Training needs of clinical physical therapists in provinces of Khyber Pakhtunkhwa and Sindh,Pakistan: A cross-sectional survey

Abstract

Background

Continuous Professional Development is essential for maintaining competency among physical therapists in evolving healthcare systems. Identifying clinicians perceived training needs is crucial for targeted educational programs; however, evidence on factors influencing these needs across professional domains remains limited.

Objective

This study was conducted to assess the perceived training needs of physical therapists across multiple professional domains and examine whether demographic and professional characteristics predict these needs.

Methods

A cross-sectional survey was conducted among practicing physical therapists from two major provinces of Pakistan. Training needs across research, communication, administration, management, and clinical tasks were assessed using the Hennessy-Hicks Training Needs Analysis questionnaire. Responses were classified as Not Required, No Need, or Need. Multinomial logistic regression examined the effects of gender, experience, position, and specialty, with odds ratios (OR) and 95% confidence intervals (CI) reported.

Results

Importance scores (5.02–6.28) were high, while performance scores (1.91–4.81) were lower, producing notable gaps (0.26–4.37). High training needs were identified in research appraisal, amputation management, health promotion, wheelchair prescription, gait training, and administrative tasks, with the largest gap in administration (4.37). Most competencies showed low gaps, while ICU management was borderline; IPA confirmed priority areas in the “Concentrate Here” quadrant. Regression analysis showed limited predictive effects (p > 0.05), except senior position reducing research training need (OR = 0.111, p = 0.040). Less experienced therapists showed higher need in administration and management domains.

Conclusion

Training needs vary across domains and are primarily influenced by experience and role. Early-career therapists require greater support, highlighting the need for targeted professional development and leadership training.

Highlights

In Pakistan, eight out of 30 physical therapy competencies were found to have high training needs.

Therapists working with patients, gaps were found in evaluating research, amputees care and clubfoot management, analyzing gait, wheelchairs prescriptions, and administrative skills.

Borderline training was needed for skills related to the ICU.

Less experienced therapist's revealed greater training requirements in administrative and management domains.

The findings revealed necessity for professional growth, curriculum reforms, and national frameworks to standardize competencies and enhance rehabilitation services.

Summary

This study examined training requirements of the physical therapists in Pakistan based on 30 critical competencies in the clinical, research and administrative domains, eight of the competencies were observed to have a high requirement to be trained. The largest disparities were in the area of establishing rapport with patients, critically assessing research, amputees and clubfoot care, analysis of gait, prescription of wheelchairs, and some administrative duties. Very little expertise was hardly necessitated in ICU. The research also investigated the possibility of using gender, experience, or specialty to predict training needs. Findings demonstrated that there was little effect of these factors, though the less qualified therapists expressed higher requirements in the administrative and management fields.

These findings indicate that among physical therapists there are serious gaps in the necessary skills, which indicates that the existing training and career development opportunities might not be enough. There is a need to address these gaps to enhance patient care, clinical decision making and administrative efficiency in rehabilitation services. The paper focuses on the need to formulate institutionalized continuing professional development (CPD) programs, review educational curricula, as well as formulate national regulations frameworks to harmonize competencies. Through such practices, Pakistan will be able to boost its Physical therapy man power, improve the quality of rehabilitation care, and improve patient outcomes throughout the country.

Keywords

Physical therapists competency-based education education professional needs assessment cross-sectional studies

Introduction

Physical therapy is a medical career which aims at maximizing both movement and functioning which is critical in rehabilitation, injury prevention and quality of life enhancement.¹ Physical therapists are imperative in promoting health and physical restoration among all ages.² Health practitioners have a specified scope of practice that is a representation of their knowledge, skills, and experience.³ Some of the specialties of physical therapy include pediatrics,⁴ musculoskeletal,⁵ cardiovascular, geriatrics, clinical electrophysiology, and neurology.⁶ The extension of this scope to post-professional education is an important part of highlighting the importance of CPD. Canadian and Australian studies verify the close relationship between CPD and expanded practice roles.⁷

The definition of competence as defined by the WHO entails the combination of knowledge, skills and values that enable one to practice effectively.⁸ Ethical competence is also critical, because the interactions between a patient and the Physical therapist are close and lasting. The codes of ethics touch upon such principles like justice, responsibility, and an ongoing process of learning.⁹

The review by Bobos et al. (2021) was based on a systematic review of the practices in licensing physical therapy around the globe. Majority of the nations need a bachelor's degree and a licensing exam along with CPD that includes the mandatory number of hours and occasional inspection of professional records.¹⁰ Different organizations such as the American Physical Therapy Association (APTA) and European Qualification Framework (EQF) have come up with organized competencies to standardize education and practice across countries.¹¹

