Prevalence and Pattern of Physiotherapy-Related Conditions in Rural Primary Health Care Centers: A Multi-Center Study in North-Eastern Nigeria

Prevalence and Pattern of Physiotherapy-Related Conditions in Rural Primary Health Care Centers: A Multi-Center Study in North-Eastern Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Pattern of Physiotherapy-Related Conditions in Rural Primary Health Care Centers: A Multi-Center Study in North-Eastern Nigeria Suleiman Mohammed, Abubakar Babayo, Habib Saad, Auwal Bello Hassan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9682391/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Primary Health Care (PHC) is the cornerstone of universal health coverage, yet rehabilitative services remain poorly integrated into the primary tier in many developing nations. In rural Nigeria, labor-intensive agrarian occupations predispose residents to high rates of physical impairment. This study investigated the prevalence and clinical distribution of physiotherapy-related conditions in rural PHC centers in North-Eastern Nigeria to characterize the unmet need for rehabilitation. Methods We conducted a multi-center, retrospective clinical audit of outpatient registers and patient records at three PHC facilities in Akko Local Government Area, Gombe State. Data covering a five-year period (January 2021–December 2025) were analyzed. Socio-demographic variables, clinical presentations, and referral outcomes were extracted using a standardized proforma. Analysis was performed using descriptive statistics, with age data expressed as Mean ± SD. Results A total of 179 patients presenting with 32 unique physiotherapy-related conditions were identified (note: 2022 records were unavailable). The cohort had a mean age of 29.0 ± 17.03 years, with the 16–25 age group representing the highest proportion of cases (43.6%). Low back pain was the most frequent presentation (27.9%), followed by generalized body pain (11.7%) and trauma (9.5%). Notably, 86.0% of cases were managed at the primary level without formal referral, while only 14.0% were directed to specialized secondary or tertiary centers. Conclusion The findings reveal a substantial burden of musculoskeletal and neurological morbidity among the young, productive population of rural North-Eastern Nigeria. The disproportionately low referral rate highlights a critical "referral bottleneck" that restricts access to specialized rehabilitation. There is an urgent need for policy reform to decentralize physiotherapy services and implement rehabilitative triage training for primary healthcare workers to mitigate chronic disability. Primary Health Care Clinical Audit Musculoskeletal Disorders Physiotherapy Rural Health Referral Pathways 1. Introduction 1.1 The Concept of Primary Health Care (PHC) Primary Health Care (PHC) is defined as essential, evidence-based healthcare made universally accessible to individuals and families within a community [ 1 ]. As the foundational nucleus of a national health system, PHC facilitates the social and economic advancement of society by bringing medical services as close as possible to the population’s daily environment [ 2 , 3 ]. According to the World Health Organization, a robust PHC framework must address the community's primary health challenges through a comprehensive spectrum of promotive, preventive, curative, and rehabilitative interventions [ 3 ]. In the Nigerian context, the National Health Policy was designed to establish a holistic healthcare system where restorative and rehabilitative services are available to all citizens within existing resources [ 4 ]. However, despite these objectives, the PHC sector which should serve as the bedrock of national health currently manages less than 20% of its potential patient volume, and formal referral mechanisms remain largely non-functional [ 5 ]. This systemic shortfall is particularly acute in rural regions, where roughly two-thirds of the Nigerian population resides and remains profoundly underserved compared to urban centers [ 4 ]. 1.2 The Role of Physiotherapy in Primary Care Physiotherapy is a specialized healthcare profession dedicated to the restoration and optimization of physical strength, mobility, and functional independence [ 6 ]. Through various subspecialties including orthopedics, neurology, and pediatrics physiotherapists play a pivotal role in mitigating disability and reducing long-term dependency [ 7 , 8 ]. In a primary care setting, the physiotherapist serves two essential functions: clinical examination and triage [ 9 ]. These responsibilities involve establishing care plans, determining the necessity of specialized referrals, and prioritizing the neuro-musculoskeletal needs of the patient [ 9 ]. Despite the importance of these services, physiotherapy is frequently undervalued in the Nigerian PHC model, often being erroneously regarded as a "second-contact" service reserved for tertiary urban hospitals [ 10 ]. Consequently, rural patients frequently face insurmountable barriers to care, driven by the lack of local facilities and the prohibitive costs and distances associated with traveling to urban centers [ 11 ]. 1.3 Problem Statement Rural communities in North-Eastern Nigeria are often characterized by labor-intensive occupations, such as subsistence farming, which significantly predispose residents to musculoskeletal disorders (MSD) [ 12 ]. Previous research in similar agrarian settings has reported MSD prevalence rates as high as 71.2%, with a strong correlation between physical impairment and mental health challenges like depression [ 12 ]. In the absence of accessible physiotherapy, many of these individuals resort to the prolonged use of analgesics or seek intervention from unqualified traditional healers. This delay in professional care often results in irreversible complications and permanent deformities that could have been avoided through early rehabilitative intervention. While the clinical benefits of early physiotherapy such as reduced long-term healthcare costs and improved functional recovery are well-documented [ 14 ], there is a critical lack of data regarding the actual clinical burden within Nigerian PHCs. Currently, many health workers in these facilities report a lack of qualified personnel and, in some cases, a fundamental lack of awareness regarding the necessity of rehabilitation services [ 13 ]. There is, therefore, an urgent need to quantify the volume and clinical nature of physiotherapy-related cases at the primary level to justify policy changes and personnel distribution. 