Acceptance and adoption of tele-rehabilitation by physiotherapists from Nigeria, a low resource setting: a mixed-method study
Authors: Odetunde Marufat Oluyemisi , Okonji Adaobi Margaret , Adeoye Adebola Peace , Onigbinde Ayodele Teslim 
Published: May 2024

Abstract
Background
Adoption of tele-rehabilitation among physiotherapists in developed countries has risen exponentially to complement conventional physical contact physiotherapy. However, many low- and middle-income countries like Nigeria where barriers to utilization of tele-physiotherapy were earlier identified still demonstrates limited evidence on its acceptance and adoption till date.

Method
This was a mixed-method design of quantitative and qualitative study, aimed at investigating acceptance and adoption of tele-rehabilitation among physiotherapists in Nigeria. Respondents comprised 331 physiotherapists practising in Nigeria and registered with the Medical Rehabilitation Therapists (Registration) Board of Nigeria (MRTB). Quantitative approach involved completion of a 33-item structured questionnaire shared as Google Forms to respondents’ WhatsApp and emails. Qualitative aspect involved in-depth interview with 12 physiotherapists at the clinics, using a 10-item semi-structured interview guide, and recorded with a voice recorder. Quantitative data was analysed using descriptive and inferential statistics at p < 0.05 alpha level. Qualitative data was analysed using thematic content analysis.

Results
Respondents comprised 172 males and 159 females. Their mean age and years of experience were 33.42 ± 8.95 and 8.86 ± 8.037 years, respectively. Pre-lockdown, only 62 (18.7%) respondents offered tele-physiotherapy. During the 35-day total lockdown, 114 (34.4%) offered tele-physiotherapy. Majority (155 (46.8%)) used smartphone apps. Fifty-seven (17.2%) respondents were confident that tele-rehabilitation can complement conventional physiotherapy, while 72 (21.8%) kept offering post-lockdown. Use of digital technology was highest for patient education (97 (29.3%)), especially for musculoskeletal conditions (85 (25.7%)). There were significant associations between pre-lockdown duties (p = 0.036), post-lockdown duties (p = 0.005) and use of digital health technology (p = 0.001) with respondents’ age. Significant associations also existed between respondents’ years of practice and each of post-lockdown duties (p = 0.017) and use of digital health technology (p = 0.001). Qualitative approach revealed that facilitators to adoption and acceptance of tele-rehabilitation included patient education, training of physiotherapists, availability of evidence-based guidelines and tele-health software and hardware systems. Barriers were lack of or limited technological infrastructures, finances, hospital management support, and knowledge of information and communication technology.

Conclusions
Physiotherapists in Nigeria demonstrated moderate acceptance but low adoption of tele-rehabilitation, in varied comparison with clinicians and physiotherapists in other climes. Training of physiotherapists in tele-rehabilitation and provision of enabling technological environment by regulatory bodies and policy makers are recommended.