The contemporary physical therapy education has shifted towards competence-based education and the profession is based on the following essential professional competencies; clinical reasoning, manual therapy, communication, interdisciplinary collaboration, and cultural competence.¹² Nevertheless, although competencies are the focus of attention, incorporation of these competencies into a single curriculum always remained a difficult task. One of the major part of the curricula consist clinical practicums that need to be reviewed using regular assessment instruments such as rubrics and direct observation to determine the performance of the student.¹³

Competency frameworks are used to match educational results with the requirements of healthcare to enhance accountability and professional role definition.¹⁴ Such frameworks include instrumental (technical), interpersonal (communication and teamwork) and systemic (real-world application) competencies.¹³

Cultural competence has recently become an international practice in physical therapy education with World Physical Therapy, APTA, and UK, Australian, and New Zealand regulatory bodies all stressing it. Though, even with this, cultural competence training is not usually consistent and is based on insufficient training techniques. It requires more profound learning strategies and experience exposure towards cultivating actual cultural sensitivity.¹⁵

International challenges such as global health issues and the rising diversity have resulted in demands to reform physical therapy education. The strategic plan of the APTA and summits on Global Health accentuate the necessity of the influence of a public health perspective on physical therapy curricula.¹⁶

Despite international progress, limited studies have been done in Pakistan to evaluate the physical therapy competencies or training requirements. Although the standards of the practice may differ, and no regulatory models are present at the moment, it is necessary to examine the current level of competency of Pakistani physical therapists. Physical therapy education in Pakistan is four or five-year BS/DPT program and have no licensing examination. Lack of a national regulating authority and low standards of CPD have resulted in large differences in clinical competencies. The purpose of the study was to recognize the main gaps and provide information on the formulation of CPD strategies and curriculum changes that align with the national context.

Methods

Study design, duration and setting

A cross-sectional survey was done on practicing physical therapists in 2 main provinces of Khyber Pakhtunkhwa and Sindh of Pakistan. The duration of data collection was six months (March 2025 to August 2025).

Ethical consideration

Institutional Ethical Review Committee of the Institute of Physical Medicine and Rehabilitation, Khyber Medical University [No: DIR/IPM&R-EC/202513, Dated 1st March 2025] granted ethical approval. The participants of the study were informed and briefed on the objective of the study. Electronic informed consent was taken, and the confidentiality was ensured. There were no incentives, and the participants were free to withdraw anytime without consequences. The data were all anonymized and kept under safe deposit in password-protected files, which were in accordance with the Declaration of Helsinki.

Sample selection

Physical therapists employed in different public and private facilities, such as hospitals, rehabilitation centers, teaching hospitals, and university-related clinics, were the sample population in the data collection. This was a multi-institutional strategy to develop generalizability between practice settings.

Eligible participants included currently practicing physical therapists who had a Bachelor degree in Physical Therapy. The criterion of a minimum of six months of clinical experience was used to make sure that the physical therapists had achieved the basic clinical competency and also had adequate exposure to daily patient management that is needed to effectively assess and react to the study variables. Those working exclusively in academic or administrative roles without patient interaction were excluded.

Sampling technique and data collection procedure

The convenience sampling method was employed to recruit the accessible physical therapists via professional contacts, the institutions, and the online platform. In particular, a multi-pronged recruitment process was used. Physiotherapists in Khyber Pakhtunkhwa (KP) and Sindh provinces were approached through the contacts received from Pakistan Physical Therapy Association (PPTA) in addition to professional networking. Several professional WhatsApp groups of practicing physical therapists were utilized, as it is one of the main channels for dissemination of data. Along with this, various institutional and academic contacts were also approached for the distribution of questionnaire.

The survey was conducted online through email and social media, and data was collected using a Google Forms questionnaire. The link to questionnaire was spread out more than once, and proactive follow-up techniques, such as reminders messages and calling non-responders personally, were used to make the most of them. Voice notes were also distributed to enhance clarity and accuracy of response by explaining the purpose of the study and how to fill in the questionnaire. In order to minimize the number of duplicates, the form had a requirement where the physical therapists had to complete the form using a personal email address and multiple responses were turned off, so that only one response was made using that email address. Moreover, the survey questions were mandatory, and no questionnaire was sent without completing all the survey items. The study initially aimed to recruit 450 physical therapists in both provinces, however only 426 consented to participate in the survey. Calculation of the sample size was not done formally.

Data collection tool and classification

The questionnaire included (two sections) which captured information on demographic data including age, gender; years of experience, current job position and specialty in clinical practice were also taken.