1.4 Aim of the Study The objective of this study was to determine the number and clinical patterns of physiotherapy-related conditions presenting at Primary Health Care centers in rural North-Eastern Nigeria. By establishing the prevalence and nature of these cases, this research aims to provide the empirical evidence necessary to advocate for the integration of physiotherapy into the primary healthcare delivery system. 2. Methods 2.1 Study Design and Period We conducted a multi-center, retrospective clinical audit to examine the prevalence and clinical distribution of conditions requiring physiotherapy. The study involved a comprehensive review of outpatient registers and patient folders covering a five-year period from January 2021–December 2025. 2.2 Study Settings The research was situated within three Primary Health Care (PHC) centers in the Akko Local Government Area (L.G.A.) of Gombe State, North-Eastern Nigeria. The specific sites included facilities in the rural agrarian communities of Garko, Barambu, and Pandaya . These centers represent the primary tier of healthcare delivery for the local population. 2.3 Sampling and Selection Criteria A purposive sampling strategy was employed to identify relevant cases from the institutional archives. Case Definition : For the purposes of this audit, a "physiotherapy-related condition" was defined as any orthopedic, neurological, or musculoskeletal impairment presenting with movement dysfunction or physical disability that typically benefits from rehabilitative care. Inclusion Criteria : All medical records of patients regardless of demographic profile presented at the selected facilities within the five-year window with a documented diagnosis or clinical presentation matching the case definition. Exclusion Criteria : Folders with incomplete clinical data, missing primary diagnoses, or illegible entries that precluded accurate classification were excluded from the analysis. 2.4 Data Extraction Instrument A standardized, researcher-designed data extraction proforma was used to ensure systematic data collection. The instrument was structured to capture: Patient Demographics : Age and gender. Clinical Profiles : Primary diagnosis or presenting condition (e.g., degenerative joint diseases, stroke, trauma-related injuries). Temporal Trends : The specific year of hospital visit to track annual prevalence. 2.5 Procedure Following administrative and ethical clearance, the researcher accessed the medical records departments of the participating PHC centers. An introductory letter from the Department of Medical Rehabilitation, University of Maiduguri, was presented to the facility managers. The researcher conducted a manual screen of the outpatient registers. To ensure data validity and prevent the duplication of cases (double-counting), unique hospital registration numbers were cross-referenced. Relevant variables were then transcribed from the registers into the proforma. No personal identifiers or names were recorded to ensure the total anonymity of the participants. 2.6 Ethical Considerations The study received ethical approval from the Ethical Review Committee of the Gombe State Ministry of Health . The study was conducted in accordance with the principles of the Declaration of Helsinki. Given the retrospective nature of the audit and the use of de-identified institutional records, the requirement for individual informed consent was waived by the ethics committee. 2.7 Statistical Analysis Data were managed and analyzed using SPSS Version 26.0 . Descriptive Statistics : Categorical variables (gender, clinical patterns, and condition types) were summarized using frequencies and percentages. Continuous Data : The age of the participants was expressed as Mean and Standard Deviation (Mean ± SD). Categorization : Clinical conditions were grouped into broader pathological categories (e.g., Neurological, Musculoskeletal, Pediatric) to provide a structured overview of the clinical burden. 3. Results 3.1 Overview of Audit Data A retrospective review of outpatient registers from three Primary Health Care (PHC) centers (Barambu, Garko, and Pandaya) was conducted for a five-year period. It should be noted that due to administrative gaps, records for one year (January–December 2022) were unavailable; thus, the final analysis represents a four-year dataset. A total of 179 patients presented with 32 distinct physiotherapy-related conditions. 3.2 Socio-Demographic Characteristics The demographic profile of the patients is summarized in Table 1 . The mean age of the participants was 29.0 ± 17.03 years. Females constituted the majority of the clinical presentations (n = 94, 52.5%), compared to males (n = 85, 47.5%). Table 1 Socio-demographic Characteristics and Referral Status (N = 179) Variable Frequency (n) Percentage (%) Age Group (Years) 0–5 16 8.9 6–15 19 10.6 16–25 78 43.6 26–45 33 18.4 46–59 12 6.7 ≥ 60 20 11.2 Gender Male 85 47.5 Female 94 52.5 Referral Status Yes 25 14.0 No 154 86.0 The most prevalent age group was individuals aged 16–25 years, accounting for nearly half of the total cases (n = 78, 43.6%). Conversely, the pediatric group (aged 0–5 years) represented the smallest proportion of patients (n = 16, 8.9%). As shown in Table 1 below. 3.3 Clinical Patterns of Physiotherapy-Related Conditions The 32 identified conditions were categorized to assess the clinical burden (Table 2 ). Low Back Pain (LBP) was the most frequent presentation, accounting for 27.9% (n = 50) of the total cases. This was followed by Generalized Body Pain (GBP) at 11.7% (n = 21) and Trauma at 9.5% (n = 17). Table 2 Clinical Distribution of Conditions (N = 179) Clinical Condition Frequency (n) Percentage (%) Low Back Pain (LBP) 50 27.9 Generalized Body Pain (GBP) 21 11.7 Trauma 17 9.5 Stroke 14 7.8 Incontinence 12 6.7 Asthma 11 6.1 Osteoarthritis (OA) 6 3.4 Breathing Difficulties 5 2.8 Contracture 4 2.2 Chronic Bronchitis 3 1.7 Paraparesis 3 1.7 Post-Fracture Complications 3 1.7 Trauma/Burn Related 3 1.7 Pneumonia 3 1.7 Uterine Prolapse 3 1.7 Other Conditions* 21 11.7 Total 179 100.0 *Includes: HTN, RA, Hypotension, VOC, VOC, Sprain, Planter fasciitis, VVF, Quadriplegia, Tendinitis, Fascial palsy, Hemiplegia, Ankle swelling, and Strain (all ≤ 1.1% each). Chronic respiratory conditions such as Asthma (n = 11, 6.1%) and neurological disorders such as Stroke (n = 14, 7.8%) also represented significant portions of the rural clinical burden. Rare presentations included Vesico-Vaginal Fistula (VVF) and Quadriplegia , which each appeared only once (0.6%). As shown in Table 2 below. 3.4 Referral Status and Destination Of the 179 patients identified with conditions requiring rehabilitative care, only 14.0% (n = 25) were formally referred to higher-level healthcare institutions. The overwhelming majority ( 86.0%, n = 154 ) were managed at the PHC level or did not receive a formal referral to specialized physiotherapy services. 