Demographic and professional profile of Brazilian Orthopedic Physical TherapistsABSTRACT
This study aimed to identify the profile of Brazilian Orthopedic Physical Therapists regarding demographic and professional characteristics. A cross-sectional study was conducted via an online questionnaire survey with a convenience sampling of 282 physical therapists. The recruitment process involved an open invitation, with contact made via the internet, social media, email, or instant messaging app. The research was promoted via a banner on the social media profile of the research team, the professional association, and the regional councils of Physical Therapy. An exploratory multivariate analysis was performed using Multiple Correspondence analysis followed by hierarchical cluster analysis. Via cluster analysis, we identified two distinct profiles of male and female physical therapists in Trauma-Orthopedics. Regarding education and qualification, there was a significant association between men and the orthopedic physical therapy field, Ph.D. title, specialist title registered with COFFITO, and the labor market. Men were also associated with careers as professors or researchers at private institutions, owners of their clinics, working in nonclinical or nonhospital settings, working in three or more places, having six to 10 years of clinical experience, and earning above the minimum wage. For women, there was a significantly higher association with home care, clinical practice, clinical experience of up to five years, and earning below the minimum wage. We concluded that there was an association between men and women for demographic and professional characteristics, and the cluster analysis revealed two distinct profiles concerning gender.
Keywords
Professional Practice; Cluster Analysis; Physical Therapists; Workforce
RESUMO
O objetivo deste trabalho foi identificar o perfil dos fisioterapeutas traumato-ortopédicos em relação aos parâmetros demográficos e profissionais. Esse estudo transversal foi realizado por meio de um questionário on-line com uma amostragem de conveniência de 282 fisioterapeutas. O processo de recrutamento foi realizado via convite aberto e o contato foi feito pela internet, por meio de redes sociais, e-mail ou aplicativo de mensagens. A pesquisa foi divulgada por meio de um banner nas redes sociais da equipe de pesquisa, da associação profissional e dos conselhos regionais de fisioterapia. Foi realizada uma análise multivariada exploratória utilizando análise de correspondência múltipla (ACM) seguida de análise de agrupamento hierárquico (cluster). Por meio da análise de cluster, identificamos dois perfis distintos de homens e mulheres fisioterapeutas traumato-ortopédicos. Em relação à formação e qualificação, houve uma associação significativa entre homens e a área de atuação da fisioterapia traumato-ortopédica, o título de doutorado e a certificação de especialista registrados pelo Conselho Federal de Fisioterapia e Terapia Ocupacional (COFFITO) e o mercado de trabalho. Também estavam associadas aos homens as carreiras de professor ou pesquisador de instituições privadas, proprietário de clínica, de atuação em área não clínica ou hospitalar, em três ou mais locais diferentes, seis a dez anos de experiência clínica e remuneração acima do salário mínimo. Para as mulheres, a associação foi significativamente maior para o atendimento domiciliar, atuação em área clínica, experiência clínica de até cinco anos e remuneração inferior a um salário mínimo. Concluímos que houve associação entre o sexo dos profissionais e os parâmetros demográficos e profissionais; a análise de cluster revelou dois perfis distintos em relação aos sexos.
Descritores
Prática Profissional; Análise por Conglomerados; Fisioterapeutas; Força de Trabalho
RESUMEN
El objetivo fue identificar el perfil de los fisioterapeutas trauma-ortopédicos en relación con parámetros demográficos y profesionales. Se realizó un estudio transversal a través de una encuesta por cuestionario en línea con un muestreo por conveniencia de 282 fisioterapeutas. El proceso de contratación implicó una invitación abierta, con contacto realizado a través de la Internet, las redes sociales, el correo electrónico o las aplicaciones de mensajería. La investigación fue promocionada a través de un banner en las redes sociales del equipo investigador, del colegio profesional y de los consejos regionales de Fisioterapia. Se realizó un análisis multivariado exploratorio mediante análisis de correspondencia múltiple seguido de un análisis de conglomerados jerárquico. A través del análisis de conglomerados, identificamos dos perfiles distintos de fisioterapeutas masculinos y femeninos en el campo de la traumatología y ortopedia. En cuanto a la educación y calificación, hubo una asociación significativa entre los hombres y el campo de la fisioterapia trauma-ortopédica, el título de doctor, el título de especialista registrado en COFFITO y el mercado laboral. Los hombres también estaban asociados con carreras como profesores o investigadores en instituciones privadas, propietarios de clínicas, trabajando en entornos no clínicos o no hospitalarios, trabajando en tres o más lugares diferentes, teniendo de 6 a 10 años de experiencia clínica y ganando más del sueldo mínimo. Para las mujeres, hubo una asociación significativamente mayor con la atención domiciliaria, la práctica clínica, la experiencia clínica de hasta cinco años y la remuneración inferior al sueldo mínimo. Concluimos que existía una asociación entre hombres y mujeres para parámetros demográficos y profesionales, y el análisis de conglomerados reveló dos perfiles distintos en cuanto a género.