The modified version of the Hennessy-Hicks training needs Analysis Questionnaire was used to gather information on perceived training needs, which is a validated instrument commonly applied in healthcare education.¹⁷ The tool is made up of five subdomains: (1) research/audit, (2) communication/teamwork, (3) clinical tasks, (4) administration, and (5) management/supervisory tasks, which have a total of 30 items. Consistent with the flexibility of the tool suggested by the developer, eight items can be changed to fit the study scenario. In this research, context-specific clinical training requirements that are applicable in the practice of physiotherapy in Pakistan were systematically adjusted on eight items, where the general framework and validity of the tool remained intact.

The scores on training needs were obtained by subtracting performance scores by the scores of importance in each item as recommended in the Hennessy Hicks Training Needs Analysis framework. A greater score was better perceived training needs. To be able to interpret these scores, these scores were classified into categories (e.g., low, moderate, high need) in regards to the size of the difference.

Data analysis

Data analysis was performed using SPSS (version 22) and R software (version 4.5.2). Training need scores were summarized using descriptive statistics (means, standard deviations). The Shapiro-Wilk test was used to determine whether the data was normal. Associations between training needs and demographic variables were measured using inferential analyses, which were independent t-tests, one-way ANOVA, and chi-square tests. Multinomial logistic regression analysis was conducted to understand the relationship of gender, years of professional experience, current position, and clinical specialty with the level of perceived training need, and reported odds ratios (OR) and 95% confidence intervals (CI). Attributes of the study participants were also evaluated in terms of performance and importance using Importance Performance Analysis (IPA) model. The p-value below 0.05 was regarded as statistically significant.

Results

610 physical therapists were invited to participate in the study through channels such as WhatsApp professional groups, institutional contacts, and PPTA provincial networks in Khyber Pakhtunkhwa and Sindh. Of these, 426 returned completed questionnaires, yielding a response rate of 69.8%. All participants had a minimum of six months of clinical experience. Within KP, participants were drawn from Peshawar, Mardan, Abbottabad, and Swat, while Sindh representation included Karachi and Hyderabad. Of all respondents, 132 (31%) were employed in public sector institutions and 294 (69%) in private sector settings, ensuring representation across different practice environments.

The importance scores for the 30 competency statements ranged from 5.02 to 6.28, while performance scores ranged from 1.91 to 4.81, resulting in gap values (A–B) between 0.26 and 4.37. Competencies classified as high training need due to high importance and low performance included critically evaluating published research (A = 6.01, B = 1.98; GAP = 4.03), assessment and management of patients with amputation (A = 6.19, B = 1.91; GAP = 4.28), undertaking health promotion studies (A = 6.25, B = 2.22; GAP = 4.03), wheelchair assessment and prescription (A = 6.25, B = 2.14; GAP = 4.11), gait assessment and training (A = 5.85, B = 2.23; GAP = 3.62), administrative activities (A = 6.28, B = 1.91; GAP = 4.37), clubfoot management (A = 5.54, B = 2.06; GAP = 3.48), and establishing a relationship with patients (A = 5.50, B = 2.45; GAP = 3.05).

One competency, assessment and physiotherapy management in ICU, showed A = 5.10, B = 2.21 with a GAP of 2.89, and was categorized as a borderline training need (Figure 1).

The remaining competencies were classified as high importance and high performance, indicating no training need, with relatively smaller gaps ranging from 0.26 to 1.50. The smallest gap was observed for making do with limited resources (A = 5.07, B = 4.81; GAP = 0.26), whereas the largest gap was reported for undertaking administrative activities (GAP = 4.37) as shown in Table 1.

Figure 1.

Importance-performance analysis (IPA) of physiotherapy competencies.

Table 1.

Importance–performance gap analysis and training need classification of professional competencies.

