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.
This research was a cross-sectional survey that employed a validated TDF questionnaire. The survey, distributed using a cloud program (e.g., Google Forms), included 24 socio-demographic, 28 TDF, and 2 logistical questions. The TDF questions covered 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.
There were 331 respondents in the survey. Sixty-three percent were females, and 37% were males. Most of the respondents were from the north (52.7%) and central (37.7%) regions of the Philippines. Only 8.9% were from the south (Mindanao), and less than 1% declined to identify their geographical location.
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 that prevented Filipinos from using manual therapy in their clinical practice fell under 2 main themes: Emotions and Environmental context and resources. The utilization was hampered by 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%).
This study determined the principal themes essential in mapping the barriers and facilitators of utilizing manual therapy among Filipino physical therapy clinicians. The utilization of the TDF allows for specific recommendations of intervention options for stakeholders such as manual therapy organization bodies, continuing education instructors, and clinicians themselves to change specific behaviors, which is crucial to making OMPT a staple intervention in Filipino PT daily clinical practice.
This is the first study known to the authors that establishes the barriers and facilitators for utilizing OMPT in the clinical practice of Filipino PTs. By specifying these factors, we can identify actionable steps stakeholders could take to address these barriers and enable facilitators.
Behavior change
