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November 2016, Volume 66, Issue 11

Special Communication

Physical therapy as a profession and its educational development in Pakistan

Aamir Raoof Memon  ( Institute of Physiotherapy and Rehabilitation Sciences, Peoples University of Medical and Health Sciences for Women, Nawabshah )
Nasir Mansoor Sahibzada  ( CMH Hospital Pano Aqil, Peoples University of Medical and Health Sciences for Women, Nawabshah. )
Muhammad Ehab Azim  ( Foundation University Institute of Rehabilitation Sciences, Foundation University Islamabad, Pakistan )
Furqan Ahmed Siddiqui  ( Foundation University Institute of Rehabilitation Sciences, Foundation University Islamabad, Pakistan. )

Abstract

Physical therapists work in different medical and related settings and serve to maintain and restore functional capability. Pakistan has a disability rate of 2.65% with a total of around 5.035 million disabled people. Physical therapy as a profession started in 1956 at the Jinnah Postgraduate Medical Centre with a 2-year diploma, later on 4 years bachelors programme was also started. In 2008, doctor of physical therapy programme was initiated. The representative body "Pakistan Physical Therapy Association" was also established in 2008 which then joined the World Confederation for Physical Therapy in 2011. There is plenty of work being done in the field and it has seen a rapid growth in the past decade compared to the last 50 years. Currently, there are 69 institutions in Pakistan offering various physical therapy courses. The profession currently requires an autonomous regulatory body to control its educational curriculum and development as well as safeguard its interests.
Keywords: Curriculum, Development, History, Pakistan, Physical Therapy.
 
Introduction
Physical therapy provides services to maintain, develop, and restore maximum movement and functional ability. 1 Physical therapists or physiotherapists are the health-care professionals that may develop and implement programmes for prevention and screening of common physical disorders and ailments.2 Areas of practice for physical therapists include outpatient department, orthopaedics, geriatric health, cardiac rehabilitation, women\\\'s health, occupational health, intensive care, sports, neurological and paediatric rehabilitation.3
Physical therapy is a very ancient field with some forms of it practiced around 3000 years ago4 but in 1813, it was introduced as a profession which was further seeded by the establishment of Chartered Society of Physical Therapy (CSP) and initiation of physical therapy schools and courses in the western world. 4 Doctor of Physical Therapy (DPT) is the latest development in the field as a step towards professional identity and autonomy initiated in 1993 in the United States and later, followed by Pakistan. Moreover, globally it is represented by the World Confederation for Physical Therapy (WCPT), established in 1951 with 160 member countries.
This study aims to analyze the development of physical therapy education in Pakistan. To the best of our knowledge, this is the first study of its kind on such a topic. This reivew will give useful insights to researchers about evolution of physical therapy and its current status in Pakistan.

Methods
An online search was carried out from electronic search engines including Cochrane, PEDro, Hooked on evidence, Pubmed, Google scholar and Pakmedinet but could not find significantly relevant literature on the topic. Another search was undertaken using worldwide web and using local blogs through which, information on history of Physical Therapy and list of institutions was obtained. The key words used were "disability", "education", "physical therapy", "history", "curriculum", "development", "rehabilitation", "developing countries", "course", "degree program", "doctor of physical therapy", "physiotherapy", "Pakistan", and "research". Statistics on disability burden were obtained from the website of Federal Bureau of Statistics of Pakistan.
The study formally spanned 6 months from September 2014 to February 2015 and important variables of the study included history and educational development of physical therapy in Pakistan, statistics on disability burden in Pakistan, physical therapy statistics about Pakistan obtained from website of the World Confederation for physical therapy, list of Physical Therapy institutions was formulated and the courses offered by them were analyzed in detail. Furthermore, research development in physical therapy in Pakistan was searched.