Palabras clave
Práctica Profesional; Análisis por Conglomerados; Fisioterapeutas; Diversidad de la Fuerza Laboral
INTRODUCTION
Physical Therapy in Brazil was regulated as a profession by Decree-Law 938, of October 13, 19691 and has undergone several changes over these 50 years. The main changes occurred in professional legislation1, in curriculum guidelines2, in the expansion of undergraduate courses3 and in scientific production4 , 5. These changes in the trajectory of the profession have consequently led to changes in the professional profile.
Knowing the profile of the physical therapist helps in the construction of a portrait of the professional identity and in the planning of future professional perspectives 4. Some studies in the literature characterized the profile of physical therapists in Brazil considering different aspects, such as territorial distribution6, different states 7 , 8, different cities 9 , 10 , 11 , 12, the area of expertise 9 , 12 , 13, and scientific production 4 , 5. However, such studies only present absolute and relative frequency data for the characteristics analyzed in isolation, making it impossible to identify and to assemble common characteristics for the construction of the profile of Orthopedic physical therapists working in Brazil. Nor did they observe relationships between the characteristics analyzed from the sex perspective.
To identify the profiles of a population, specific methods capable of measuring, explaining, and predicting the degree of relationship between all evaluated variables are needed. Such degree can be interpreted via multivariate analysis that simultaneously analyzes all study variables. Seeking to identify the profiles of physical therapists working in Brazil, this study aims to identify the profile of orthopedic physical therapists regarding the demographic and professional characteristics by cluster analysis.
METHODOLOGY
Study Design
The paper reports secondary analysis of a cross-sectional study via an online questionnaire survey (e-survey) with a convenience sampling of Brazilian Orthopedic Physical Therapists. The informed consent with the purpose of study and the researchers’ contact details were provided on the first page of the e-survey.
Setting
This study analyzed data referring to the profile of Brazilian physical therapists that participated in the research on adherence to carpal tunnel syndrome practice guidelines. This paper presents a piece of the research regarding the professional, geographical, and educational profile of Brazilian physical therapists.
Participants
Data were collected from May to September, 2020, and 292 physical therapists answered the questionnaire; of these, 10 were excluded because they were not currently working in the area. The eligibility criteria were a) being a Brazilian physical therapist with orthopedic/trauma experience; b) having graduated in Brazil; c) accepting taking part in the research; and d) filling out the form correctly.
Instrument
An e-survey was elaborated using professional survey software (Google Forms by Google LLC, Mountain View, CA). A self-administered structured questionnaire was designed by two independent authors (AAR and LFRMF) and a pre-test was sent to five physical therapist researchers so they could evaluate the questionnaire regarding: a) the adequacy and ordering of the questions; b) comprehensiveness of the content; c) questions clarity, and d) feasibility of the technology. Their feedback was incorporated in the final version. This e-survey followed the CHERRIES checklist, which ensures reporting quality of web-based surveys14.
The recruitment process was an open invitation to physical therapists and the contact was made via the Internet by social media, email, or messaging app. The survey was advertised by a banner ad on the social media profiles of the research team, the professional association, and the regional councils of Physical Therapy.
The e-survey was in Brazilian Portuguese. Twenty multiple choice questions on physical therapists’ profile characterization (demographic, professional, level of education, and professional training data) were analyzed. The complete e-survey had 11 sections with an average of four questions per page.
The questionnaire items were not randomized. Access to e-survey was via Google Forms link or QRCode.
Statistical analysis
A database was created from the data collected on the e-survey. A univariate descriptive statistical analysis via absolute and relative frequencies of all categorical variables was made. A bivariate analysis was performed to compare the association of sex and each category of all variables. Data were organized in contingency tables, and Chi-squared test with Yates correction was used to analyze the association among variables. Fisher’s Exact Test was used if the minimum expected value in any cell was < 5. The significance level was 0.05. For this analysis, the variables were grouped into three aspects (demographic profile, training and qualification, labor market).
In this study, many variables consisting of many categories were collected and, to simultaneously analyze all the categories, an exploratory multivariate analysis using Multiple Correspondence analysis (MCA) was carried out followed by Agglomerative Hierarchical Cluster analysis (AHC). In MCA, the Chi-squared test was used to standardize frequency values from the contingency table and form the basis for MCA association or similarity. The significance level was 0.05. A perceptual map of hierarchical clustering shows the results of this analysis (Dendrogram).