S.No	Competency statement	Importance (A)	Performance (B)	GAP (A–B)	Classification rule	Training need
Q1	Establishing a relationship with patients	5.50	2.45	3.05	High A&Low B	High Training Need
Q2	Doing paperwork and/or routine data inputting	5.29	4.71	0.58	High A&High B	No Training Need
Q3	Critically evaluating published research	6.01	1.98	4.03	High A&Low B	High Training Need
Q4	Appraising your own performance	5.19	4.05	1.14	High A&High B	No Training Need
Q5	Getting on with your colleagues	5.10	4.29	0.81	High A&High B	No Training Need
Q6	Assessment and PT management of MSK disorders	5.54	4.31	1.23	High A&High B	No Training Need
Q7	Assessment and PT management of Neuro disorders	5.44	4.05	1.39	High A&High B	No Training Need
Q8	Communicating with patients face-to-face	5.64	4.49	1.15	High A&High B	No Training Need
Q9	Assessment and PT management of Cardio disorders	5.09	3.69	1.40	High A&High B	No Training Need
Q10	Assessment and management of clubfoot patients	5.54	2.06	3.48	High A&Low B	High Training Need
Q11	Introducing new ideas at work	5.38	3.94	1.44	High A&High B	No Training Need
Q12	Accessing relevant literature for clinical work	5.28	3.78	1.50	High A&High B	No Training Need
Q13	Providing feedback to colleagues	5.21	3.88	1.33	High A&High B	No Training Need
Q14	Giving information to patients and/or carers	5.47	4.25	1.22	High A&High B	No Training Need
Q15	Assessment and management of patients with amputation	6.19	1.91	4.28	High A&Low B	High Training Need
Q16	Showing colleagues/students how to do things	5.36	4.10	1.26	High A&High B	No Training Need
Q17	Planning and organizing patient care	5.50	4.14	1.36	High A&High B	No Training Need
Q18	Evaluating patients’ psychological/social needs	5.29	4.05	1.24	High A&High B	No Training Need
Q19	Organizing own time effectively	5.45	4.01	1.44	High A&High B	No Training Need
Q20	Using technical equipment including computers	5.11	3.89	1.22	High A&High B	No Training Need
Q21	Assessment and PT management in ICU	5.10	2.21	2.89	High A&Low B	Borderline Training Need
Q22	Undertaking health promotion studies	6.25	2.22	4.03	High A&Low B	High Training Need
Q23	Making do with limited resources	5.07	4.81	0.26	High A&High B	No Training Need
Q24	Assessing patients’ clinical needs	5.46	4.48	0.98	High A&High B	No Training Need
Q25	Wheelchair assessment and prescription	6.25	2.14	4.11	High A&Low B	High Training Need
Q26	Gait assessment, gait deviations and training	5.85	2.23	3.62	High A&Low B	High Training Need
Q27	Working as a team member	5.44	4.30	1.14	High A&High B	No Training Need
Q28	Accessing research resources	5.02	3.71	1.31	High A&High B	No Training Need
Q29	Undertaking administrative activities	6.28	1.91	4.37	High A&Low B	High Training Need
Q30	Coping with change in the health service	5.14	3.93	1.21	High A&High B	No Training Need

The IPA plot presents 30 competency items based on mean importance and performance scores. The crosshair lines indicate the grand mean importance (5.48) and grand mean performance (3.53). In the “Concentrate Here” quadrant (high importance, low performance), items Q29 (6.28, 1.91), Q25 (6.25, 2.14), Q22 (6.25, 2.22), Q15 (6.19, 1.91), Q3 (6.01, 1.98), Q26 (5.85, 2.23), Q1 (5.50, 2.45), and Q10 (5.54, 2.06) indicate high training need. The “Keep up the Good Work” quadrant (high importance, high performance) includes Q8 (5.64, 4.49), Q6 (5.54, 4.31), Q17 (5.50, 4.14), Q14 (5.47, 4.25), Q24 (5.46, 4.48), and Q27 (5.44, 4.30). In the “Possible Overkill” quadrant (low importance, high performance), items such as Q2 (5.29, 4.71), Q23 (5.07, 4.81), Q4 (5.19, 4.05), Q5 (5.10, 4.29), and Q30 (5.14, 3.93) are located. The “Low Priority” quadrant contains Q21 (5.10, 2.21), identified as a borderline training need, as shown in Multinomial logistic regression analysis indicated that the majority of predictors were not significantly associated with perceived need for research training (p > 0.05). In the “No Need” category, gender (OR = 1.003, 95% CI: 0.394–2.551, p = 0.996), years of experience (all categories p > 0.05), current position (Junior/General: OR = 0.316, p = 0.160; Senior/Specialist: OR = 0.281, p = 0.179), and clinical specialty (MSK: OR = 0.378, p = 0.358; Neuro: OR = 0.296, p = 0.266) were not significantly associated with reporting no need for research training.

Similarly, within the “Need” category, gender (OR = 1.092, 95% CI: 0.396–3.009, p = 0.865), years of experience (all categories p > 0.05), and clinical specialty (MSK: OR = 0.390, p = 0.391; Neuro: OR = 0.221, p = 0.190) did not demonstrate statistically significant associations. However, holding a Senior/Specialist position was significantly associated with lower odds of reporting a need for research training (OR = 0.111, 95% CI: 0.014–0.900, p = 0.040), indicating that individuals in senior roles were less likely to perceive a need for further training.

For communication training needs, using “Not Required” as the reference category, no statistically significant associations were identified across predictors. In the “No Need vs Not Required” comparison, gender (OR = 1.061, p = 0.893), years of experience (all categories p > 0.05), current position (Junior/General: OR = 1.507, p = 0.534; Senior/Specialist: OR = 0.812, p = 0.811), and clinical specialty (MSK: OR = 2.150, p = 0.146; Neuro: OR = 1.705, p = 0.396) were not significant.