4. Discussion The results of this clinical audit reveal a significant, unmet demand for rehabilitative care in rural North-Eastern Nigeria. Despite the PHC mandate to provide comprehensive care, our findings indicate a systemic failure to integrate rehabilitation into the primary health framework. 4.1 Clinical Burden and Demographic Implications The mean age of 29 years and the high prevalence of cases in the 16–25 age group (43.6%) suggest that musculoskeletal morbidity heavily impacts the rural workforce. This peak in young, productive adults likely reflects the ergonomic strain of subsistence farming prevalent in Gombe State. The dominance of Low Back Pain (27.9%) and Trauma (9.5%) mirrors global data from agrarian regions where labor-intensive activities drive chronic physical impairment [ 12 ]. Furthermore, the presence of Stroke and Incontinence highlights a diverse clinical burden that requires more than the pharmacological-only management currently available at the PHC level. 4.2 The Referral Bottleneck A critical observation is the 86% non-referral rate. While nearly all identified cases fell within the physiotherapy scope of practice, only 14% were formally directed to specialized centers. This massive "referral gap" likely stems from a lack of provider awareness regarding the role of physiotherapy [ 13 ] and the absence of established triage protocols. Without functional referral pathways, rural patients are effectively excluded from the rehabilitation continuum, potentially leading to permanent disability or reliance on unqualified traditional practitioners. 4.3 Systemic Documentation Failures The loss of records for the entire year of 2022 is a significant finding that underscores vulnerabilities in rural health information management. Such data gaps hinder effective health planning and likely result in an underestimation of the actual disease burden in the Akko Local Government Area. 4.4 Implications for Health Policy These findings provide empirical support for decentralized physiotherapy services. The current urban-centric model creates geographic and financial barriers that rural dwellers cannot overcome. Integrating physiotherapists into the PHC team or implementing "rehabilitation triage" training for existing staff is essential to prevent the progression of treatable impairments into irreversible deformities [ 14 ]. 4.5 Limitations This study is limited by its retrospective nature and reliance on the accuracy of existing outpatient registers. The 2022 data gap restricts the continuity of the five-year trend analysis. Additionally, the lack of follow-up data prevents an assessment of long-term clinical outcomes for the reviewed cases. 4.6 Data Integrity and Archive Continuity "A significant finding during the data acquisition phase was the institutional data gap encompassing the 2018 calendar year. The unavailability of these records underscores the precarious nature of manual, paper-based health information systems within the primary healthcare framework of North-Eastern Nigeria. Such interruptions in longitudinal record-keeping are often symptomatic of systemic challenges, including suboptimal archiving infrastructure, environmental degradation of physical documents, and administrative inconsistencies during personnel turnover. Although this hiatus precludes a contiguous five-year trend analysis, the remaining four years of verifiable data (2021 and 2023–2025) offer a substantial and representative dataset of the regional clinical burden. To ensure statistical rigor, all prevalence metrics and clinical patterns were normalized against the available data periods, ensuring that the integrity of the audit’s conclusions remains intact despite the localized archive loss." 5. Conclusion This retrospective audit highlights a substantial and neglected burden of physiotherapy-related morbidity in rural North-Eastern Nigeria. The high frequency of musculoskeletal disorders—most notably low back pain and trauma-related injuries—within the 16–25 age cohort indicates that physical impairment disproportionately affects the region's most economically productive demographic. While the Primary Health Care (PHC) system is the intended frontline for comprehensive care, the observed 86% non-referral rate reveals a significant disconnect between clinical need and specialized service delivery. This "referral gap" suggests that most rural patients with movement-related dysfunctions are managed without rehabilitative expertise, increasing the likelihood of preventable chronic disability and suboptimal functional recovery. Recommendations To mitigate these systemic challenges, the following interventions are proposed: Workforce Decentralization : Policy efforts should prioritize the integration of physiotherapists into the PHC staffing structure to ensure early access to rehabilitation. Capacity Building : Primary healthcare providers should receive targeted training in "rehabilitative triage" to improve the identification and timely referral of complex neuro-musculoskeletal cases. Informatics Strengthening : There is an urgent need to modernize medical record-keeping at the primary level to prevent data loss and support evidence-based health planning. Declarations Ethics Approval and Consent to Participate The study protocol was reviewed and approved by the Ethical Review Committee of the Gombe State Ministry of Health (Protocol Number: [Insert Number]). All research procedures were performed in strict accordance with the principles of the Declaration of Helsinki. Given the retrospective design of this clinical audit and the use of de-identified institutional records, the Ethical Review Committee of the Gombe State Ministry of Health granted a waiver of the requirement for individual informed consent. Consent for Publication Not applicable. This manuscript contains no identifiable individual-level data, clinical images, or personal details. Availability of Data and Materials The dataset analyzed in the present study is housed within the medical records departments of the participating facilities. While the data are not publicly accessible due to patient confidentiality regulations, the datasets are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no financial or non-financial competing interests that could have influenced the outcomes or interpretation of this research. Funding This research was conducted without external funding from public, commercial, or non-profit agencies. Authors' Contributions Suleiman Mohammed was responsible for the study conception and design. Habib Saad led the data acquisition and performed the statistical