obstetric and gynecologic physiotherapy is a subspecialty in physiotherapy concerned with 
 promotion of health throughout the child - bearing period , and helps the mother to adjust 
 advantageously to the physical and psychologic changes of pregnancy and the post - natal period , so 
 that the stresses of child - bearing are minimized .
physiotherapists specializing in obstetrics and 
 gynecology require a mature blend of attributes , enabling women to disclose confidently what may be 
 some of the most intimate and personal details of their lives.1 the role of the physiotherapist in obstetrics and gynecology involves 
 pregnancy , labor , and the puerperium , and the preoperative and postoperative periods.2 however , the extent of utilization of physiotherapy 
 services by obstetricians and gynecologists will depend on their knowledge and attitude towards 
 physiotherapists .
physiotherapy in nigeria operates on a referral system , so utilization depends on 
 the attitudes of physicians towards physiotherapy .
physiotherapists in nigeria hold a 
 bachelor s degree , and some also have a master s degree or doctoral 
 qualifications .
utilization of individual professional skills depends on cooperation between health team members 
 and the extent to which they value the knowledge of other team members in discharging their services 
 to the patient , who is the main focus of the team.3 
 therefore , there is a need for interdisciplinary cooperation between health care professionals , 
 including obstetricians , gynecologists , midwives , physiotherapists , medical laboratory scientists , 
 and social workers.4 ogbona reported that 
 physicians who trained in nigeria had a poor knowledge and awareness of the physiotherapy profession 
 compared with their counterparts who trained in the west.5 this limited knowledge may affect appropriate utilization of physiotherapy services by 
 doctors , and could have an adverse effect on overall health care delivery in the country . in 
 contrast , ikhizama3 observed an increase in 
 knowledge of physicians trained in nigeria about physiotherapy services compared with that reported 
 by stephenson.4 however , both ogbona and abayomi 
 observed that , despite the positive attitude of obstetricians in selected hospitals in ibadan 
 township and ogun state towards physiotherapists , utilization of physiotherapy services was 
 poor.5,6 several studies have been carried out to assess the awareness , knowledge , attitudes , and 
 utilization of physiotherapy services in various medical conditions.3,6,7 inclusion of physiotherapy services in obstetrics and 
 gynecology is pivotal to delivery of an optimal health care service .
however , in nigeria , there is 
 limited information concerning the attitudes of obstetricians and gynecologists towards the 
 involvement of physiotherapists in the management of patients with obstetric and gynecologic 
 conditions as well as factors affecting their utilization of these services .
this study was designed as a descriptive survey in which the participants were consultants and 
 senior registrars in obstetrics and gynecology selected from seven hospitals in south - western 
 nigeria .
the investigators identified the names of all senior 
 registrars and consultants in the selected hospitals from hospital records .
this was a population 
 study because of the limited number of obstetricians practicing in the region , so all senior 
 registrars and consultants were invited to participate , and all those who gave their consent were 
 included .
sixty - seven ( 52.76% ) of the 127 senior registrars and consultants working in the selected 
 hospitals participated in the study .
the hospitals selected were university college hospital in ibadan , obafemi awolowo university 
 teaching hospital in ile - ife , lagos university teaching hospital in idi - araba , lagos , ladoke 
 akintola university teaching hospital in osogbo , olabisi onabanjo university teaching hospital in 
 sagamu , the federal medical centre in idi - aba , abeokuta , and lagos state university teaching 
 hospital in ikeja , lagos .
these hospitals are located in the south - western part of nigeria , and the 
 majority of obstetricians in the country are trained and located in these institutions .
the study 
 instrument was a 28-item self - reported questionnaire in the english language adapted from a 
 standardized questionnaire used in previous work.6 
 the questions were selected from the earlier questionnaire , the language of which was modified to 
 suit the nigerian context , with addition of some other items deemed to be relevant .
the 
 questionnaire was then presented at a seminar for expert face and content validation .
expert 
 consensus was reached and the questionnaire was piloted in another location outside the study 
 population .
this was done on two occasions within one week to test the reliability of the 
 instrument .