Results
Disability Burden in Pakistan
Pakistan is world\\\'s 6th most populous country with an estimated over 182 million people in 2011.5 According to 2012 statistics, national disability rate was 2.65% which accounts for 5.035 million people with disabilities (PWDs) in Pakistan. Rural areas have more PWDs (65.7%) than urban areas (34.3%). Males constitute 58.4% PWDs whereas females make 41.6% population of PWDs. Major share to PWDs is from Punjab (55.9%) and Sindh (28.4%).6 The type of disabilities in Pakistan include blind (0.412 million), deaf/mute (0.379 million), crippled (0.964 million), insane (0.324 million), mentally retarded (0.383 million), multiple disabilities (0.417 million) and others (2.15 million).7
History of Physical Therapy Education in Pakistan
The first school of physical therapy, considered pioneer in the history, was established in Jinnah Post-graduate Medical Centre (JPMC) in 1956 by the Ministry of Health (MOH) in collaboration with the World Health Organization (WHO) which offered 2-year physical therapy diploma with minimum starting education of Secondary School Certificate. In 1961, 2-year diploma got upgraded to 3-year diploma. Later in 1963, school of physical therapy was affiliated with the University of Karachi, modifying the 3-year diploma to 3-year B.Sc physical therapy degree with minimum starting education of Higher Secondary School Certificate. Mayo Hospital established the second school of physical therapy in Pakistani physical therapy history, in 1986, offering 3-year B.Sc physical therapy degree. In 1999, B.Sc was modified to B.S physical therapy degree of 4-year education. Professional autonomy and direct access were core issues in Pakistan since 2005. During that period, physical therapists in Pakistan were struggling for competence, professional identity and autonomy of practice-freedom and independence in performing a role (that does not include prescription of specific medicines). In 2008, Riphah College of Rehabilitation Sciences (RCRS) offered the first Doctor of Physical Therapy (DPT) degree and Post-professional Doctor of Physical Therapy (PP-DPT) degree programme giving way to horizon of professional development in Pakistan. DPT was a positive step towards professional autonomy and direct access of the patients/clients to the physical therapist without need of an unnecessary referral. 8 Direct access here signifies patient visiting the physical therapist without a referral from other health-care professionals as this practice has almost been obsolete in most of the parts of developed world howerver, not prevalent here. This step enhances multi-disciplinary approach and defines the scope of practice for physical therapists and related health-care professionals.
Physical Therapy Representative Organizations
Even after 60 years of inception of physical therapy, there is no regulatory council in Pakistan. However, some of the private bodies had been working for professional growth. Of these, Pakistan Physiotherapy Society (PPS), Chartered Society of Physiotherapy (CSP) of Pakistan and Pakistan Physical Therapy Association (PPTA) are worth mentioning.  PPS was a member of World Confederation for Physical Therapy (WCPT) till 1998 and CSP of Pakistan and PPTA (member of WCPT since 2011) worked as local bodies for some regions. These local bodies have merged recently into PPTA, member of WCPT since 2011.3,8,9 Necessary steps have been taken for the legislation of physical therapy council and a framework for such has been proposed.10
Educational and Professional Development in Physical Therapy
Present scenario of physical therapy in Pakistan has improved over time. The Higher Education Commission of Pakistan (HEC) regulates physical therapy education in Pakistan. All the members of the HEC and the National Curriculum and Revision Committee (NCRC) played a significant role in approving unanimous curriculum for entry level physical therapy education throughout the country. A mature entry level degree was introduced and recognised by the HEC resulting to the autonomous status of the profession in the country.8 DPT curriculum as approved by the HEC consists of 10 semesters of at least 175 credit hours. In Pakistan, DPT and PP-DPT were initiated in 2008 and the institutions offering these courses have increased rapidly in number. Currently, there are 69 institutions offering DPT in Pakistan (Table)

However, due to the absence of a regulatory body, this rapid growth has not been regulated and monitored. The HEC or the WCPT can propose guidelines regarding curriculum and physical therapy practice but those guidelines can be implemented and ensured by a regulatory body, which unfortunately does not exist. The faculty for different physical therapy programmes is usually blended containing local and international professionals from medical, allied and social sciences for their respective subjects. Some institutions however, do not offer quality facilities (in terms of infrastructure) as expected. Moreover, some public sector institutions have been improperly named "Institute of Physical Medicine and Rehabilitation", which can be controlled only if there is a regulatory body available.
Physical Therapy Research in Pakistan
However, The Journal of Physical Therapy and Sports Medicine (JOPSM) was the first peer-reviewed journal in Pakistan followed by the International Journal of Rehabilitation Sciences (IJRS).8 JOPSM was initiated in 2012 and it is published for bi-annually.11 IJRS also is a biannual journal initiated in 2012. 12
Moreover, recently online Journal of Riphah College of Rehabilitation Science has also been initiated. Today, physical therapists are actively participating in research activities in contrast to their solitude from research in the past as evident from the initiation of research journals and their work.
 
Conclusion
Physical therapy services and its education have seen boom of development during the last decade compared to the last 50 years. However, currently the specialty requires proactive regulatory authority to control its educational curriculum and development as well as safeguard its interests.

Disclosure: None.

Funding: None.

Conflict of Interest: None.

References
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2.Classifying health workers: Mapping occupations to the international standard classification. World Health Organization. [online] 2014 [cited 2014 December 26]. Available from: URL: www.who.int/hrh/statistics/Health_workers_classification.pdf.
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8.Amin SJ. Perception of Physical Therapists about Professional Growth & Development in developing countries: Example from Pakistan. J Physiother Sports Med 2012; 1: 86-103
9.Rathore FA, New PW, Iftikhar A. A report on disability and rehabilitation medicine in Pakistan: past, present, and future directions. Arch Phys Med Rehab 2011; 92: 161-6.
10.Dustagir A, Raza A. Professional Development of Physical Therapy and Framework of Clinical Expertise in Pakistan. Journal of Physical Therapy and Sports Medicine. 2013; 2: 45-59
11.Journal of Physical Therapy& Sports Medicine. [online]  [cited 2015 January 7] Available from: URL: www.pgip.co.uk/jopsm.
12.International Journal of Rehabilitation Sciences (IJRS).   [online] [cited 2015 January 7]. Available from: URL: http://www.ijrs.org/.

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