RESULTS
Demographic profile
In total, 282 physical therapists took part in this study with a mean age of 32 (±7.53) years. Participants have a mean of 8.67 (±7.21) years working as physical therapists. The research was conducted in 22 Brazilian states, covering all regions of the country (North, Northeast, Midwest, Southeast, and South). Most participants reside in the state of São Paulo (30.6%).
Out of 282 physical therapists who took part in this study, 191 (67.7%) were women. More than half of them were aged 26–35 years and more than 60% live in the Southeast region of Brazil. We found a significant difference between sex only for the age group of 36 to 45 years (Table 1).
Training and qualification
More than 70% of the physical therapists attended undergraduate programs in Private Institutions and more than 50% held some specialization degree. In this study, physical therapists who completed a specialization post-graduation course (specialization/improvement/enhancement) were considered “experts” and, within this group, those who had the title of specialist by COFFITO were analyzed. Considering the Orthopedic Physical Therapy expertise area, PhD title, and title registered by COFFITO, male percentage was significantly higher in each one of them. Regarding the number of attendees at congresses and/or courses per year, 64.5% attended between one and three events. A higher percentage (79.4%) of physical therapists are not members of any association (Table 2).
Labor market
Most physical therapists (69.9%) work at private institutions. The percentages of male physical therapists were significantly higher for the following variables: a) professors at private institutions; b) owners of their own clinics; c) work at an area different from clinical or hospital (country clubs, fitness centers, and others); d) work at three or more different places; e) have between six to 10 years of clinical experience; and f) earn above the minimum wage. For women, the percentages were significantly higher for: a) home physical therapy; b) work in a clinical area; c) clinical experience up to five years; and d) earn below the minimum wage (Table 3).
Considering the minimum wage of the category is R$ 3,214.22, 6.0% of the participants reported receiving less than R$1,000.00 a month and only 1.4% receive more than R$20,000.00 a month (Table 3).
Exploratory multivariate analysis
The multiple correspondence analysis was used to visualize the associations between demographic and professional profile with the sexes of Brazilian orthopedic physical therapists who took part in this e-survey.
The numerical values of coordinates of all the dimensions obtained in MCA were used as input variables in the cluster analysis and the perceptual map of hierarchical clustering (Dendrogram) was obtained. We highlighted the two groups based on cluster analysis (Figure 1). An illustrated summary with the main results is available in the supplementary material.
Cluster analysis revealed two different profiles of the Orthopedic Brazilian Physical therapists
DISCUSSION
Most physical therapists who answered the e-survey were women (67.7%). Previous studies conducted in Brazil also found a percentage of 80% of women physical therapists in the state of São Paulo7 and 77% in the state of Paraná8, confirming that Physical Therapy in Brazil is predominantly a female profession8. In other countries, Physical Therapy is also a predominantly female profession as we can see, i.e., in Ireland ( 74%)15. The predominance of one sex in the profession may be related to the history of its creation. In many countries in which there is a predominance of women in the area, Physical Therapy was closely associated with Nursing, which at the time was a profession only for women. According to Short16, Physical Therapy was created as a profession for middle-class women in which family responsibilities continued to take priority over professional responsibilities. However, in some places the ratio of women and men is slowly leveling off, for example, in New South Wales, Australia, in 1995, 81% of new registrants were women, while in 2000 only 66% of new registrants were female17.
Even being an e-survey with a convenience sampling, the percentage of responses was similar to the study of Matsumura et al.6 regarding the territorial distribution of physical therapists in Brazil. In our study, 64.2% of physical therapists who answered the survey were from the Southeast and 23.4% from the South. Matsumura et al.6 also observed a higher density of professionals in the Southeast region and lack of professionals in the North region.
In relation to professional qualification, 72.7% of the interviewees graduated in Private Institutions and 53.5% concluded at least one specialization course (expert). Sampaio et al.18 conducted research on Physical Therapy education programs in Brazil and observed a great growth in the number of courses, from 68 in 1996 to 536 in 2014, and the percentage of graduate courses in private institutions ranged from 72.1% to 89.5%. In 2021, according to the website of the Ministry of Education, out of 917 active Physical Therapy graduation programs, 846 (92.3%) were offered by Private Institutions and 32.4% were in the states of São Paulo and Minas Gerais19. From the total of lato sensu post-graduation active courses, 1,293 are in-person courses and 617 are e-learning courses18. Despite a large number and modalities of specialization courses, only 53.5% of physical therapists have lato sensu post-graduation courses. When we analyze the percentage of physical therapists with specialist titles registered by COFFITO, this percentage is much lower (18.1%).
Considering stricto sensu post-graduation courses, the percentage of PhD males was significantly higher than females. In a research conducted by Melo et al.5 via Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) data, they found a number of experts, master, PhD, and Postdoc significant higher in men than in women physical therapists. Despite the emphasis in recent decades on the importance of evidence-based practice in Physical Therapy and the growth of PhD from 57 in 1998 to 573 in 2008, in Brazil4, the number of physical therapists with research experience is still small. This reduced number may be related to the restricted number of courses, location, and currently, the reduction of investments in research.
