Direct Access to Physiotherapy in Saudi Arabia

Direct Access to Physiotherapy in Saudi Arabia
I. Introduction
Physiotherapy is an important aspect of health care. It is the most common intervention for pain that does not involve medications (Porter 2008). The effectiveness of this particular health intervention has been professed and also studied by different researchers (Ulusoy et al. 2011; Karki 2005). This treatment should be promoted all over the world in order to maximize the therapeutic benefits. Moreover, direct access to physiotherapy should primarily be practiced in medically advanced countries such as Saudi Arabia.
This paper will provide a definition of ‘direct access` to physiotherapy. Moreover, the benefits of this service will be presented and will be correlated to the state of physiotherapy in Saudi Arabia. Finally, this author will present a conclusion to these evidences.
II. Physiotherapy
Physiotherapy is a form of treatment that is executed in forms of manual, electronic and exercise programs (Better Health Channel 2011). Manual techniques involve massages, joint manipulation, resistance trainings and stretches (Better Health Channel 2011). On the other hand, electronic or electrotherapeutic techniques involve the use of ultrasound, laser therapy and transcutaneous electrical nerve stimulation (TENS) (Better Health Channel 2011). Finally, exercise therapies include muscle strengthening, posture retraining or cardiovascular exercises. Physiotherapists also provide information regarding the use of walking frames or wheelchairs to first-time users (Better Health Channel 2011). Otherwise, physiotherapists help disabled or injured patients cope with their disabilities.
Physiotherapy is a treatment that deals with musculoskeletal, cardiothoracic and neurological disorders. Musculoskeletal conditions commonly include sprains, arthritis and back pains (Better Health Channel 2011). In contrast, cardiothoracic conditions include bronchitis, asthma and emphysema (Better Health Channel 2011). Finally, neurological conditions include diseases such as multiple sclerosis, stroke and Parkinson`s disease (Better Health Channel 2011). Physiotherapy is also important in post-surgery patients because it is believed that this kind of treatment helps relieve patients` pain and restores body functions after surgery (Oh, Kim and Lee 2002).
The role of physiotherapists in the healthcare industry is undeniable. In fact, Holdsworth and Webster (2002) stated that in the 1990s, general practitioners have chosen physiotherapy as a priority among other clinical services. In the United Kingdom, physiotherapists have been awarded autonomy to practice since 1978. However, the National Health Service of the country does not enforce direct access to physiotherapy.
According to Holdsworth and Webster (2002), ‘direct access` is also synonymous to self-referral. A self-referral would entail that individuals or patients could go directly to any regulated health practitioner without the need for a referral from a general practitioner (Middleton 2008). It is alleged that self-referral is a patient-focused approach and that it helps maximize the skills and talents of healthcare providers (Keen 2008). Furthermore, allowing patients to self-refer would entail empowerment, directing patients to manage or care for their own health (Keen 2008). Individuals` confidence and self-efficacy in handling their own health will also be developed (Porter 2008). Such a development in self-management is believed to promote health awareness and responsibility for patients and individuals.
In certain countries around the world, including Canada and the US, direct access to physiotherapy and other allied health service is already established. In the UK and in Saudi Arabia however, this service is not widely practiced or not practiced at all. This should be changed in every community because a direct access to physiotherapy benefits a large number of people.
III. Evidences of the Benefits of Physiotherapy to Patients
A study performed by Ulusoy et al. (2011) investigated the effects of supervised physiotherapy in treating adhesive capsulitis. The respondents were evaluated by one of four physiotherapists and were subjected to a physiotherapy program, which ran for three to five times a week. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were provided as supplements (Ulusoy et al. 2011). The researchers found that physiotherapy was able to resolve adhesive capsulitis in 86.2% of patients (Ulusoy et al. 2011). Long-term results also showed that 45.4% of the cases were resolved through physiotherapy. Moreover, supervised physiotherapy with NSAID supplements improved the ROM values of patients with adhesive capsulitis. Although NSAIDs were involved in the research, these served to moderate the shoulder pain, and thus, increased the patients` tolerance to the exercise programs (Ulusoy et al. 2011).
In another study by Karki (2005), she evaluated the rehabilitative effects of postoperative breast cancer patients. It is alleged that physical activity is an essential part of the restoration process; however, patients may become insecure with what their bodies can do after the operation. Such situations are where the importance of physiotherapists becomes pragmatic. Physiotherapists guide the patients and help them attain the sufficient physical activity that is relevant for their rehabilitation (Karki 2005). Karki (2005) revealed that positive effects have been attributed to the use of physiotherapy on breast cancer patients. Lymphedema is reduced while functional movements of the different areas of the upper body are increasingly restored upon continuous treatment (Karki 2005).