Likewise, in the “Need vs Not Required” comparison, gender (OR = 1.216, p = 0.712), years of experience (all categories p > 0.05), current position (Junior/General: OR = 1.867, p = 0.414; Senior/Specialist: OR = 1.167, p = 0.876), and clinical specialty (MSK: OR = 2.929, p = 0.145; Neuro: OR = 2.007, p = 0.410) showed no statistically significant relationships.

Overall, only one predictor Senior/Specialist position demonstrated a statistically significant association, with reduced odds of reporting a need for research training. All other variables were not significantly associated with either research or communication training needs. Detailed findings are presented in Table 2.

Table 2.

Multinomial logistic regression analysis showing predictors of perceived need for research and communication training, presented as odds ratios (OR) and p-values.

Outcome category		Predictor	B	OR	95% Cl	p-value
Research Training	No Need	Intercept	4.926	—	—	0.001
		Gender (Male)	0.003	1.003	[0.394, 2.551]	0.996
		Experience <5 yrs	−0.214	0.808	[0.133, 4.919]	0.817
		Experience = 6–10 yrs	−0.085	0.919	[0.153, 5.521]	0.926
		Experience = 11–15 yrs	−0.758	0.469	[0.087, 2.523]	0.377
		Current Position Junior/General	−1.153	0.316	[0.153, 5.521]	0.160
		Current Position Senior/Specialist	−1.271	0.281	[0.087, 2.523]	0.179
		Clinical Specialty = MSK	−0.972	0.378	[0.063, 1.575]	0.358
		Clinical Specialty = Neuro	−1.218	0.296	[0.044, 1.790]	0.266
	Need	Intercept	3.840	—	—	0.010
		Gender (Male)	0.088	1.092	[0.396, 3.009]	0.865
		Experience <5 years	−0.884	0.413	[0.060, 2.838]	0.369
		Experience 6–10 Years	−0.457	0.633	[0.095, 4.227]	0.637
		Experience 11–15 Years	−0.705	0.494	[0.083, 2.944]	0.439
		Current Position Junior/General	−0.937	0.392	[0.074, 2.088]	0.272
		Current Position Senior/Specialist	−2.201	0.111	[0.014, 0.900]	0.040*
		Clinical Specialty = MSK	−0.942	0.390	[0.045, 3.364]	0.391
		Clinical Specialty = Neuro	−1.510	0.221	[0.023, 2.116]	0.190
Communication Training Needs	No Need vs Not Required	Intercept	2.169	—	—	0.010
		Gender (Male)	0.059	1.061	[0.450, 2.502]	0.893
		Experience ≤5 yrs	−1.269	0.281	[0.053, 1.477]	0.134
		Experience 6–10 yrs	−0.011	0.989	[0.200, 4.886]	0.989
		Experience 11–15 yrs	0.385	1.470	[0.273, 7.926]	0.654
		Current Position Junior/General	0.410	1.507	[0.414, 5.489]	0.534
		Current Position Senior/Specialist	−0.208	0.812	[0.147, 4.485]	0.811
		Clinical Specialty = MSK	0.765	2.150	[0.767, 6.026]	0.146
		Clinical Specialty = Neuro	0.533	1.705	[0.497, 5.843]	0.396
	Need vs Not Required	Intercept	−0.261	—	—	0.806
		Gender (Male)	0.196	1.216	[0.430, 3.443]	0.712
		Experience ≤5 yrs	−1.607	0.200	[0.029, 1.385]	0.103
		Experience 6–10 yrs	−0.394	0.675	[0.105, 4.317]	0.678
		Experience 11–15 yrs	0.799	2.224	[0.343, 14.428]	0.402
		Current Position Junior/General	0.624	1.867	[0.418, 8.333]	0.414
		Current Position Senior/Specialist	0.155	1.167	[0.167, 8.148]	0.876
		Clinical Specialty = MSK	1.075	2.929	[0.691, 12.410]	0.145
		Clinical Specialty = Neuro	0.697	2.007	[0.383, 10.515]	0.410

Multinomial logistic regression analysis demonstrated that only a limited number of predictors were significantly associated with administration and management training needs, while the majority of variables were not statistically significant (p > 0.05).

For administration training needs, in the “No Need Vs Not Required” comparison, participants with ≤5 years of experience (OR = 0.157, 95% CI: 0.026–0.932, p = 0.042) and 6–10 years of experience (OR = 0.180, 95% CI: 0.034–0.946, p = 0.043) had significantly lower odds of reporting no need for training compared to the reference group. No other predictors, including gender, current position, or clinical specialty, showed statistically significant associations in this category. Similarly, in the “Need vs Not Required” comparison, none of the predictors demonstrated statistically significant associations (all p > 0.05).

