This present study evaluated the perceptions of physiotherapists in the regions that constitute Northern Nigeria on FCP. Our respondents were mostly young male physiotherapists aged between 24 and 57 years with working experience of not more than 3 years and the majority were general physiotherapy practitioners. This seems not cofounding because this age group is the age of productivity in most organizations and the age of graduation from physiotherapy programs in Nigeria. Also, physiotherapy programs in Nigeria, especially in the Northern part, are dominated by males. Additionally, it takes about 6 to 9 years post-graduation in Nigeria before a physiotherapist acquires experience, qualifies, and decides on an area of speciality to practice. This finding is not at variance with that of Mbada et al. .
Respondents were asked questions about the existing legislation, payment, or reimbursement of physiotherapists’ services, perceived barriers, and facilitators of first contact physiotherapy in Nigeria. The finding of this study is in tandem with a previous study by Mbada et al. , which reported that there is legislation that regulates the practice of physiotherapy in Nigeria, and this also defines the scope of practice of physiotherapists. In our study, the respondents asserted that the national legislation permits the practice of physiotherapy as a first contact profession and this contradicts the finding by Mbada et al.  in a similar study among physiotherapists who practice in Southwestern Nigeria. In their study, the authors noted that though physiotherapists in Southwestern Nigeria practice as first contact professionals, there was no legal backing to that effect. This could be confusing that physiotherapists in some parts of Nigeria are already practicing as first contact professionals without any legislative support; hence, the respondents in our study assumed that the existing legislation permits physiotherapists to take up the role. This depicts the poor implementation of Nigerian Laws.
First contact physiotherapy practice may be feasible in Nigeria as shown by the current practice as asserted by the respondents in this study and that of Mbada et al.  but it may require advanced qualifications and competency. For instance, Onyeso and colleagues had reported deficient medical imaging training in most physiotherapy programs in Nigeria . However, the undergraduate training for physiotherapists in Nigeria was perceived as adequate in preparing graduate physiotherapists to function as first contact practitioners. Most of the respondents, however, suggested that it is important to have advanced training to acquire more skills and relevant competencies to be able to qualify as a first contact practitioner. Conversely, a previous study had reported service competence for FCP model of primary care . In our study, the majority of the respondents noted that advanced training and continuing professional development programs organized by professional bodies such as the Nigeria Society of Physiotherapy (NSP) and Medical Rehabilitation Therapist Board of Nigeria (MRTBN) are vital.
The first contact practice model was perceived by many of the respondents in this study to receive support from NSP, the general public, and service users. This again shows the feasibility of this practice in Nigeria. This further underscores the importance of professional bodies in activating needed policy changes and subsequent implementation. A reference to such positive change as a result of professional advocacy can be seen in the Australian Physiotherapy association’s advocacy for referral policy change from referral policy to direct access in the 1970s . With the emergence of a new professional body in recent times known as the Association of Clinical and Academic Physiotherapists of Nigeria (ACAPN), there is a need for synergistic action of the two professional bodies toward advocacy and action to actualize FCP and improve the professional status of physiotherapy in Nigeria.
Most respondents asserted that physicians are not in support of this model of practice. This mirrors the interprofessional rivalry between medical doctors and other healthcare practitioners in Nigeria . To reinforce the claim of poor referral by physicians, the respondents reported that even with the current intermediary referral model of practice, the referring physicians rarely refer patients for physiotherapy timeously . This may be due to low-level awareness among medical doctors on the role of physiotherapy inpatient management or poor system setup that hinders smooth referral. It could also be due to interprofessional ego and rivalry.
Furthermore, on the issue of barriers and facilitators of first contact physiotherapy in Nigeria, the respondents identified barriers to this model of practice as non-support by the physicians, lack of policies, lack of relevant skills and competencies by physiotherapists, poor public awareness, and professional autonomy. Alnaqbi et al.  had reported similar findings such as limited support from the physicians and policymakers, professional autonomy, and the limited scope of practice for physiotherapists, as well as evidence-based practice as barriers to FCP among physiotherapists in Saudi Arabia. In Nigeria, the medical profession is a major player in the health policy and implementation landscape. Hence, the full support of medical practitioners is seen as a major facilitator of the adoption of FCP in Nigeria. Further, facilitators to FCP include support by the physicians, adequate training for and skills by physiotherapists, legislative support, and creation of public awareness. The perceived barriers to and facilitators of first contact practice around the views of key stakeholders (the medical profession, policy makers, and the public), represent the views of physiotherapists and may not be an accurate representation of those stakeholder groups. Since all appear to some extent as both barriers and facilitators, it shows how important they are to the profession and that, whether real or perceived, they need to be addressed. The perceived influence of policy makers on the availability of first contact physiotherapy, irrespective of whether it was permitted under legislation, was evident from the respondents and is consistent with previous studies [13, 20]. A latent limitation in the findings of this study is the respondents’ obliviousness of the current activities of the physiotherapy association (The Nigerian Society of Physiotherapy) which may not be in tandem with current realities thus depicting the association as ineffective in the advocacy for FCP of physiotherapists in Nigeria.