the questionnaire was in three sections , ie , demographic 
 characteristics , attitude of obstetricians and gynecologists to the role of physiotherapists in 
 obstetrics and gynecology , and extent of utilization and factors affecting utilization of 
 physiotherapy services by obstetricians and gynecologists . the attitude and utilization
ethical approval for the study was obtained from the institutional review committee at university 
 college hospital .
permission to conduct the study was obtained from the heads of departments of 
 obstetrics and gynecology in each of the selected facilities .
informed consent was obtained from the 
 participants in this study and the questionnaires were self - administered .
the questionnaires were 
 collected immediately after completion , and those who could not complete their questionnaire 
 immediately were contacted for collection on a return visit or through a contact person .
the 
 questionnaires were anonymous , so the researcher did not know who did or did not complete the 
 questionnaire .
the data were analyzed using descriptive statistics of frequency , percentages , and 
 chi - square inferential statistics , with the statistical significance level set at p 
 < 0.05 .
sixty - seven participants , comprising 26 ( 38.8% ) consultants and 41 ( 61.2% ) senior 
 registrars from seven selected hospitals , were included in this study .
three ( 4.47% ) of the 67 questionnaires 
 were not completed , so were not included in the analysis .
the age range of the participants was 
 3150 ( modal age range 3140 ) years .
the study group included 61 ( 91.0% ) men 
 and six ( 9.0% ) women . the majority ( 75.5% ) of the participants knew the role of 
 physiotherapists in obstetrics and gynecology .
the majority ( 80.6% ) of participants strongly 
 agreed and 13.4% agreed to involvement of physiotherapists in obstetric palsy , followed by 
 muscle weakness ( 79.1% strongly agreeing and 20.9% agreeing ) and gait postural 
 alteration ( 77.6% strongly agreeing and 22.4% agreeing , respectively ) .
further , 
 11.9% strongly agreed and 34.3% agreed to involvement of physiotherapists in the 
 management of dyspareunia , while 34.3% strongly agreed and 13.3% agreed to 
 involvement of physiotherapy in pelvic inflammatory disease .
it was noted that 94.0% and 1.5% of participants strongly agreed and agreed , 
 respectively , that physiotherapy service does not cause patients any harm , 92.5% and 
 4.5% strongly agreed and agreed , respectively , that physiotherapy can not be replaced with 
 drugs and instructions , and 92.5% agreed that physiotherapists are competent to manage 
 patients with obstetric and gynecologic conditions , as shown in table 3 .
also , 86.6% and 1.5% of gynecologic patients 
 while 76.1 and 1.5% of obstetric patients strongly agreed and agreed , respectively , that 
 physiotherapy service may contribute significantly to the complete well - being of gynecologic 
 patients .
further , 80.6% of participants strongly agreed that a physiotherapy service would 
 not be too expensive for patients , 50.7% and 6.0% strongly agreed and agreed , 
 respectively , that physiotherapy is time - consuming , 56.7% and 10.4% strongly agreed 
 and agreed , respectively , that physiotherapists should be allowed to attend surgical procedures for 
 patients with gynecologic conditions , and 38.8% and 16.4% strongly agreed and 
 agreed , respectively , that physiotherapists should be allowed to attend the labor ward , while 
 41.8% and 13.4% strongly disagreed and agreed in that order that physiotherapists 
 maintained adequate interprofessional relationships .
sixty - three ( 94.0% ) of the participants reported having referred patients for 
 physiotherapy , while four ( 6.0% ) had not done so ( see table 4 ) .
forty - eight ( 71.6% ) of participants had referred 
 patients with a prescription , while 14 ( 20.9% ) had referred patients without a prescription . 

