The present study demonstrated that licensed physiotherapists in Israel have a positive attitude towards integrating nutritional assessment and counseling into their clinical practice (mean total score of 19.8/25). This result is consistent with APTA’s assertion that nutritional assessment and counseling is a discipline (6). This is also consistent with previous studies (5, 14,15,16), which demonstrated that practicing physical therapists agreed with the APTA statement because they had a positive attitude toward integrating nutritional assessment and counseling into their physical therapy.
In the current study, 67% of participants reported that they did not receive formal nutrition education as part of their basic education. These results are consistent with previous studies that identified a nutrition knowledge gap among physiotherapists through objective testing (11, 14, 16, 17). Nevertheless, to our knowledge, this study stands out as the first to investigate the correlation between prior nutrition education during entry-level studies and attitudes toward integrating nutrition into practice. The results of the present study indicate that being exposed to nutrition courses during entry-level studies predicts positive attitudes towards integrating nutritional assessment and counseling into the clinical practice. These findings complement previous research that highlights the importance of attitudes and behavioral beliefs as factors influencing the actual integration of nutrition into the physiotherapy treatment system (5). This highlights the need to re-evaluate physiotherapy programs to ensure appropriate content is incorporated. Additionally, it is imperative to establish continuing education programs offering a range of seminars and workshops for physical therapists who have completed their formal education (5). Furthermore, the content of nutrition-related studies should be standardized to ensure their contribution to improving patient outcomes and, therefore, improving the overall effectiveness of physiotherapy. Improving knowledge related to nutritional issues is essential to position the profession at the forefront in efforts to mitigate lifestyle-related diseases and promote optimal health. (5).
Based on the current findings, significant predictors of a positive attitude toward integrating nutritional assessment and counseling into physiotherapy practice are clinical experience of ≥13 years and prior knowledge acquired during training entry-level physiotherapist. To our knowledge, no previous study has examined the correlation between attitudes toward incorporating nutritional counseling and years of clinical practice, which was a positive predictor in the current study. In contrast, several studies have examined the correlation between attitudes toward incorporating nutritional counseling and prior knowledge. Similar to the present study, a previous study conducted among members of the APTA Geriatric Section showed a positive correlation between the two variables (15). However, other studies of physical therapists treating orthopedic and sports injuries (14) and those in acute care settings (16) did not demonstrate a similar correlation. This discrepancy between studies may be related to differences in the measurement tools used to determine the level of prior knowledge. Additionally, differences in questions addressing subjects’ attitudes (i.e. referring to the importance of acquiring nutritional knowledge, incorporating nutritional advice and/or referral to a dietitian) may also led to disagreements.
Our hypothesis, based on previous studies (14, 16), was that the physiotherapists’ work environment could contribute to the physiotherapist’s attitude towards the integration of nutrition into treatment. However, this hypothesis was not supported in the present study, as no significant differences were found in the mean attitude score between different work contexts. This result may be due to the unbalanced representation of different work settings, since a high percentage (63.3%) of participants worked in outpatient clinics, while only 23.6% worked in acute care hospitals/hospitals. rehabilitation/retirement homes.
This study presents a unique examination of factors that predict favorable attitudes toward integrating nutrition issues into physical therapy practice. We identified two significant predictors of these positive attitudes: prior knowledge acquired during entry-level physiotherapist studies (β = 0.17, P < 0.01) and having more than 13 years of experience clinical (β = −0.13, P < 0.05). However, these predictors only explained about 2% of the variance in positive attitude. Notably, other factors tested such as age, body mass index, and confidence level in nutritional knowledge were not significantly correlated with participants' attitudes. Given the absence of previous studies on this topic in the literature, we are unable to compare our results with previous studies. Further research is needed to identify other factors influencing these attitudes, such as aspects related to lifestyle and cultural context. Physiotherapists demonstrated low confidence in their level of knowledge that would enable them to assess the nutritional status of patients and identify the need for referral. for dietary advice. This may be related to the fact that most respondents did not take nutrition courses during their entry-level physical therapist training (67%) or in other educational settings (63.0%). This finding is supported by previous studies demonstrating that physical therapists' lack of confidence can be improved by additional training on nutrition issues (5, 22, 23). However, further studies should investigate whether lack of physical therapist confidence may prevent the integration of nutrition into physical therapy, as noted in previous studies (5).
Examination of physiotherapists’ sources of knowledge regarding nutrition revealed that most had received no formal education either during their entry-level physiotherapist training (67.0%) or in other educational settings (63.0%). This finding should be noted by those who design curricula for physiotherapists in Israel, as physiotherapists must provide accurate information about nutritional issues, correct patient misinformation, and refer patients to other health professionals. health if necessary. This is particularly important when patients are referred directly to a physiotherapist, as the meeting with the physiotherapist may be the only point of entry into the healthcare system (14).
The main informal source of nutritional information mentioned by physiotherapists in the present study was the Internet (87.3%), followed by consultation with a registered dietitian (70.2%); only 36.0% referred to professional and scientific literature for information. These results contradict previous results (14,15,16), whose main source of information was the media and magazines. In contrast, in the present study, media and newspapers/magazines were among the least cited sources of information for nutritional information. Our results may be related to greater use of the Internet as a general source of information compared to 20 years ago, when the cited references were made (14,15,16). As the quality and accuracy of information obtained via the Internet is sometimes questionable, nutritional studies should be integrated into entry-level and postgraduate physiotherapy curricula, so that physiotherapists can reliably include nutritional assessment and advice in the framework of physiotherapy.
With the growing role of physiotherapists in promoting wellness and healthy living, it is essential to determine their attitudes and knowledge regarding nutritional issues. The present study, which included physiotherapists from a wide range of specialties, constitutes an important contribution to the literature.
Limitation
Some limitations of the study should be noted. The survey was distributed via the Internet, so we could not calculate the response rate. Additionally, nutrition knowledge acquisition during entry-level studies was self-assessed based on participants’ memory. To mitigate this potential bias, we introduced the ability to select “I don’t remember” as a possible answer to relevant questions. Future studies may consider incorporating objective knowledge assessments. However, even for a direct assessment of respondents’ knowledge, their answer as to the source of their knowledge will depend on their memories. Another limitation of this study is selection bias, as individuals with increased interest in nutrition were likely more likely to participate in the survey. All of these limitations may potentially affect the generalizability of the current results.