For management training needs, in the “No Need vs Not Required” category, participants with ≤5 years (OR = 0.159, 95% CI: 0.027–0.919, p = 0.040) and 6–10 years of experience (OR = 0.193, 95% CI: 0.038–0.977, p = 0.047) were significantly less likely to report no need for training. In contrast, individuals in Junior/General positions had significantly higher odds of reporting no need for management training (OR = 3.693, 95% CI: 1.391–9.809, p = 0.009). Other variables, including gender and clinical specialty, were not statistically significant in this comparison.

In the “Need vs Not Required” category for management training, only clinical specialty (MSK) showed a statistically significant association (OR = 0.085, 95% CI: 0.010–0.734, p = 0.025), indicating lower odds of reporting a need for management training among individuals in this specialty. All other predictors, including gender, experience, and job position, were not significantly associated with training need (p > 0.05).

Overall, experience level (particularly early career stages), job position (Junior/General), and MSK specialty emerged as the only significant predictors across the models. All other variables did not demonstrate meaningful associations with administration or management training needs. Detailed findings are presented in Table 3.

Table 3.

Multinomial logistic regression analysis of predictors of administration and management training needs.

Outcome category		Predictor	B	OR	95%Cl	p-value
Administration Training Needs	No Need vs. Not Required	Intercept	5.172	—	—	0.000
		Gender (Male)	−0.161	0.851	[0.382, 1.898]	0.694
		Experience ≤5 yrs	−1.854	0.157	[0.026, 0.932]	0.042*
		Experience 6–10 yrs	−1.716	0.180	[0.034, 0.946]	0.043*
		Experience 11–15 yrs	−1.168	0.311	[0.058, 1.673]	0.174
		Current Position Junior/General	0.514	1.671	[0.547, 5.104]	0.367
		Current Position Senior/Specialist	−0.747	0.474	[0.120, 1.876]	0.287
		Clinical Specialty = MSK	−1.680	0.186	[0.024, 1.433]	0.106
		Clinical Specialty = Neuro	−1.071	0.343	[0.038, 3.074]	0.339
	Need vs Not Required	Intercept	2.465	—	—	0.097
		Gender (Male)	−0.210	0.811	[0.298, 2.204]	0.681
		Experience ≤5 yrs	−1.148	0.317	[0.038, 2.653]	0.289
		Experience 6–10 yrs	−0.835	0.434	[0.062, 3.033]	0.400
		Experience 11–15 yrs	−0.487	0.614	[0.087, 4.362]	0.626
		Current Position Junior/General	−0.155	0.857	[0.227, 3.230]	0.819
		Current Position Senior/Specialist	−0.637	0.529	[0.101, 2.775]	0.451
		Clinical Specialty = MSK	−1.317	0.268	[0.028, 2.605]	0.256
		Clinical Specialty = Neuro	−0.460	0.631	[0.055, 7.230]	0.712
Training need in Management	No Need vs Not Required	Intercept	4.173	—	—	0.001
		Gender (Male)	0.763	2.145	[0.952, 4.828]	0.065
		Experience ≤5 yrs	−1.841	0.159	[0.027, 0.919]	0.040*
		Experience 6–10 yrs	−1.645	0.193	[0.038, 0.977]	0.047*
		Experience 11–15 yrs	−1.125	0.325	[0.062, 1.704]	0.184
		Current Position Junior/General	1.307	3.693	[1.391, 9.809]	0.009*
		Current Position Senior/Specialist	0.583	1.791	[0.359, 8.942]	0.477
		Clinical Specialty = MSK	−1.888	0.151	[0.019, 1.181]	0.072
		Clinical Specialty = Neuro	−1.423	0.241	[0.027, 2.143]	0.202
	Need vs Not Required	Intercept	2.488	—	—	0.071
		Gender (Male)	0.766	2.150	[0.821, 5.634]	0.119
		Experience ≤5 yrs	−1.042	0.353	[0.048, 2.602]	0.307
		Experience 6–10 yrs	−1.660	0.190	[0.029, 1.251]	0.084
		Experience 11–15 yrs	−0.733	0.480	[0.074, 3.119]	0.442
		Current Position Junior/General	1.132	3.102	[0.917, 10.491]	0.069
		Current Position Senior/Specialist	0.828	2.289	[0.361, 14.498]	0.379
		Clinical Specialty = MSK	−2.462	0.085	[0.010, 0.734]	0.025*
		Clinical Specialty = Neuro	−1.509	0.221	[0.022, 2.190]	0.197

Multinomial logistic regression analysis examining training needs in clinical tasks was not statistically significant (χ² (16) = 12.11, p = 0.737), indicating that the included predictors did not meaningfully explain variation in clinical task training needs. Model fit indices suggested an adequate fit to the data (Pearson χ² (88) = 95.13, p = 0.283; Deviance χ² (88) = 91.03, p = 0.391); however, the model demonstrated limited explanatory power (Nagelkerke R² = 0.038).