one ( 1.5% ) participant had referred patients with and without a prescription , and four 
 ( 6.0% ) did not refer at all .
thirty - eight ( 60.3% ) participants referred patients to general / state hospitals , eight 
 ( 11.9% ) to their hospital of practice , six ( 9.0% ) to a private physiotherapy clinic , 
 five ( 7.5% ) to both a private physiotherapy clinic and a general / state hospital , three 
 ( 4.5% ) to a private physiotherapist , two ( 3.0% ) to a physical health educator , one 
 ( 1.5% ) to both a private physiotherapy clinic and a private physiotherapist , and four 
 ( 6.0% ) did not refer at all , as shown in table 
 4 .
sixty - five ( 97.0% ) of the participants had a physiotherapy department in their hospital 
 of practice , 17 ( 25.4% ) had a physiotherapy clinic within the vicinity of their hospital , 
 and 63 ( 94.0% ) had physiotherapists as close friends .
thirty - four ( 50.7% ) 
 participants reported that the physiotherapy service in their hospital of practice is not too 
 expensive and 62 ( 92.5% ) considered that the physiotherapy service had not worsened the 
 condition of their patients .
thirty - one ( 46.3% ) of the respondents reported that there were 
 not enough physiotherapists in their hospital of practice to cover the obstetrics and gynecology 
 wards .
forty - seven ( 70.1% ) had worked previously with physiotherapists in the management of 
 obstetric patients , while 49 ( 73.1% ) had worked previously with physiotherapists in the 
 management of gynecologic patients .
forty - five ( 67.2% ) of the participants reported that a 
 physiotherapy training program existed as a degree course in their college of basic medical 
 training .
however , only 10 ( 14.9% ) had physiotherapists posted in their hospitals and seven 
 ( 10.4% ) had attended ward rounds with physiotherapists , while 56 ( 83.6% ) had a 
 physiotherapy training program in their institution of residency training ( see table 5 ) .
it was noted that 94.0% and 1.5% of participants strongly agreed and agreed , 
 respectively , that physiotherapy service does not cause patients any harm , 92.5% and 
 4.5% strongly agreed and agreed , respectively , that physiotherapy can not be replaced with 
 drugs and instructions , and 92.5% agreed that physiotherapists are competent to manage 
 patients with obstetric and gynecologic conditions , as shown in table 3 .
also , 86.6% and 1.5% of gynecologic patients 
 while 76.1 and 1.5% of obstetric patients strongly agreed and agreed , respectively , that 
 physiotherapy service may contribute significantly to the complete well - being of gynecologic 
 patients .
further , 80.6% of participants strongly agreed that a physiotherapy service would 
 not be too expensive for patients , 50.7% and 6.0% strongly agreed and agreed , 
 respectively , that physiotherapy is time - consuming , 56.7% and 10.4% strongly agreed 
 and agreed , respectively , that physiotherapists should be allowed to attend surgical procedures for 
 patients with gynecologic conditions , and 38.8% and 16.4% strongly agreed and 
 agreed , respectively , that physiotherapists should be allowed to attend the labor ward , while 
 41.8% and 13.4% strongly disagreed and agreed in that order that physiotherapists 
 maintained adequate interprofessional relationships .
sixty - three ( 94.0% ) of the participants reported having referred patients for 
 physiotherapy , while four ( 6.0% ) had not done so ( see table 4 ) .
forty - eight ( 71.6% ) of participants had referred 
 patients with a prescription , while 14 ( 20.9% ) had referred patients without a prescription . 

one ( 1.5% ) participant had referred patients with and without a prescription , and four 
 ( 6.0% ) did not refer at all .
thirty - eight ( 60.3% ) participants referred patients to general / state hospitals , eight 
 ( 11.9% ) to their hospital of practice , six ( 9.0% ) to a private physiotherapy clinic , 
 five ( 7.5% ) to both a private physiotherapy clinic and a general / state hospital , three 
 ( 4.5% ) to a private physiotherapist , two ( 3.0% ) to a physical health educator , one 
 ( 1.5% ) to both a private physiotherapy clinic and a private physiotherapist , and four 
 ( 6.0% ) did not refer at all , as shown in table 
 4 .
sixty - five ( 97.0% ) of the participants had a physiotherapy department in their hospital 
 of practice , 17 ( 25.4% ) had a physiotherapy clinic within the vicinity of their hospital , 
 and 63 ( 94.0% ) had physiotherapists as close friends .