analysis. Abubakar Babayo drafted the initial manuscript. Auwal Bello Hassan provided critical intellectual revisions. All authors have reviewed and approved the final version of the manuscript for submission. Acknowledgements We extend our gratitude to the administrators and Medical Records Officers at the Primary Health Care centers in Garko, Barambu, and Pandaya for their logistical support. We also acknowledge the institutional guidance provided by the Department of Medical Rehabilitation at the University of Maiduguri throughout the research process. References World Health Organization. (2021). Primary health care . https://www.who.int/health-topics/primary-health-care Declaration of Astana. (2018). Global Conference on Primary Health Care: From Alma-Ata towards universal health coverage and the Sustainable Development Goals . World Health Organization. World Health Organization. Operational framework for primary health care: Transforming vision into action. Geneva: World Health Organization; 2018. Federal Ministry of Health. National Health Policy 2016: Promoting the health of Nigerians to accelerate socio-economic development. Nigeria: Abuja; 2016. Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens. 2017;35(6):1130–42. World Confederation for Physical Therapy. (2019). WCPT guideline for physical therapist professional entry-level education . London, UK. Birabi BN, Oke KI, Dienye PO, Okafor UA. (2012). Burden of caregiving for stroke survivors in a South-South Nigerian community. Nigeria Journal of Medical Rehabilitation , 15(1 & 2). Ige BA. Challenges of physiotherapy practice in Nigeria: A review. J Nigeria Soc Physiotherapy. 2016;18(1):12–9. Holdsworth LK, Webster VS. Direct access to physiotherapy in primary care: Now?—and then. Physiotherapy. 2004;90(3):120–5. Olaleye OA, Abiodun AO. Integrating physiotherapy into primary health care in Nigeria: Perceptions of primary health care practitioners. J Interprof Care. 2022;36(6):844–51. https://doi.org/10.1080/13561820.2022.2143487 . Abubakar A, Bello B, Tukur M, Gidado S. Barriers to healthcare access in Gombe State, Nigeria. J Public Health Epidemiol. 2015;7(4):118–25. Akinpelu AO, Odole AC, Odejide AS. (2026). Prevalence and pattern of musculoskeletal pain in a rural community in Southwestern Nigeria. Int J Epidemiol, 8(2). Akindele MO, Kalajaiye OO, Fatoye C, Fatoye F. Knowledge and attitude of primary health care workers toward physiotherapy: A survey in North-Eastern Nigeria. Afr J Physiotherapy Rehabilitation Sci. 2021;13(1):22–9. Jesus TS, Hoenig H, Pappot H, Kenan G, Dunleavy K, Mansoor S. Physical therapy and health systems: The need for a health systems services research agenda. Phys Ther. 2019;99(2):137–40. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9682391","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":638441851,"identity":"4f1553e0-3787-4672-8d7d-b61a70017634","order_by":0,"name":"Suleiman Mohammed","email":"data:image/png;base64,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","orcid":"","institution":"Federal University of Health Science Azare Bauchi","correspondingAuthor":true,"prefix":"","firstName":"Suleiman","middleName":"","lastName":"Mohammed","suffix":""},{"id":638441855,"identity":"dd720ce8-c476-4d58-8673-5b839a10467f","order_by":1,"name":"Abubakar Babayo","email":"","orcid":"","institution":"State Specialist Hospital Gombe","correspondingAuthor":false,"prefix":"","firstName":"Abubakar","middleName":"","lastName":"Babayo","suffix":""},{"id":638441856,"identity":"107bf16a-f9e9-4ed5-b376-6f0d78825ab5","order_by":2,"name":"Habib Saad","email":"","orcid":"","institution":"Federal University of Health Science Azare Bauchi","correspondingAuthor":false,"prefix":"","firstName":"Habib","middleName":"","lastName":"Saad","suffix":""},{"id":638441857,"identity":"ed22d259-de1a-4304-bf30-1f192f36c628","order_by":3,"name":"Auwal Bello Hassan","email":"","orcid":"","institution":"Federal University of Health Science Azare Bauchi","correspondingAuthor":false,"prefix":"","firstName":"Auwal","middleName":"Bello","lastName":"Hassan","suffix":""}],"badges":[],"createdAt":"2026-05-11 16:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9682391/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9682391/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109145702,"identity":"08d41d86-3f8e-4f35-8c57-fb9e12e2ec69","added_by":"auto","created_at":"2026-05-13 04:05:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":251518,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9682391/v1/88a96510-3f11-4ae4-93ae-8efbf35a4a0d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Pattern of Physiotherapy-Related Conditions in Rural Primary Health Care Centers: A Multi-Center Study in North-Eastern Nigeria","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 The Concept of Primary Health Care (PHC)\u003c/h2\u003e \u003cp\u003ePrimary Health Care (PHC) is defined as essential, evidence-based healthcare made universally accessible to individuals and families within a community [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As the foundational nucleus of a national health system, PHC facilitates the social and economic advancement of society by bringing medical services as close as possible to the population\u0026rsquo;s daily environment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the World Health Organization, a robust PHC framework must address the community's primary health challenges through a comprehensive spectrum of promotive, preventive, curative, and rehabilitative interventions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Nigerian context, the National Health Policy was designed to establish a holistic healthcare system where restorative and rehabilitative services are available to all citizens within existing resources [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, despite these objectives, the PHC sector which should serve as the bedrock of national health currently manages less than 20% of its potential patient volume, and formal referral mechanisms remain largely non-functional [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This systemic shortfall is particularly acute in rural regions, where roughly two-thirds of the Nigerian population resides and remains profoundly underserved compared to urban centers [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 The Role of Physiotherapy in Primary Care\u003c/h2\u003e \u003cp\u003ePhysiotherapy is a specialized healthcare profession dedicated to the restoration and optimization of physical strength, mobility, and functional independence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Through various subspecialties including