Across both outcome comparisons (“No Need vs Not Required” and “Need vs Not Required”), none of the examined predictors including gender, years of experience, current position, and clinical specialty were statistically significant (all p > 0.05). In the “No Need vs Not Required” category, odds ratios for all predictors were close to unity and associated with wide confidence intervals, indicating imprecision and lack of meaningful association.

Similarly, in the “Need vs Not Required” comparison, no variables reached statistical significance. However, a non-significant trend was observed for current position, where individuals in supervisory roles (Senior/Specialist) demonstrated higher odds of reporting a need for clinical task training compared to the reference group (OR = 5.545, 95% CI: 0.514–59.873, p = 0.158).

Overall, the findings indicate that none of the demographic or professional variables included in the model were significant predictors of clinical task training needs. Detailed results are presented in Table 4.

Table 4.

Multinomial logistic regression for training needs in clinical tasks.

Outcome category		Predictor	B	OR	95%Cl	p-value
Training needs in clinical tasks	No Need vs. Not Required	Intercept	1.944	—	—	0.010
		Gender (Male)	−0.014	0.986	[0.472, 2.059]	0.969
		Experience ≤5 yrs	0.649	1.913	[0.531, 6.897]	0.322
		Experience 6–10 yrs	0.284	1.329	[0.408, 4.330]	0.637
		Experience 11–15 yrs	−0.079	0.924	[0.299, 2.859]	0.891
		Current Position Junior/General	−0.091	0.913	[0.376, 2.217]	0.841
		Current Position Senior/Specialist	1.549	4.705	[0.582, 38.061]	0.147
		Clinical Specialty = MSK	−0.113	0.893	[0.290, 2.747]	0.844
		Clinical Specialty = Neuro	0.284	1.329	[0.360, 4.906]	0.669
	Need vs Not Required	Intercept	0.149	—	—	0.874
		Gender (Male)	−0.044	0.957	[0.384, 2.382]	0.924
		Experience ≤5 yrs	−0.358	0.699	[0.149, 3.285]	0.650
		Experience 6–10 yrs	−0.320	0.726	[0.173, 3.041]	0.661
		Experience 11–15 yrs	−0.835	0.434	[0.105, 1.800]	0.250
		Current Position Junior/General	0.879	2.409	[0.727, 7.978]	0.150
		Current Position Senior/Specialist	1.713	5.545	[0.514, 59.873]	0.158
		Clinical Specialty = MSK	−0.184	0.832	[0.208, 3.322]	0.795
		Clinical Specialty = Neuro	0.141	1.152	[0.233, 5.686]	0.862

Discussion

This paper set out to determine the training needs of the physical therapists in Pakistan and the findings indicated that there were significant deficiencies in competencies in various areas such as clinical care, research literacy, administration, and communication. The results of the research can lead to the possible implications of the further development of professional steps (CPD), the design of physical therapy curricula and policy. The results of the investigation showed that there were certain areas whose training is relatively greater, such as development of relationships with the patients, critical evaluation of published research, assessment and management of clubfoot and amputee patients, health promotion research, wheelchair assessment and prescription, gait assessment and training, and administrative duties. The identified gaps can signify the aspects that have the potential to affect the quality and efficacy of physical therapy services in a clinical environment.

The most critical domain identified by the study was establishing a relationship with patients (GAP: 3.05). Physical therapists are directly involved with patients with diverse conditions, and therefore, the importance of establishing positive relationships with patients cannot be neglected. However, literature suggests that technical skills are often more emphasized in physical therapy training while competencies related to patient dealing, such as empathy, active listening, and trust-building, are often overlooked during training.^18,19 In the context of the present findings, the observed gap suggests that interpersonal competencies may not be sufficiently emphasized during training. Similarly, the significant gap in evaluating published research (GAP: 4.03) indicates a potential gap in integrating evidence-based practice (EBP) into clinical practice. The finding suggests that although physical therapists may recognize the importance of research, they may face challenges in appraising or applying research findings in practice. These findings align with studies, particularly from low-middle-income countries (LMICs), where limited access to journals, insufficient EBP training, and heavy clinical workloads hinder research integration into clinical practice. Due to this, physical therapists often practice outdated assessment methods and interventions and fail to improve clinical practice with emerging research.^20,21,22,23