thirty - four ( 50.7% ) 
 participants reported that the physiotherapy service in their hospital of practice is not too 
 expensive and 62 ( 92.5% ) considered that the physiotherapy service had not worsened the 
 condition of their patients .
thirty - one ( 46.3% ) of the respondents reported that there were 
 not enough physiotherapists in their hospital of practice to cover the obstetrics and gynecology 
 wards .
forty - seven ( 70.1% ) had worked previously with physiotherapists in the management of 
 obstetric patients , while 49 ( 73.1% ) had worked previously with physiotherapists in the 
 management of gynecologic patients .
forty - five ( 67.2% ) of the participants reported that a 
 physiotherapy training program existed as a degree course in their college of basic medical 
 training .
however , only 10 ( 14.9% ) had physiotherapists posted in their hospitals and seven 
 ( 10.4% ) had attended ward rounds with physiotherapists , while 56 ( 83.6% ) had a 
 physiotherapy training program in their institution of residency training ( see table 5 ) .
our findings indicate that consultants tend to be more aware and have better knowledge than 
 senior registrars about the role of physiotherapy in obstetrics and gynecology due to exposure 
 resulting from years of experience .
the majority ( 79.1% ) of participants knew of the role of 
 physiotherapists in obstetrics , with postnatal care having the highest score ( 98.5% ) , 
 followed by antenatal care ( 82.1% ) and parturition ( 56.7% ) .
these findings agree 
 with those of another report.6 we found that 66 
 ( 98.5% ) of participants knew the role of physiotherapy in uterine prolapse , 47 
 ( 70.1% ) in hysterectomy , 22 ( 32.8% ) in pelvic inflammatory disease , and five 
 ( 7.5% ) in cervical incompetence , indicating that participants were knowledgeable about the 
 role of physiotherapy in obstetrics and gynecology .
however , the low score observed for knowledge of 
 the role of physiotherapy in pelvic inflammatory disease indicates that although obstetricians and 
 gynecologists had general knowledge of the role of physiotherapy service , they had limited knowledge 
 with regard to specific conditions .
this also shows that obstetricians had not been involving 
 physiotherapists in the management of conditions such as pelvic inflammatory disease .
it was 
 observed that of all the 28 obstetric and gynecologic conditions listed , 80% strongly agreed 
 about the role of physiotherapists in obstetric palsy .
this is consistent with a previous report 
 that physiotherapy is the main management modality for this condition.8 however , it is noteworthy that 43.4% and 41.8% of the 
 participants did not agree about the role of physiotherapy in the management of episiotomy care 
 perineal tears , respectively , even though it has already been pointed out that management of 
 episiotomy requires more physical therapy than is currently appreciated.8 most of our study participants ( 86.6% and 76.1% , respectively ) agreed that 
 patients with obstetric and gynecologic conditions also require physiotherapy services .
this is in 
 agreement with two other reports.6,7 the majority of participants strongly agreed that 
 physiotherapy would not cause harm to patients , and 92.5% strongly agreed that physiotherapy 
 services can not be replaced with drugs and instructions , and that physiotherapists are competent to 
 manage obstetric and gynecologic conditions .
more than 80% of participants strongly agreed 
 that a physiotherapy service is not expensive and could be afforded by patients , while 50.7% 
 considered it to be time - consuming .
also , 56.7% of participants strongly agreed that 
 physiotherapists should be allowed to attend surgical procedures for patients with gynecological 
 conditions , and 38.8% strongly agreed that physiotherapists should be allowed to attend the 
 labor ward .
it is agreed that physiotherapists can attend the labor ward , but should not interfere 
 in any way in its normal operation but merely reinforce to the mother the teaching she had received 
 in the antenatal period .
underutilization of physiotherapy may be due to limited knowledge on the 
 part of obstetricians and gynecologists about the role of physiotherapists in parturition .
further , 
 41.8% of participants strongly agreed that physiotherapists have not performed adequately in 
 their interprofessional relationships .
this is indicative of a need for improved communication in 
 the form of seminars , workshops , and attendance at grand rounds .