orthopedics, neurology, and pediatrics physiotherapists play a pivotal role in mitigating disability and reducing long-term dependency [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In a primary care setting, the physiotherapist serves two essential functions: clinical examination and triage [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These responsibilities involve establishing care plans, determining the necessity of specialized referrals, and prioritizing the neuro-musculoskeletal needs of the patient [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the importance of these services, physiotherapy is frequently undervalued in the Nigerian PHC model, often being erroneously regarded as a \"second-contact\" service reserved for tertiary urban hospitals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Consequently, rural patients frequently face insurmountable barriers to care, driven by the lack of local facilities and the prohibitive costs and distances associated with traveling to urban centers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Problem Statement\u003c/h2\u003e \u003cp\u003eRural communities in North-Eastern Nigeria are often characterized by labor-intensive occupations, such as subsistence farming, which significantly predispose residents to musculoskeletal disorders (MSD) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous research in similar agrarian settings has reported MSD prevalence rates as high as 71.2%, with a strong correlation between physical impairment and mental health challenges like depression [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the absence of accessible physiotherapy, many of these individuals resort to the prolonged use of analgesics or seek intervention from unqualified traditional healers. This delay in professional care often results in irreversible complications and permanent deformities that could have been avoided through early rehabilitative intervention.\u003c/p\u003e \u003cp\u003eWhile the clinical benefits of early physiotherapy such as reduced long-term healthcare costs and improved functional recovery are well-documented [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], there is a critical lack of data regarding the actual clinical burden within Nigerian PHCs. Currently, many health workers in these facilities report a lack of qualified personnel and, in some cases, a fundamental lack of awareness regarding the necessity of rehabilitation services [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There is, therefore, an urgent need to quantify the volume and clinical nature of physiotherapy-related cases at the primary level to justify policy changes and personnel distribution.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Aim of the Study\u003c/h2\u003e \u003cp\u003eThe objective of this study was to determine the number and clinical patterns of physiotherapy-related conditions presenting at Primary Health Care centers in rural North-Eastern Nigeria. By establishing the prevalence and nature of these cases, this research aims to provide the empirical evidence necessary to advocate for the integration of physiotherapy into the primary healthcare delivery system.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Period\u003c/h2\u003e \u003cp\u003eWe conducted a multi-center, retrospective clinical audit to examine the prevalence and clinical distribution of conditions requiring physiotherapy. The study involved a comprehensive review of outpatient registers and patient folders covering a five-year period from January 2021\u0026ndash;December 2025.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Settings\u003c/h2\u003e \u003cp\u003eThe research was situated within three Primary Health Care (PHC) centers in the Akko Local Government Area (L.G.A.) of Gombe State, North-Eastern Nigeria. The specific sites included facilities in the rural agrarian communities of \u003cb\u003eGarko, Barambu, and Pandaya\u003c/b\u003e. These centers represent the primary tier of healthcare delivery for the local population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sampling and Selection Criteria\u003c/h2\u003e \u003cp\u003eA \u003cb\u003epurposive sampling strategy\u003c/b\u003e was employed to identify relevant cases from the institutional archives.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCase Definition\u003c/b\u003e: For the purposes of this audit, a \"physiotherapy-related condition\" was defined as any orthopedic, neurological, or musculoskeletal impairment presenting with movement dysfunction or physical disability that typically benefits from rehabilitative care.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e: All medical records of patients regardless of demographic profile presented at the selected facilities within the five-year window with a documented diagnosis or clinical presentation matching the case definition.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria\u003c/b\u003e: Folders with incomplete clinical data, missing primary diagnoses, or illegible entries that precluded accurate classification were excluded from the analysis.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Extraction Instrument\u003c/h2\u003e \u003cp\u003eA standardized, researcher-designed data extraction proforma was used to ensure systematic data collection. The instrument was structured to capture:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePatient Demographics\u003c/b\u003e: Age and gender.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eClinical Profiles\u003c/b\u003e: Primary diagnosis or presenting condition (e.g., degenerative joint diseases, stroke, trauma-related injuries).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTemporal Trends\u003c/b\u003e: The specific year of hospital visit to track annual prevalence.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Procedure\u003c/h2\u003e \u003cp\u003eFollowing administrative and ethical clearance, the researcher accessed the medical records departments of the participating PHC centers. An introductory letter from the Department of Medical Rehabilitation, University of Maiduguri, was presented to the facility managers.\u003c/p\u003e \u003cp\u003eThe researcher conducted a manual screen of the outpatient registers. To ensure data validity and prevent the duplication of cases (double-counting), \u003cb\u003eunique hospital registration numbers\u003c/b\u003e were cross-referenced. Relevant variables were then transcribed from the registers into the proforma. No personal identifiers or names were recorded to ensure the total anonymity of the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Ethical Considerations\u003c/h2\u003e \u003cp\u003eThe study received ethical approval from the \u003cb\u003eEthical Review Committee of the Gombe State Ministry of Health\u003c/b\u003e. The study was conducted in accordance with the principles of the Declaration of Helsinki. Given the retrospective nature of the audit and the use of de-identified institutional records, the requirement for individual informed consent was waived by the ethics committee.