In certain countries, including the UK, which is a highly developed country, direct access to physiotherapy is still not established. However, this service has become widely acceptable to patients and health providers (Holdsworth and Webster 2002). A study performed by the UK Department of Health (2008) revealed that there are patient and service benefits from this service change. Patient benefits include a) "high levels of service-user satisfaction and confidence", b) "a more responsive and attractive service to patients with acute conditions, affording them wider access", c) "empowering of patients to self-care/ self-manage to meet their needs", d) "lower levels of work absence" (UK Department of Health 2008, pp. 9). On the other hand, service benefits include a) no change in the demand for services b) physiotherapy access to people of all ages and gender c) no difference in the use of the service among ethnicities d) higher chances for completion of the treatment process e) approximately 75% of self-referring patients were not prescribed with medicines thus, the therapy also becomes cost-effective, both for the government and the patients (UK Department of Health 2008).
Holdsworth and Webster (2002) also stated that a direct access to physiotherapy encourages people, particularly men, to request for treatments for their musculoskeletal disorders. A direct access to physiotherapy reduces waiting time for patients to be treated compared to general practitioner referrals (Holdsworth and Webster 2002). Holdsworth and Webster (2002) explained that the delay experienced with referrals from general practitioners may be due to administrative processes that occur between clinics or institutions. If patients directly call and ask for an appointment for physiotherapy, they may save four days of waiting compared to when they go to a general practitioner (Holdsworth and Webster 2002). A reduction of waiting time is especially beneficial to elderly individuals who need urgent treatments for certain musculoskeletal pain that they may experience.
On a different note, a study conducted by Addley, Burke and McQuillan (2010) evaluated the impacts of direct access occupational physiotherapy treatment service on workers experiencing musculoskeletal disorders (MSDs). The researchers studied 231 participants who were evaluated before and after treatment. The participants were also asked to answer a questionnaire pertaining to the effects of physiotherapy to their lives and their work. Answers to the questionnaire revealed that the participants believed that physiotherapy could reduce absences from work and could even improve mental well-being (Addley, Burke and McQuillan 2010). In the end, the researchers concluded that physiotherapy for MSDs have the potential to "improve not only clinical status and pain as expected but also work function, psychological well-being and sickness absence" (Addley, Burke and McQuillan 2010, pp. 651).
Furthermore, the UK Department of Health (2008) also conducted their own study regarding a direct access to physiotherapy. An interesting result by the UK Department of Health (2008) revealed the following: a) 77% of patients were satisfied that they were able to self-refer; b) 59% were in favor of locating treatment centers within the community; c) about 65% were more in favor of being able to directly make an appointment with a physiotherapist without the need to go to a GP for a referral; d) 74% of patients thought that they learned a lot regarding the management of their own conditions; and e) that 89% stated that they would use the service again.
IV. The State of Physiotherapy in Saudi Arabia
There are a limited number of studies conducted in Saudi Arabia regarding the state of physiotherapy in the area. However, it is evident that the country is concerned with the quality of healthcare that they provide to citizens. It is also helpful to know that Saudi Arabia is very rich in resources. This has contributed to the country`s ability to afford advanced medical technology and practices. It is therefore undeniable that Saudi Arabia is one of the leading countries, which enforce quality health care. Health institutions within the country own sophisticated machines and employ quality health measures. Furthermore, upon observation of the country, it is evident that there are many healthcare providers, particularly physiotherapists, employed in the different health institutions.
Just like other countries, Saudi Arabia healthcare practitioners understand the importance of physiotherapy in the healing of the sick. For example, a study conducted by Alghamdi, Olney and Costigan (2003) presented the fact that exercise therapy could be an intervention that is beneficial to patients with osteoarthritis. While the researchers found the effectiveness of exercise therapy in osteoarthritis, they still recommend more extensive studies regarding this form of treatment on osteoarthritis. In another study conducted by El Salam and Elhafz (2010), the researchers suggested that ultrasound and calf muscle stretching, accompanied with medial arch supports, are more effective in addressing pain and pain-related dysfunctions associated with plantar fasciitis. That is in comparison to using low-dye taping with ultrasound and calf muscle stretching (El Salam and Elhafz (2010). This is physiotherapy in exc...