the majority ( 94.0% ) of participants referred patients for physiotherapy , while 
 6.0% did not , and this could be due to the fact that the participants had better knowledge , 
 a better attitude , and hence improved utilization of physiotherapy service .
most ( 76.2% ) of 
 the participants referred obstetric and gynecologic patients with a prescription while 20.9% 
 referred patients without a prescription , and the majority of the participants referred patients to 
 general / state hospitals .
this could be due to nonavailability of a department of physiotherapy in 
 their hospitals of practice .
our findings in this regard are consistent with those of adegoke.9 referral with a prescription does not show regard for 
 professionalism and needs to be investigated .
ninety - seven percent of the participants had a physiotherapy department in their hospital of 
 practice , 94.0% had physiotherapists as close friends , 83.6% had a physiotherapy 
 training program in their institution of residency , 73.1% and 70.1% had worked with 
 physiotherapists before in the management of gynecologic patients and obstetric patients , 
 respectively , 67.2% had physiotherapy as a degree program in their school of basic medical 
 training , and 92.5% noted that physiotherapy had not worsened the condition of their 
 patients .
it is noteworthy that only 14.9% of the participants had physiotherapy postings in 
 their hospital and only 10.4% went on ward rounds with physiotherapists .
it was observed 
 that the present status of the participants resulted in better knowledge of the role of 
 physiotherapy service in obstetrics and gynecology but not necessarily their attitudes .
senior 
 registrars had a better attitude than consultants towards the role of physiotherapists in obstetrics 
 and gynecology , despite their lesser knowledge .
our findings indicate that consultants tend to be more aware and have better knowledge than 
 senior registrars about the role of physiotherapy in obstetrics and gynecology due to exposure 
 resulting from years of experience .
the majority ( 79.1% ) of participants knew of the role of 
 physiotherapists in obstetrics , with postnatal care having the highest score ( 98.5% ) , 
 followed by antenatal care ( 82.1% ) and parturition ( 56.7% ) .
these findings agree 
 with those of another report.6 we found that 66 
 ( 98.5% ) of participants knew the role of physiotherapy in uterine prolapse , 47 
 ( 70.1% ) in hysterectomy , 22 ( 32.8% ) in pelvic inflammatory disease , and five 
 ( 7.5% ) in cervical incompetence , indicating that participants were knowledgeable about the 
 role of physiotherapy in obstetrics and gynecology .
however , the low score observed for knowledge of 
 the role of physiotherapy in pelvic inflammatory disease indicates that although obstetricians and 
 gynecologists had general knowledge of the role of physiotherapy service , they had limited knowledge 
 with regard to specific conditions .
this also shows that obstetricians had not been involving 
 physiotherapists in the management of conditions such as pelvic inflammatory disease .
it was 
 observed that of all the 28 obstetric and gynecologic conditions listed , 80% strongly agreed 
 about the role of physiotherapists in obstetric palsy .
this is consistent with a previous report 
 that physiotherapy is the main management modality for this condition.8 however , it is noteworthy that 43.4% and 41.8% of the 
 participants did not agree about the role of physiotherapy in the management of episiotomy care 
 perineal tears , respectively , even though it has already been pointed out that management of 
 episiotomy requires more physical therapy than is currently appreciated.8
most of our study participants ( 86.6% and 76.1% , respectively ) agreed that 
 patients with obstetric and gynecologic conditions also require physiotherapy services .
this is in 
 agreement with two other reports.6,7 the majority of participants strongly agreed that 
 physiotherapy would not cause harm to patients , and 92.5% strongly agreed that physiotherapy 
 services can not be replaced with drugs and instructions , and that physiotherapists are competent to 
 manage obstetric and gynecologic conditions .
more than 80% of participants strongly agreed 
 that a physiotherapy service is not expensive and could be afforded by patients , while 50.7% 
 considered it to be time - consuming .
also , 56.7% of participants strongly agreed that 
 physiotherapists should be allowed to attend surgical procedures for patients with gynecological 
 conditions , and 38.8% strongly agreed that physiotherapists should be allowed to attend the 
 labor ward .