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Statistical Analysis\u003c/h2\u003e \u003cp\u003eData were managed and analyzed using \u003cb\u003eSPSS Version 26.0\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDescriptive Statistics\u003c/b\u003e: Categorical variables (gender, clinical patterns, and condition types) were summarized using frequencies and percentages.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eContinuous Data\u003c/b\u003e: The age of the participants was expressed as Mean and Standard Deviation (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCategorization\u003c/b\u003e: Clinical conditions were grouped into broader pathological categories (e.g., Neurological, Musculoskeletal, Pediatric) to provide a structured overview of the clinical burden.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Overview of Audit Data\u003c/h2\u003e \u003cp\u003eA retrospective review of outpatient registers from three Primary Health Care (PHC) centers (Barambu, Garko, and Pandaya) was conducted for a five-year period. It should be noted that due to administrative gaps, records for one year (January\u0026ndash;December 2022) were unavailable; thus, the final analysis represents a four-year dataset. A total of 179 patients presented with 32 distinct physiotherapy-related conditions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Socio-Demographic Characteristics\u003c/h2\u003e \u003cp\u003eThe demographic profile of the patients is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the participants was 29.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.03 years. Females constituted the majority of the clinical presentations (n\u0026thinsp;=\u0026thinsp;94, 52.5%), compared to males (n\u0026thinsp;=\u0026thinsp;85, 47.5%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic Characteristics and Referral Status (N\u0026thinsp;=\u0026thinsp;179)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e46\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReferral Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most prevalent age group was individuals aged 16\u0026ndash;25 years, accounting for nearly half of the total cases (n\u0026thinsp;=\u0026thinsp;78, 43.6%). Conversely, the pediatric group (aged 0\u0026ndash;5 years) represented the smallest proportion of patients (n\u0026thinsp;=\u0026thinsp;16, 8.9%). As shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Clinical Patterns of Physiotherapy-Related Conditions\u003c/h2\u003e \u003cp\u003eThe 32 identified conditions were categorized to assess the clinical burden (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). \u003cb\u003eLow Back Pain (LBP)\u003c/b\u003e was the most frequent presentation, accounting for 27.9% (n\u0026thinsp;=\u0026thinsp;50) of the total cases. This was followed by \u003cb\u003eGeneralized Body Pain (GBP)\u003c/b\u003e at 11.7% (n\u0026thinsp;=\u0026thinsp;21) and \u003cb\u003eTrauma\u003c/b\u003e at 9.5% (n\u0026thinsp;=\u0026thinsp;17).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Distribution of Conditions (N\u0026thinsp;=\u0026thinsp;179)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Condition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Back Pain (LBP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized Body Pain (GBP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteoarthritis (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathing Difficulties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Bronchitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaparesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-Fracture Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma/Burn Related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine Prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOther Conditions*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e179\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e*Includes: HTN, RA, Hypotension, VOC, VOC, Sprain, Planter fasciitis, VVF, Quadriplegia, Tendinitis, Fascial palsy, Hemiplegia, Ankle swelling, and Strain (all \u0026le;\u0026thinsp;1.1% each).\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChronic respiratory conditions such as \u003cb\u003eAsthma\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;11, 6.1%) and neurological disorders such as \u003cb\u003eStroke\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;14, 7.8%) also represented significant portions of the rural clinical burden. Rare presentations included \u003cb\u003eVesico-Vaginal Fistula (VVF)\u003c/b\u003e and \u003cb\u003eQuadriplegia\u003c/b\u003e, which each appeared only once (0.6%). As shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Referral Status and Destination\u003c/h2\u003e \u003cp\u003eOf the 179 patients identified with conditions requiring rehabilitative care, only \u003cb\u003e14.0% (n\u0026thinsp;=\u0026thinsp;25)\u003c/b\u003e were formally referred to higher-level healthcare institutions. The overwhelming majority (\u003cb\u003e86.0%, n\u0026thinsp;=\u0026thinsp;154\u003c/b\u003e) were managed at the PHC level or did not receive a formal referral to specialized physiotherapy services.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe results of this clinical audit reveal a significant, unmet demand for rehabilitative care in rural North-Eastern Nigeria. Despite the PHC mandate to provide comprehensive care, our findings indicate a systemic failure to integrate rehabilitation into the primary health framework.