In our study, we found a smaller percentage of physical therapists who work only in the orthopedic area (17.7%). The orthopedic physical therapy area is considered the largest research area in Physical Therapy4, it was the lato sensu post-graduation area with the highest percentage in the states of São Paulo7 and Paraná8. In our study, the percentage of men in the orthopedic area and with the specialist title registered by COFFITO in this area was significantly higher. However, only 6.7% physical therapists have the COFFITO specialist certificate in the orthopedic physical therapy area. This small number may be related to the fact that this area of specialization has only recently been approved (COFFITO Resolution No. 260/2004), furthermore, to be considered a specialist, the physical therapist needs to pass an exam that assesses specific knowledge and curriculum vitae, elaborated by COFFITO and associations (COFFITO Resolution No. 360/2008 and COFFITO Resolution No. 377/2010).
In other countries, such as the USA and Canada, to be considered a specialist, they must have completed a specialty certification program recognized by the College and ensure that this information is included in the Public Register (https://www.ifompt.org/ and https://www.collegept.org/). A bachelor’s degree (the most common degree) is earned by 58% of all physical therapists, the second most common degree is a doctorate (about 17% of all physical therapists have a doctor’s), only 6% of all physical therapists have an associate’s degree while 14% of them hold a master. In terms of salary, $91,000 is earned by the top 10% of all physical therapists in the profession, though some earn much more (https://datausa.io/profile/soc/physical-therapists).
When it comes to professional associations, only 20.6% of interviewees are affiliated to any associations. In the study of Badaró and Guilhem10, only 31.7% referred to participating in any association. According to Article 34 of Chapter VII, of the Code of Ethics and Deontology of Physical Therapy, “It is recommended that the physical therapists, with a view to social responsibility and political awareness, belong to associative entities of the class, of a cultural, social, scientific or union character at the local or national level in which he/she performs their professional activity”20. The low participation of physical therapists in trade associations may be due to not being aware of the role of a trade association (Law No. 10,406, of January 10, 2002) or even not being clear about the functions of an association, council, or union (https://crefito16.gov.br/site/index.php/2016/02/02/veja-a-diferenca-entre-conselho-associacao-e-sindicato/).
Related to the labor market, men who are physical therapists showed significantly higher percentages for research area and teaching, owners of clinics, having three or more jobs, and receiving salaries above the minimum. On the other side, women had significantly higher percentages in areas with greater flexibility of schedules, such as clinical and home Physical Therapy areas, however, they are the highest percentage which receive salaries below the minimum. Although the Brazilian Federal Law No. 8,856 limits the physical therapists’ working hours to 30 hours/week, reality is quite different. To have higher salaries, physical therapists look for other job opportunities. In our study, 15.4% of men reported that they work at 3 or more places. Considering both men and women, 43.3% work at two or more places. It makes us conclude that many physical therapists work more than 30 hours/week. We could conclude that there was a sex association for professional profile parameters of the Brazilian physical therapists. The grouping of Brazilian physical therapists, according to the common characteristics, permitted the identification of two distinct profiles (female and male) for demographic and professional parameters.
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Financing source:
This study was financed in part by the Coordination for the Improvement of higher Education Personnel – Brasil (CAPES) – Finance Code 001
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Approved by the local Research Ethics Committee under CAAE: 26412219.0.0000.5154.
Note: The female profile had ages between 18-35 years. They were residents of the southeast of Brazil, studied in Private Institutions and the highest level of education was bachelor or expert. They had lato sensu specialization in another physical therapy area, worked in Orthopedic Trauma Physical Therapy area and another one and did not have a Specialist Certificate by COFFITO. They attended one to three courses/congresses a year and were not members of the professional associations. They worked at private institutions, were not professors, did not have their own clinics, and did not work with home physical therapy. They worked in the clinical area and had only one job. They had up to five years of clinical experience and their salaries were below the minimum. The male profile had ages of over 36 years. They were residents of the other regions of Brazil and graduated in Public Institutions with PhD being the highest education level. They had lato sensu specialization in Orthopedic Trauma Physical Therapy area, worked in the same area and had a Specialist Certificate by COFFITO (Orthopedic Trauma Physical Therapy area or another area). They did not attend any courses or more than four courses/congresses a year. They were members of associations (orthopedic trauma physical therapy or another area). They worked at public or public/private institutions, were professors, had their own clinics, worked with home physical therapy, in the hospital area or hospital/clinical area, and had more than one job. They had more than six years of clinical experience and their salaries were the minimum or above the minimum.