Understanding the challenges and opportunities for orthopedic manual physical therapy in Filipino physical therapy practice: An exploratory survey

Introduction: Orthopedic manual physical therapy (OMPT) is renowned for its positive biophysical and psychosocial effects, making it an important tool in clinical practice. Although OMPT has long been a stable intervention used in developed countries, its adoption has spiked in developing countries, including the Philippines. Despite this progress, no comprehensive study has explored the factors that may hinder or enable Filipino physical therapists (PTs) from utilizing OMPT into their daily clinical practice. The aim of this study was to conduct a thorough behavioral analysis to determine Filipino PTs' capabilities, opportunities, and motivations for using orthopedic manual therapy in their clinical practice, using the Theoretical Domains Framework (TDF) of the Behavioral Change Wheel model. Methods: This research was a cross-sectional survey that employed a validated TDF questionnaire covering various domains, including knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcements, intentions, memory/attention and decision processes, environmental context and resources, social influences, emotions, behavioral regulation, and goals. Filipino PTs were purposefully recruited to participate in in-person CE courses, conferences, symposiums, and through social media. Results: There were 331 respondents in the survey. The study revealed five dominant themes enabling Filipino clinicians to use manual therapy. These themes included Social/Professional role and identity (n=311, 94%), optimism (n=307, 93%), belief about consequences (n=304, 92%), knowledge (n=289, 87%), and the goal (n=288, 87%) of practicing manual therapy more frequently. The top 5 barriers included legal implications (environmental context and resources) (n=263, 79%), which also provoked fear of causing injury to patients (emotions) (n=171, 52%). Furthermore, clinicians received the same or less insurance reimbursement (environmental context and resources) (n=161, 49%) or out-of-pocket payment (environmental context and resources) (n=135, 41%) and did not have the necessary materials to effectively and safely perform manual therapy techniques (environmental context) (n=125, 38%). Conclusion: This study determined the principal themes essential in mapping the barriers and facilitators of utilizing OMPT among Filipino physical therapy clinicians. The utilization of the TDF allows for specific recommendations of intervention options for stakeholders to change specific behaviors, which will be crucial to becoming OMPT a staple intervention in Filipino PT daily clinical practice. Funding: The authors did not receive any external funding for this study.