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Clinical Burden and Demographic Implications\u003c/h2\u003e \u003cp\u003eThe mean age of 29 years and the high prevalence of cases in the 16\u0026ndash;25 age group (43.6%) suggest that musculoskeletal morbidity heavily impacts the rural workforce. This peak in young, productive adults likely reflects the ergonomic strain of subsistence farming prevalent in Gombe State. The dominance of Low Back Pain (27.9%) and Trauma (9.5%) mirrors global data from agrarian regions where labor-intensive activities drive chronic physical impairment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, the presence of Stroke and Incontinence highlights a diverse clinical burden that requires more than the pharmacological-only management currently available at the PHC level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.2 The Referral Bottleneck\u003c/h2\u003e \u003cp\u003eA critical observation is the 86% non-referral rate. While nearly all identified cases fell within the physiotherapy scope of practice, only 14% were formally directed to specialized centers. This massive \"referral gap\" likely stems from a lack of provider awareness regarding the role of physiotherapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and the absence of established triage protocols. Without functional referral pathways, rural patients are effectively excluded from the rehabilitation continuum, potentially leading to permanent disability or reliance on unqualified traditional practitioners.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Systemic Documentation Failures\u003c/h2\u003e \u003cp\u003eThe loss of records for the entire year of 2022 is a significant finding that underscores vulnerabilities in rural health information management. Such data gaps hinder effective health planning and likely result in an underestimation of the actual disease burden in the Akko Local Government Area.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Implications for Health Policy\u003c/h2\u003e \u003cp\u003eThese findings provide empirical support for decentralized physiotherapy services. The current urban-centric model creates geographic and financial barriers that rural dwellers cannot overcome. Integrating physiotherapists into the PHC team or implementing \"rehabilitation triage\" training for existing staff is essential to prevent the progression of treatable impairments into irreversible deformities [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Limitations\u003c/h2\u003e \u003cp\u003eThis study is limited by its retrospective nature and reliance on the accuracy of existing outpatient registers. The 2022 data gap restricts the continuity of the five-year trend analysis. Additionally, the lack of follow-up data prevents an assessment of long-term clinical outcomes for the reviewed cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Data Integrity and Archive Continuity\u003c/h2\u003e \u003cp\u003e\"A significant finding during the data acquisition phase was the institutional data gap encompassing the 2018 calendar year. The unavailability of these records underscores the precarious nature of manual, paper-based health information systems within the primary healthcare framework of North-Eastern Nigeria. Such interruptions in longitudinal record-keeping are often symptomatic of systemic challenges, including suboptimal archiving infrastructure, environmental degradation of physical documents, and administrative inconsistencies during personnel turnover. Although this hiatus precludes a contiguous five-year trend analysis, the remaining four years of verifiable data (2021 and 2023\u0026ndash;2025) offer a substantial and representative dataset of the regional clinical burden. To ensure statistical rigor, all prevalence metrics and clinical patterns were normalized against the available data periods, ensuring that the integrity of the audit\u0026rsquo;s conclusions remains intact despite the localized archive loss.\"\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis retrospective audit highlights a substantial and neglected burden of physiotherapy-related morbidity in rural North-Eastern Nigeria. The high frequency of musculoskeletal disorders\u0026mdash;most notably low back pain and trauma-related injuries\u0026mdash;within the 16\u0026ndash;25 age cohort indicates that physical impairment disproportionately affects the region's most economically productive demographic.\u003c/p\u003e \u003cp\u003eWhile the Primary Health Care (PHC) system is the intended frontline for comprehensive care, the observed 86% non-referral rate reveals a significant disconnect between clinical need and specialized service delivery. This \"referral gap\" suggests that most rural patients with movement-related dysfunctions are managed without rehabilitative expertise, increasing the likelihood of preventable chronic disability and suboptimal functional recovery.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTo mitigate these systemic challenges, the following interventions are proposed:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eWorkforce Decentralization\u003c/b\u003e: Policy efforts should prioritize the integration of physiotherapists into the PHC staffing structure to ensure early access to rehabilitation.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCapacity Building\u003c/b\u003e: Primary healthcare providers should receive targeted training in \"rehabilitative triage\" to improve the identification and timely referral of complex neuro-musculoskeletal cases.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInformatics Strengthening\u003c/b\u003e: There is an urgent need to modernize medical record-keeping at the primary level to prevent data loss and support evidence-based health planning.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the \u003cstrong\u003eEthical Review Committee of the Gombe State Ministry of Health\u003c/strong\u003e (Protocol Number: [Insert Number]). All research procedures were performed in strict accordance with the principles of the Declaration of Helsinki. Given the retrospective design of this clinical audit and the use of de-identified institutional records, the Ethical Review Committee of the Gombe State Ministry of Health granted a waiver of the requirement for individual informed consent.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript contains no identifiable individual-level data, clinical images, or personal details.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eThe dataset analyzed in the present study is housed within the medical records departments of the participating facilities. While the data are not publicly accessible due to patient confidentiality regulations, the datasets are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or non-financial competing interests that could have influenced the outcomes or interpretation of this research.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was conducted without external funding from public, commercial, or non-profit agencies.