Higher training requirements in particular fields e.g., amputation, clubfoot, wheelchair prescription and gait analysis, could indicate an insufficient clinical exposure and specialist mentorship.^24,25,26 Additionally, the study findings indicated that the administration practice (GAP: 4.37) and the health promotion research (GAP: 4.03) were some of the most significant training requirements. Past studies conducted by LMICs also presented that physical therapists are typically advanced to the managerial level without any organized leadership or management training. The new functions of a physical therapist are more likely to require the skills of scheduling, documentation, inter-professional cooperation, and quality management. Thus, the results shows that the aspects of leadership and health systems management might be required to be incorporated into CPD programs.^27,28,29 Likewise, health promotion domain can be perceived as a non-clinical skill; nevertheless, the comparably high GAP score can be an indication of the evolving role of physical therapists as the agents of public health and preventative care. This is consistent with the new global trends of rehabilitation professionals to practice preventive health,^30,31,32 but existing trainings in Pakistan may not fully reflect this transition.

Regression analyses showed that most training needs were not predictable by factors like gender, experience, position and specialty at all. This indicates that the identified gaps are widely spread between participants as opposed to them being localized among particular subgroups. Nevertheless, there were considerable associations in some regions; specifically, the significant differences in odds of less experienced therapists were notable in some of the models, and the perceived needs were considered relatively higher in administrative and management areas. This could indicate the difficulties in managing non-clinical tasks like documentation and coordination at the beginning of the career that students do not tend to focus on during their undergraduate training. On the other hand, the more qualified therapists might have acquired the competencies through exposure with experiences.

There are a number of implications of the current study findings. It may be essential to reform curriculum in Pakistan, which can make training more relevant to its needs. The modules based on interpersonal skills and patient-centered communication must be included in training programs at early physical therapy education levels. It may improve the EBP education by adding coordinated training in critical appraisal and research application in clinical settings. Moreover, the specialized clinical content must be elaborated and emphasized on the local related fields like amputation, club foot, gait analysis, and wheelchair training. This can be done by rotations in trauma centers, rehabilitation hospitals and pediatrics. Moreover, administrative and health promotion skills can be included in academic programs involving systematic study and real-life experience. In addition to the initial training, organized CPD programs are important. Gaps of high priority should be filled by the development of accredited short courses. In order to stimulate the concept of lifelong learning, one can take into justification a minimum number of CPD hours based on the international standards. The national regulatory bodies may be involved in the development of competency frameworks and standardization of the education and CPD requirements.

The present study is also one of the pioneers in Pakistan, which evaluated training requirements of physical therapists through a validated instrument, but it has certain weaknesses. The first is that the research was based on self-reported data, thus subject to reporting bias. Second, even though there are attempts to attract a diverse and wide sample, geographical representation might remain unequal. Finally, although the analysis examined demographic predictors, a qualitative exploration, which might have been done using focus groups or interviews, could have helped to give a better contextual picture on the identified gaps. The research gap to be considered in the future will involve trying to understand the root causes of the competency gap using qualitative methods. Also, the objective assessment instruments must be designed and tested to evaluate competencies more objectively and go beyond the self-reported data. The effectiveness of the specified gaps should also be explored through research that addresses them with the help of the targeted curricular interventions.

Conclusion

This study identifies critical training needs in the physical therapists of Khyber Pakhtunkhwa and Sindh that could be taken as national trends but required confirmation through nationwide studies. The study provides evidence of critical training needs among physical therapists in Pakistan. The high-priority needs, including patient-centered communication, evidence-based practice, specialized clinical management, and administration, demand urgent steps to fulfill the critical gaps. Educational institutions must develop curricula to address these deficiencies, while policymakers and professional bodies should establish robust CPD frameworks and regulatory standards.

Footnotes

Acknowledgements

We express our sincere gratitude to Dr Asif Gulzar Shaikh, Director of the Institute of Physical Therapy and Rehabilitation at Liaqat University of Medical Sciences, Jamshoro, and Mr Iftikhar Ali (PharmD), Lecturer and Research Coordinator at the College of Physical Medicine & Rehabilitation, Paraplegic Centre, Peshawar, for facilitating the main investigator throughout the data collection process in Sindh Province and Khyber Pakhtunkhwa, respectively.

Ethical consideration

Ethical approval was granted by the Institutional Ethical Review Committee of the Institute of Physical Medicine and Rehabilitation, Khyber Medical University [No: DIR/IPM&R-EC/202513, Dated 1st March 2025].

Consent to participate

Study participants were informed and briefed about the purpose of the study. Informed consent was obtained and confidentiality was maintained. No incentives were provided, and participants could skip questions or withdraw at any time. All data were anonymized and stored securely in password-protected files, ensuring compliance with the Declaration of Helsinki.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Reporting guidelines

This study is reported according to the STROBE guidelines for cross sectional studies.

ORCID iDs

Aatik Arsh

Ikram Ali

Seema Gul

Haider Darain

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