Knowledge and Using of Dry needling by Physiotherapists in Central Africa in the management of Trigger points: the first cross sectional survey in Cameroon

Knowledge and Using of Dry needling by Physiotherapists in Central Africa in the management of Trigger points: the first cross sectional survey in Cameroon | 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 Knowledge and Using of Dry needling by Physiotherapists in Central Africa in the management of Trigger points: the first cross sectional survey in Cameroon Dilane Landry NSANGOU MUNTESSU, Nicodemos NGueha, Hyacinte Trésor Ghassi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5814993/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 Dry Needling (DN) emerged in the 1970s as a therapeutic breakthrough, proving effective in the treatment of Trigger Points (TP). Despite its worldwide application, there is little data on the knowledge, attitudes and practices (KAP) of physiotherapists in Central Africa, particularly in Cameroon. This study aims to fill this gap by exploring the knowledge, attitudes and practices of Cameroonian physiotherapists in relation to pressure point management. Understanding their current levels of CAP is essential for identifying educational needs and developing strategies to improve DN practice in the region. Methods A quantitative, analytical, cross-sectional survey was carried out online in the 10 regions of Cameroon over a six-month period. All practicing physiotherapists with at least one year's work experience and who had given their consent were included. They were asked KAP questions relating to DN and TP. Pearson correlations were performed between KAP domains together and with sociodemographic data, Using Epi Info software version 7.2.5.0. Results 123 physiotherapists participated. The majority were male (56.1%), with an average age of 29 ± 5 years and a mean year of experience of 5 ± 2 years. The majority of physiotherapists obtained scores < 50% of the total score allocated to the domain for knowledge of TP and DN and practice of DN, thus indicating insufficient knowledge and weak practices. However, they had positive attitudes, i.e., a score > 50%. Conclusions This study highlights a significant need for educational initiatives in the field of Trigger Point and Dry Needling among physiotherapists in Cameroon. The results reveal a lack of knowledge and practice, despite a positive attitude towards the technique. Addressing this need for training is essential to improving the quality of patient care and the effectiveness of trigger zone management. The data collected provides a solid basis for the development of targeted training programmes and resources to equip physiotherapists with the necessary skills and knowledge. Such efforts will ultimately contribute to the advancement of physiotherapy practice in Cameroon and Africa as a whole. Knowledge attitudes practices Dry Needling Cameroon physiotherapists and trigger point Introduction Considered a genuine public health problem, musculoskeletal disorders (MSDs), one of the main causes of which is the Trigger Point (TP), have a negative impact on people's quality of life and socio-professional fulfilment ( 1 ). It affects around 1.71 billion people, i.e. 22% of the world's population ( 2 ). Studies in some African countries and in Cameroon show a prevalence of MSDs in excess of 50%, with preferential regions being the lumbar and cervical spine, hip, knee and wrist ( 3 , 4 ). A TP is a hypersensitive zone, generally in a taut band of skeletal muscle or in the muscle fascia, painful on compression or not, and which may give rise to characteristic tenderness or autonomic phenomena ( 5 ). In recent years, therapeutic advances have led to Dry Needling (DN), which emerged in the 70s as a proven therapy for the treatment of PD to resolve this health problem. Its use by physiotherapists in developed countries is around 30%: 25% in Australia, 15.7% in France and 26.8% in China; In South Africa, 75% of physiotherapists use it at least once a day ( 6 ). A number of studies have evaluated the risks of the practice for doctors and physiotherapists, and have all concluded that it is safe ( 7 ). We found that the diagnosis of TP as a cause of MSDs was rarely discussed, and the practice of DN as a therapy for TP was not mentioned. However, over the past few years, evidence-based studies have been published with considerable scientific proof of the relevance of DN for the treatment of MSDs, and physiotherapists seem to be using it more and more in their practices. ( 6 , 7 , 8 , 9 ). According to the literature search in PubMed, PEDro, Cochrane