Unmet Need for Physiotherapy and Its Determinants Among Children with Neuromusculoskeletal Disorders in Rural Sindh, Pakistan

Abstract

Background
Children with neuromusculoskeletal disorders may require timely and sustained physiotherapy to improve mobility, functional independence, and participation in daily activities. This study assessed the unmet need for physiotherapy, healthcare-seeking behavior, and factors associated with physiotherapy utilization among children with neuromusculoskeletal disorders in rural Sindh, Pakistan.
Methods
A cross-sectional study was conducted among 240 caregivers of children with neuromusculoskeletal disorders in selected rural communities of Sindh, Pakistan. Data were collected using a structured questionnaire. For this analysis, unmet need was operationally defined as the absence of previous physiotherapy utilization among children identified as requiring or potentially benefiting from physiotherapy. Associations were assessed using chi-square tests, followed by multivariable binary logistic regression.
Results
The mean age of the children was 8.1 ± 3.6 years, and 137 (57.1%) were male. Of the 240 children, 142 (59.2%) had previously utilized physiotherapy, whereas 98 (40.8%) had never received physiotherapy, representing the operationally defined unmet need in this study. Government health facilities were the most common initial healthcare source (52.5%), followed by private providers (29.6%). Transportation difficulties were associated with lower odds of utilization (AOR 0.54, 95% CI 0.31–0.94, p=0.030).
Conclusion
A substantial proportion of children in the study had never accessed physiotherapy despite having conditions that could benefit from rehabilitation. Strengthening referral pathways, providing caregiver education, and expanding affordable, geographically accessible rehabilitation services may help reduce unmet rehabilitation needs in rural Sindh.