014 Jan;94(1):14-30.

Saudi Physical Therapy Association | World Physiotherapy. 2020. [Accessed 2022 Apr 12]. Available from:

Policy statement: Autonomy | World Physiotherapy. 2019. [Accessed 2022 Apr 12]. Available from:

Aljuaid M, Mannan F, Chaudhry Z, Rawaf S, Majeed A. Quality of care in university hospitals in Saudi Arabia: A systematic review. BMJ Open. 2016 Feb 25;6(2):e008988.

Burn D, Beeson E. Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates. Clinic Gover Intern J. 2014; 19(2):126–136.

de Gruchy A, Granger C, Gorelik A. Physical therapists as primary practitioners in the emergency department: Six-month prospective practice analysis Phys Ther. 2015 Sep;95(9):1207-16.

Balogun JA, Aka PC, Balogun AO, Mbada C, Okafor U. Evolution of physical therapy education in Australia, United Kingdom, United States of America, and Nigeria: A comparative analysis. Internat Med J. 2018; 25(2):103–107.

Medicines, prescribing and injection therapy | The Chartered Society of Physiotherapy. 2020. [Accessed 2022 Apr 12]. Available from:

Scope of Practice | APTA. 2019. [Accessed 2022 Apr 12]. Available from:

Alghadir A, Zafar H, Iqbal ZA, Anwer S. Physical therapy education in Saudi Arabia. J Phys Ther Sci. 2015 May;27(5):1621-3.

Institute of Medicine (US) Committee on the Future of Primary Care Molla Donaldson, Karl Yordy, Neal Vanselow , Defining Primary Care. Washington, D.C.: National Academies Press. 1994.

Aiken AB, Harrison MM, Atkinson M, Hope J. Easing the burden for joint replacement wait times: The role of the expanded practice physiotherapist. Healthc Q. 2008;11(2):62-6.

Froment FP, Olson KA, Hooper TL, Shaffer SM, Sizer PS, Woodhouse LJ, et al. Large variability found in musculoskeletal physiotherapy scope of practice throughout WCPT and IFOMPT affiliated countries: An international survey. Musculoskelet Sci Pract. 2019 Jul;42:104-119.

Desmeules F, Roy JS, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders: A systematic review. BMC Musculoskelet Disord. 2012 Jun 21;13:107.

Piscitelli D, Furmanek MP, Meroni R, De Caro W, Pellicciari L. Direct access in physical therapy: A systematic review. Clin Ter. 2018 Sep-Oct;169(5):e249-e260.

Alshehri MA, Alhasan H, Alayat M, Al-Subahi M, Yaseen K, Ismail A, et al. Factors affecting the extent of utilization of physiotherapy services by physicians in Saudi Arabia. J Phys Ther Sci. 2018 Feb;30(2):216-222.

Gentle PH, Herlihy PJ, Roxburgh IO. Controlled trial of an open-access physiotherapy service. J R Coll Gen Pract. 1984 Jul;34(264):371-6.

Norman P, Clifton H, Williams E, Nichols PJ. Access by general practitioners to physiotherapy department of a district general hospital. BMJ. 1975;4(5990): 220–221.

Mohammed J, Alhamidah M, Alammar R, Jawkhab M, Bukhari L. Awareness and knowledge of physical therapy among saudi arabia adult population. J Physiother Rehabil. 2018.

Al-Eisa ES, Al-Hoqail H, Al-Rushud AS, Al-Harthi A, Al-Mass B, Al-Harbi BM, et al. Awareness, perceptions and beliefs about physiotherapy held by physicians working in Saudi Arabia: A cross-sectional study. J Phys Ther Sci. 2016 Dec;28(12):3435-3439.

Holdsworth LK, Webster VS, McFadyen AK. Physiotherapists’ and general practitioners’ views of self-referral and physiotherapy scope of practice: Results from a national trial. Physiotherapy. 2008:94(3): 236–243.

Bindawas SM, Vennu V, Azer SA. Are physical therapy interns competent in-patient management skills? Assessment of the views of clinical and academic physical therapists. J Phys Ther Sci. 2013 May;25(5):649-55.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2021 Safwan M. Alosaimi, Raed A. Alamri, Maher A. Alghamdi


Download data is not yet available.


Metrics Loading ...