In total 698 people, 275 PT and 423 physiotherapy students participated in the conference. Of all conference participants, 322 filled in and returned the questionnaire presented in Additional file 1. The overall response rate was 46.1%. The sociodemographic characteristics of the respondents are presented in Figs. 1, 2, 3, 4, and 5 in Additional file 2. Overall, 59.3% of the respondents are less than 25 years old and 17.7% are between 36 and 45 years old. In total, 51.2% are male, and 45.3% of them are physiotherapy students. All tables with study results are represented in Additional file 3.
Knowledge of CR among PT and physiotherapy students
On average, the respondents indicated that they had medium level of knowledge about CR (41.3%, n = 133). About one quarter of the respondents (24.5%, n = 79) stated that they had good to excellent knowledge of CR while 30.1% (n = 97) of them stated that they had poor to very poor knowledge of CR.
In addition, nearly half of the respondents stated that they had medium level of knowledge about the multidisciplinary content/components of CR (45%, n = 145), and about one quarter had good to excellent knowledge of this CR aspect (25.5%, n = 82). About one third of the respondents (27%, n = 87) stated that they had poor to very poor knowledge of the multidisciplinary CR components (details can be found in Additional file 3, Table 1).
The majority of the respondents specified that they had good adherence to health promotion guidelines despite the absence of such programs in the country. Knowledge on WHO and WCPT guidelines on prevention and healthy promotion of CR is stated to be good to excellent by nearly half of the respondents (45.9%, n = 148). In addition, 46% stated that they had a good adherence to healthy promotion.
Attitude of PT and physiotherapy students toward CR
Our results also provide information on the attitude toward CR. Most of the respondents in our survey had a positive attitude toward CR. Only about one third, 35.7% (n = 115), stated that CR in Lebanon is effective and 95% (n = 306) believed that CR will have an added value for the country. In total, 95.7% (n = 308) of the respondents agreed that CR could improve quality of life and lifestyle of a stable patient post-surgery or suffering from cardiovascular and pulmonary diseases. In addition, 95.3% (n = 307) indicated that CR could change patient behavior post-surgery or suffering from cardiovascular diseases (CVDs). Further details can be found in Additional file 3, Table 2.
CR practice among PT and physiotherapy students
Regarding the practice of CR, our results indicate the respondents’ views on what type of patients are supposed to be eligible to start a CR. Most of the respondents stated that patients suffering from NCDs (post cardiac event, cardiac surgery, COPD patients, or with pulmonary diseases) should be “eligible candidates” for CR. Further details on this issue can be found in Additional file 3, Table 3.1.
Regarding the difficulty for a physiotherapist to refer patients to CR, about 80% of respondents agreed that it would be difficult to refer patients to a CR in the country. On the question regarding who should take the initiative to initiate this kind of program in the country, close to three quarter of the respondents thought that they “themself as physio” needed to initiate CR and a bit less than 70% stated that physicians need to select and refer the patients. About 40% of the respondents indicated that the insurance companies also play a role to initiate a CR program. Nearly half of the respondents believed that policy makers (person who established the policy) should play an important role to integrate the patient into a CR program (see Additional file 3, Table 3.2).
Additional analysis showed that almost no activity related to CR treatment was performed by PT at their work place or patient home during the preceding month. Specifically, more than 80% of the respondents did not treat patients suffering from cardiopulmonary diseases at their work place, private office or hospital setting during the preceding month. Also, more than 80% of the respondents did not treat patients suffering from cardiopulmonary diseases at patients’ home. Only “1 to 2 patients suffering from cardiopulmonary diseases” were treated at hospital or private clinic according to 63% (n = 11) of the PT in our study (see Additional file 3, Table 3.3).
Barriers facing PT and physiotherapy students related to CR
Our survey provided data on whether the PT face barriers to integrate a CR program in Lebanon as well as the types of barriers. More than 60% of the respondents indicate possible barriers when patients are referred from physicians or primary care providers to start rehabilitation treatment. One of two respondents think that the main barrier is the absence of skills for implementing a CR program. The second most-supported barrier is the lack of specialists in this field. The third top barrier is the absence of specialized centers in Lebanon. Slightly more than 20% of the respondents indicated that a barrier is the lack of patients’ interest in CR when patients are referred from physicians to start a program. In addition, more than three quarters of the respondents think that a CR program will not benefit the patient and would not change patient behavior (details can be found in Additional file 3, Table 4).
In addition, more than half of the respondents confirmed that they will face barriers regarding the price of the program when patients are referred by primary health care providers to start treatment and think that not covering the program by insurance and NSSF (social security) is a barrier to enter to the CR program. No enough endorsement by physicians to start a CR program is also seen as a top barrier by more than half of the respondents. In addition, one quarter of the participants suggest additional barriers in the category “others” like the need of more education in this field of practice and more training for physiotherapy students, as well as to raise awareness about the CR importance and also the need to implement a master degree in this field practice which is missing in the country.
Role played by PT in prevention through CR
Our respondents suggest that PT are playing a key role in the prevention of NCDs. More than 90% of the respondents supported this statement. Respondents agree that the PT have also other key prevention roles, such as to discuss the benefits of a healthy and active lifestyle with their patients, to encourage physical activity in their clinical practice on a daily basis (beyond therapeutic exercises) to promote the prevention of cardiovascular and pulmonary diseases. Findings show that the majority of PT are confident when giving advice to patients on physical therapy and act as a model for their patients. Regarding CR programs, PT are interested to participate in the assessment of patient’s body mass index (BMI) and to assess exercise capacity via 6-min walk test, make screening of cardiovascular risk factors, to give patient education, diet, and smoking cessation counselling. Finally, PT are playing a major role in psychological management during the patient treatment (see Additional file 3, Table 5).
Support for types of CR delivery and recommendations by PT and physiotherapy students
Our findings suggest that PT and physiotherapy students in Lebanon support all kinds of CR programs in the country, namely inpatient and outpatient clinical setting as well as telemedicine delivery (details can be found in Additional file 3, Table 6). The majority of the respondents support the implementation of a CR center in the country as inpatient or outpatient clinics as well as future implementation of telerehabilitation.
PT and physiotherapy students in our study also stated several recommendations for CR in Lebanon. Specifically, the participants recommended more training and education in CR for physicians, to raise awareness about the CR importance in the country. In addition, they pointed out the need to solve the financial issue of covering the costs of patients’ enrollment in CR. They also recommended the promotion of CR for the prevention of NCDs and removing barriers to the enrollment of patients into CR.
Associations
In addition, the degree of association between sociodemographic data of the respondents and responses to the KAP questions was analyzed using regression methods. However, we did not find any consistent pattern.