The study explored the characteristics and level of MI training among physiotherapists in Nigeria. There was a paucity of literature on the essence of physiotherapy training in diagnostic and procedural imaging. The inclusion of standalone MI module in entry-level physiotherapy programme is recent and curricular emphasis differs across institutions and countries of the world [20, 21].
The present survey had a similar demographic finding with another online study conducted on the same population [22]. The study reported that 42.5% of the physiotherapists in Nigeria were in the orthopaedic or musculoskeletal specialty, but the present study reported a slightly higher percentage, 46.3%. The increase could be attributed to a phenomenon by which subject area (musculoskeletal imaging) influences the response rate of an online survey. The age of the respondents in the study (32±6 years) [22], is similar (33±8 years) to our study participants. However, our study recorded a female to male response ratio of 1:2 against 1:1 that was reported by (xxxx) and colleagues [22]. Interestingly, the finding (male = 68.7%) concurred with the report of (xxxx) and colleagues who posits that physiotherapists in Nigeria are dominated by men, who made up 72% of university lecturers and 63% of practicing physiotherapists [23].
Comparatively, the diagnostic imaging curricula of the US-based institutions [19], revealed that their Nigerian counterparts are still deficient. The present study reported that 74.3% of the respondents received at least one type of MI training at the undergraduate, 23.5% had a standalone course. While in the US, 98.1% of the (n = 206) institutions had incorporated diagnostic imaging in their medical track courses or electives, and 50.0% had specifically adopted a standalone course [20]. This finding is not surprising; aside from few institutions that took proactive steps, the physiotherapy education programs in Nigeria did not include a standalone diagnostic imaging course in their curricula [16].
However, the findings in this study showed that majority of the respondents (51.5%) received MI training between the third and fourth (penultimate) years. The outcome is in contrast with a study [20], that reported that 92.7% of the institutions in the US introduced imaging content in the first or second year of the programme. It will be advantageous to integrate MI knowledge and skills early in the educational programme in tandem with the preclinical science contents [15]. As Nigerian institutions prepare to implement the newly approved DPT programme with a standalone diagnostic imaging course [18], the contents should be introduced early in the curriculum.
The results showed that physiotherapists taught 26.3% of the respondents; radiologists taught 22.0%, both personnel taught another 22.0%, adjutant staff instructed the remaining 4.0%, and 25.7% were not taught MI at entry-level. We are not aware of any previous study that investigated the personnel that delivered the undergraduate MI contents and their qualifications.
An undergraduate clinical posting exposure which 58.0% of respondents of this survey received at the diagnostic imaging department of the affiliate hospitals is in line with best practices. A similar study conducted at the University of Puget Sound in the USA reported an average student exposure to imaging during clinical experiences as 43.13 hours and 34 hours of classroom instruction [21].
Our findings revealed that only a few physiotherapy departments had adopted the best practice of posting interns to the diagnostic imaging department of their hospitals. Consequently, most of the respondent, 92.8%, did not have diagnostic imaging posting exposure. Diagnostic imaging exposure is recommended during classroom instruction, during onsite clinical experiences, and full-time internships [21].
Virtually all the respondents (95.5%) did not receive USS training during the undergraduate and internship programmes. The finding concurred with the point of view by Potter and colleagues that musculoskeletal ultrasound imaging is an advanced CPD content [24]. Correspondingly, the Federation of State Boards of Physical Therapy (FSBPT) in the US has stated that the ability to carry out rehabilitative ultrasound imaging, at this time, is not entry-level skills and should require additional training [25].
The MRTBN has made CPD programmes a prerequisite for the mandatory annual renewal of physiotherapy practicing license in Nigeria. Therefore, our study excluded respondents without a current practicing license. Professional associations mainly organize CPD programmes in Nigeria. Yearly, a Nigerian physiotherapist is expected to accrue over 30 CPD points through workshops. A question of interest asked was if these workshops incorporate diagnostic imaging contents.
Respondents were asked how many diagnostic imaging workshops they have ever attended; unfortunately, the majority (67.3%) had never participated in any diagnostic imaging workshop. The few respondents that had attended (1 to 3) such workshops did not have any hands-on experience during the workshops, especially in the area of USS. Our finding corroborated Potter and colleagues [24] who reported that most respondents in their survey indicated that there were inadequate resources to receive supervision to maintain USS CPD; suggesting a lack of appropriately qualified and skilled mentors.
Physiotherapy training institutions in Nigeria have developed postgraduate (M.Sc. and Ph.D.) programmes [26]. The present study focused on the local physiotherapy programme, so those with postgraduate outside the country were excluded. Postgraduate training in Nigeria involves both taken specified physiotherapy and elective courses and research work. Diagnostic imaging is not included among the core and elective courses.
Consequently, virtually all the postgraduate respondents neither had clinical postings nor hands-on USS training at that level. In a study (n = 1,574) conducted among registered physiotherapists in Ontario, Canada, few respondents had taken postgraduate causes in ordering diagnostic imaging as follows; 5% plain film X-ray, 4% each for MRI, diagnostic ultrasound and CT scan [27]. Since some imaging modalities like procedural and rehabilitative USS is beyond entry-level programme [24, 25], it is hereby recommended that postgraduate educational programmes should put more emphasis on them.
Our study explored the self-reported level of MI training. The median respondents’ rating indicated that training on X-ray was significantly higher than all other modalities, but MRI and CT scan were higher than USS, scintigraphy, and DEXA. Our findings were consistent with the conclusions of a previous study [21], that exposure to X-ray and MRI was higher in both the didactic portion and clinical experiences when compared to other modalities.
It is worthy to note that educational programmes in the USA have proactively integrated ultrasound imaging content into their curricula [20, 24]. There is a paucity of literature on physiotherapists’ level of training in DEXA and scintigraphy; even though some studies opined that physiotherapists are competent in the use of both modalities [5, 9, 20]. DEXA is a prerequisite for spinal manipulation in all women and men age 65 and 70 years and older, respectively [15].
In our study, after adjusting for higher educational qualification, internship training, workshops, specialty, practice setting and years of experience, there was no significant difference in the level of diagnostic imaging training received by respondents across the institutions. Thus, we found that MI training is uniformly-poor across the institutions.
Our findings also revealed a significant difference in the level of diagnostic imaging training between DPT and bachelor’s degree holders. Thus, supporting the need to transition the bachelor’s degree programme to entry-level DPT. A previous study has indicated that the implementation of the DPT resulted in an increased emphasis on imaging as a content area [20]. Similarly, the entry-level DPT programme was designed to provide enough imaging education to prepare new graduate-physiotherapists for imaging privileges [21].
The advocacy for the entry-level DPT education has been ongoing in Nigeria for over three decades [27, 29]. Fortunately, the NUC approved the DPT curriculum in 2018; the emphasis has shifted to speedy implementation. A programme readiness evaluation survey conducted among all the institutions in Nigeria offering physiotherapy educational programme (n = 7), showed that the vast majority (71%) of the universities were ready to implement the DPT curriculum [23]. The few DPT holders (n = 8) that participated in our study obtained their DPT training abroad, but with an enormous financial burden.