it is agreed that physiotherapists can attend the labor ward , but should not interfere 
 in any way in its normal operation but merely reinforce to the mother the teaching she had received 
 in the antenatal period .
underutilization of physiotherapy may be due to limited knowledge on the 
 part of obstetricians and gynecologists about the role of physiotherapists in parturition .
further , 
 41.8% of participants strongly agreed that physiotherapists have not performed adequately in 
 their interprofessional relationships .
this is indicative of a need for improved communication in 
 the form of seminars , workshops , and attendance at grand rounds .
the majority ( 94.0% ) of participants referred patients for physiotherapy , while 
 6.0% did not , and this could be due to the fact that the participants had better knowledge , 
 a better attitude , and hence improved utilization of physiotherapy service .
most ( 76.2% ) of 
 the participants referred obstetric and gynecologic patients with a prescription while 20.9% 
 referred patients without a prescription , and the majority of the participants referred patients to 
 general / state hospitals .
this could be due to nonavailability of a department of physiotherapy in 
 their hospitals of practice .
our findings in this regard are consistent with those of adegoke.9 referral with a prescription does not show regard for 
 professionalism and needs to be investigated .
ninety - seven percent of the participants had a physiotherapy department in their hospital of 
 practice , 94.0% had physiotherapists as close friends , 83.6% had a physiotherapy 
 training program in their institution of residency , 73.1% and 70.1% had worked with 
 physiotherapists before in the management of gynecologic patients and obstetric patients , 
 respectively , 67.2% had physiotherapy as a degree program in their school of basic medical 
 training , and 92.5% noted that physiotherapy had not worsened the condition of their 
 patients .
it is noteworthy that only 14.9% of the participants had physiotherapy postings in 
 their hospital and only 10.4% went on ward rounds with physiotherapists .
it was observed 
 that the present status of the participants resulted in better knowledge of the role of 
 physiotherapy service in obstetrics and gynecology but not necessarily their attitudes .
senior 
 registrars had a better attitude than consultants towards the role of physiotherapists in obstetrics 
 and gynecology , despite their lesser knowledge .
obstetricians and gynecologists in south - western nigeria have a general knowledge of 
 physiotherapy services in obstetrics and gynecology .
they also demonstrate a positive attitude 
 towards involvement of physiotherapists in the management of patients with obstetric and gynecologic 
 conditions .
however , their knowledge about the value of a physiotherapy service in specific 
 conditions is limited .
physiotherapy posting during basic medical training and better interaction 
 between obstetricians , gynecologists , and physiotherapists in the form of seminars , workshops , and 
 grand rounds , could enhance knowledge and attitudes of obstetricians towards involvement of 
 physiotherapists in patient management .
 background : the role of physiotherapists in obstetrics and gynecology is pivotal 
 . however , utilization of 
 their capabilities depends on the cooperation of other health professionals in discharging their 
 services to patients , who are the focus of the team . 
 this study was designed to assess the attitude 
 of obstetricians and gynecologists in south - western nigeria towards involving physiotherapists in 
 the management of patients with obstetric and gynecologic conditions.methods:this was a descriptive survey of obstetricians and gynecologists from seven hospitals in 
 south - western nigeria . 
 sixty - seven participants , including 41 senior registrars and 26 consultants , 
 participated in the study . 
 more consultants ( 73.1% ) than senior registrars ( 46.3% ) 
 had a good knowledge of the role of physiotherapists in obstetric and gynecological practice . all 
 participants had general knowledge of the role of physiotherapists in obstetrics and gynecology , but 
 a limited knowledge of specific conditions amenable to treatment by physiotherapists . 
 more senior 
 registrars had a better attitude ( 73.2% ) than consultants ( 53.8% ) towards 
 involvement of physiotherapists in their practice , and 94.0% of the obstetricians and 
 gynecologists utilized the services of physiotherapists , with referral of patients ( 56.7% ) 
 mainly to physiotherapists working in general / state hospitals.conclusion:there is a need for better interaction and communication between physiotherapists and 
 obstetricians and gynecologists , which could be achieved through clinical meetings , seminars , and 
 workshops . 