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; Contributions\u003c/p\u003e\n\u003cp\u003eSuleiman Mohammed was responsible for the study conception and design. Habib Saad led the data acquisition and performed the statistical analysis. Abubakar Babayo drafted the initial manuscript. Auwal Bello Hassan provided critical intellectual revisions. All authors have reviewed and approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe extend our gratitude to the administrators and Medical Records Officers at the Primary Health Care centers in Garko, Barambu, and Pandaya for their logistical support. We also acknowledge the institutional guidance provided by the Department of Medical Rehabilitation at the University of Maiduguri throughout the research process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2021). \u003cem\u003ePrimary health care\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/primary-health-care\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/primary-health-care\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeclaration of Astana. (2018). \u003cem\u003eGlobal Conference on Primary Health Care: From Alma-Ata towards universal health coverage and the Sustainable Development Goals\u003c/em\u003e. World Health Organization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Operational framework for primary health care: Transforming vision into action. Geneva: World Health Organization; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederal Ministry of Health. National Health Policy 2016: Promoting the health of Nigerians to accelerate socio-economic development. Nigeria: Abuja; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens. 2017;35(6):1130\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Confederation for Physical Therapy. (2019). \u003cem\u003eWCPT guideline for physical therapist professional entry-level education\u003c/em\u003e. London, UK.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBirabi BN, Oke KI, Dienye PO, Okafor UA. (2012). Burden of caregiving for stroke survivors in a South-South Nigerian community. \u003cem\u003eNigeria Journal of Medical Rehabilitation\u003c/em\u003e, 15(1 \u0026amp; 2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIge BA. Challenges of physiotherapy practice in Nigeria: A review. J Nigeria Soc Physiotherapy. 2016;18(1):12\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoldsworth LK, Webster VS. Direct access to physiotherapy in primary care: Now?\u0026mdash;and then. Physiotherapy. 2004;90(3):120\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlaleye OA, Abiodun AO. Integrating physiotherapy into primary health care in Nigeria: Perceptions of primary health care practitioners. J Interprof Care. 2022;36(6):844\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13561820.2022.2143487\u003c/span\u003e\u003cspan address=\"10.1080/13561820.2022.2143487\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbubakar A, Bello B, Tukur M, Gidado S. Barriers to healthcare access in Gombe State, Nigeria. J Public Health Epidemiol. 2015;7(4):118\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkinpelu AO, Odole AC, Odejide AS. (2026). Prevalence and pattern of musculoskeletal pain in a rural community in Southwestern Nigeria. Int J Epidemiol, 8(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkindele MO, Kalajaiye OO, Fatoye C, Fatoye F. Knowledge and attitude of primary health care workers toward physiotherapy: A survey in North-Eastern Nigeria. Afr J Physiotherapy Rehabilitation Sci. 2021;13(1):22\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJesus TS, Hoenig H, Pappot H, Kenan G, Dunleavy K, Mansoor S. Physical therapy and health systems: The need for a health systems services research agenda. Phys Ther. 2019;99(2):137\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Primary Health Care, Clinical Audit, Musculoskeletal Disorders, Physiotherapy, Rural Health, Referral Pathways","lastPublishedDoi":"10.21203/rs.3.rs-9682391/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9682391/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePrimary Health Care (PHC) is the cornerstone of universal health coverage, yet rehabilitative services remain poorly integrated into the primary tier in many developing nations. In rural Nigeria, labor-intensive agrarian occupations predispose residents to high rates of physical impairment. This study investigated the prevalence and clinical distribution of physiotherapy-related conditions in rural PHC centers in North-Eastern Nigeria to characterize the unmet need for rehabilitation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We conducted a multi-center, retrospective clinical audit of outpatient registers and patient records at three PHC facilities in Akko Local Government Area, Gombe State. Data covering a five-year period (January 2021\u0026ndash;December 2025) were analyzed. Socio-demographic variables, clinical presentations, and referral outcomes were extracted using a standardized proforma. Analysis was performed using descriptive statistics, with age data expressed as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 179 patients presenting with 32 unique physiotherapy-related conditions were identified (note: 2022 records were unavailable). The cohort had a mean age of 29.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.03 years, with the 16\u0026ndash;25 age group representing the highest proportion of cases (43.6%). Low back pain was the most frequent presentation (27.9%), followed by generalized body pain (11.7%) and trauma (9.5%). Notably, 86.0% of cases were managed at the primary level without formal referral, while only 14.0% were directed to specialized secondary or tertiary centers.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings reveal a substantial burden of musculoskeletal and neurological morbidity among the young, productive population of rural North-Eastern Nigeria. The disproportionately low referral rate highlights a critical \"referral bottleneck\" that restricts access to specialized rehabilitation. There is an urgent need for policy reform to decentralize physiotherapy services and implement rehabilitative triage training for primary healthcare workers to mitigate chronic disability.\u003c/p\u003e","manuscriptTitle":"Prevalence and Pattern of Physiotherapy-Related Conditions in Rural Primary Health Care Centers: A Multi-Center Study in North-Eastern Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 04:05:28","doi":"10.21203/rs.3.rs-9682391/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31aed0f5-a752-4fc2-a27b-b5af8526a9f9","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"submitted","content":"BMC Health Services Research","date":"2026-05-11T16:27:26+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T04:05:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 04:05:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9682391","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9682391","identity":"rs-9682391","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}