and Google Scholar, studies with high levels of evidence on DN and TP were found, including studies made by: Dommerholt et al. 2006 ( 6 ), Gattie et al. 2017( 8 ), Lew et al. 2020 ( 9 ), and Navarro et al. 2020 ( 10 ). Hence the need to investigate the practice of this technique in Central Africa in general, and Cameroon specifically where the techniques used and taught in physiotherapy schools are based on massage, thermotherapy, and electrotherapy, the diagnostic methods for trigger points are either not known or very little known.. The aim of this study was to highlight the level of knowledge and practice of physiotherapists with regard to DN, as well as their attitudes towards this technique in the management of TP. Methods Study design we conducted a quantitative, analytical and cross-sectional study during 6 months, from January 10 to July 10, 2023. It was carried out online throughout Cameroon, i.e. in the 10 regions of Cameroon and among physiotherapists. Cameroon, a Central African country located at the bottom of the Gulf of Guinea, between the 2nd and 13th degrees North latitude and the 9th and 16th degrees East longitude, with an estimated population of 28,647,293 in 2023. ( 11 , 12 ) Study participants Physiotherapists present and practicing in the 10 regions of Cameroon with at least 1 year's work experience and who had given their consent during the phone calls exchange were included in the study. Those who did not meet the inclusion criteria were not included in the study. Sampling We used non-probability snowball sampling, as we did not have a precise sampling frame at the outset, although the expected sample size was estimated at 250 physiotherapists based on WP data in 2022 ( 13 ). Participants were recruited online, via social networks (fora-WhatsApp) or by e-mail and telephone, for those for whom we had telephone numbers and e-mail addresses. Data collection tool : This study used an electronic questionnaire consisting of a header note and 34 questions distributed as follows: Nine (09) questions for socio-demographic data; Twelve ( 12 ) questions for knowledge, i.e. 05 questions for knowledge of TP and the various treatment methods and 07 questions for knowledge of DN; Nine (09) questions for DN practices and four (04) questions for attitudes to DN. Notations were made during the analysis (1 point for each correct proposition and 0 for each false proposition) and a total score was obtained for knowledge of TP (score/5) and DN (score/9), attitudes (score/18) and practices (score/22). At the end, mentions were attributed to these different scores as follows: Poor (less than 25% of the total score); Insufficient (between 25 and 50% of the total score); Good (between 50 and 75% of the total score) and Very Good (more than 75% of the total score). Data collection techniques : The data collection procedure was carried out as follows: Acquiring authorization from the Director of Foyaguem Health Personnel Institute ( IFPSF) Dschang; Submitting the request for ethical clearance; Putting the questionnaire online and obtaining the link; Obtaining a brochure with the Cameroon Society of Physiotherapist (CASP) office representatives in the different regions and their contacts published on the CASP Facebook page; Calling the different office members (President, Secretary, Treasurer, ...) to submit the study, the questionnaire and to plead to integrate their regional WhatsApp group. In favourable cases, once the group had been integrated, contact was made with the members and the questionnaire was circulated within the group; the contacts of the various group members were listed for individual calls with a view to reaching the participants closely for an individual exchange in order to send them the questionnaire in their personal WhatsApp with notification of the principles, modalities and steps to follow in order to answer, and begging them to share with their colleagues and physiotherapist friends. A reminder was sent to the participant 2 or 3 days later to confirm or deny participation. The participant was free to accept or refuse to take part in the study, and in no case was a participant forced to respond. Data analysis Epi Info software version 7.2.5.0 was used, and data were expressed as percentages. Linear regression was used to establish the degrees of association between the dependent and independent variables, which were defined using Pearson's correlation coefficient followed by the P value. Associations were said to be significant for P˂0.05 and r-values between one and one. These results were presented in tables and figures produced using Microsoft (Word and Excel) 2016 software. The Vancouver model was used for bibliographic references. Ethical consideration the confidentiality and anonymity of respondents were respected in accordance with the principles of medical ethics and deontology. Results Socio-demographic characteristics of respondents 123 physiotherapists took part in the study out of the 240 contacted, giving an overall response rate of 51.25%. The study revealed that 56.1% (69) of participants were male and 43.9% (54) were female, giving a sex ratio (M/F) of 1.07. The average age of respondents was 29 ± 5 years, with extremes of 21 and 50 years. The most represented age group was [26–31[or 33.33% followed by [21–26[or 32.52% and the least represented were [41–46[and [46–51[or 0.81% each. The average year of experience of respondents was four ± 3 years, with extremes of 1 and 15 years. The most common year of experience was [1–3 [or 44.72%. Physiotherapists practicing in the West, Centre and Littoral regions were the most represented, at 29.25%, 28.45% and 21.14% respectively; the North, South and Adamaoua regions were the least represented, at 0.81% each. By level of study, physiotherapists with a Bachelor's degree were the most represented, at 51%, followed by those with a BTS or TPMS diploma, at 34%, those with a Master's degree, at 14%, and those with a PhD diploma, at 1%. Most physiotherapists (36%) worked in hospitals, 34% in private practice and 30% in both regimes. The average year of graduation was 2019 ± 3 years, with extremes of 2008 and 2023. The most represented year of graduation was [2020–2024 [or 44.72%. Concerning the place of training, 93.5% were trained in Cameroon and 6.5% abroad. The majority of physiotherapists (86.99%) had attended at least one seminar, while 13.01% had never attended a seminar. (Table 1 ) Table 1 Sociodemographic data Sociodemographic data Option Staff (%)N = 123 Gender Male 69(56) Female 54(44) Age [21–26[ 40(32.52) [26–31[ 41(33.33) [31–36[ 20(16.26) [36–41[ 20(16.26) [41–46[ 1(0.81) [46–51[ 1(0.81) Year of experience [1–3[ 55(44.72) [3–5[ 17(13.82) [5–7[ 16(13.01) [7–9[ 15(12.20) [9–11[ 12(9.76) [11–13[ 3(2.44) [13–15[ 4(3.25) [15–17[ 1(0.81) Place (region) of exercise West 36(29.25) North west 6(4.88) East 2(1.63) South west 12(9.77) Littoral 26(21.14) North 1(0.81) South 1(0.81) Extreme-north 3(2.44) Adamaoua 1(0.81) Center 35(28.45) Level of study Bachelor 63(51) Phd 1( 1 ) Master 17( 14 ) Hnd/tms 41(34) Exercise regime In hospital 44(36) The two 37(30) Liberal 42(34) Place of formation Abroad 08(6.5) In cameroon 115(93.5) Year of obtaining the last diploma (in relation to physiotherapy) [2008–2012[ 4(3.25) [2012–2016[ 20(16.26) [2016–2020[ 23(18.70) [2020–2024[ 76(61.79) Number of seminars participate to date No one 16(13.01) One 5(4.07) Two 20(16.26) Three 14(11.38) Four 13(10.57) Five 13(10.57) Between six and ten 17(13.82) More than ten 25(20.33) Respondents' knowledge of triggers points and dry needling Of the 123 physiotherapists questioned, the majority (37.40%) had insufficient knowledge, 30.08% had very good knowledge, 26.02% had good knowledge and 6.50% had poor knowledge of TP and the various treatment methods. Furthermore, 14.63% had no knowledge of DN, 11.38% had poor knowledge, 30.9% had poor knowledge, 26.83% had good knowledge and 16.26% had very good knowledge. Respondents' attitudes and practices towards Dry Needling Of the 123 physiotherapists surveyed, 1.63% had a neutral attitude towards DN, 21.96% had weak attitudes, 18.7% had insufficient attitudes, 30.09% had good attitudes and 27.64% had very good attitudes. With regard to respondents' DN practices, 75.61% of respondents were not active, 7.32% were slightly active, 16.26% were active and 0.81% were very active. (Table 2 ) Table 2 knowledge, attitudes and practices of DN and TP CAP Mention Score Staff (%)N = 123 Knowledge of TP Weak 2 8(6.50) Insufficient 3 46(37.40) Good 4 32(26.02) Very Good 5 37(30.08) Knowledge of DN No knowledge 0 18(14.63) Low 1 8(6.50) 2 6(4.88) Insufficient 3 19(15.45) 4 19(15.45) Good 5 15(12.20) 6 18(14.63) Very Good 7 12(9.76) 8 4(3.25) 9 4(3.25) Attitude Neutral 0 2(1.63) Weak 2 2(1.63) 3 23(18.70) 4 2(1.63) Insufficient 5 3(2.44) 6 4(3.25) 7 5(4.07) 8 4(3.25) 9 7(5.69) Good 10 6(4.88) 11 10(8.13) 12 9(7.32) 13 12(9.76) Very Good 14 8(6.50) 15 6(4.88) 16 10(8.13) 17 4(3.25) 18 6(4.88) Practice Inactive 0 93(75.61) Slightly active 9 1(0.81) 10 3(2.44) 11 5(4.07) Active 12 8(6.50) 13 2(1.63) 14 5(4.07) 15 4(3.25) 16 1(0.81) Very active 18 1(0.81) TP: Trigger Point DN: Dry Needling Correlation between KAP and sociodemographic characteristic : We found that there was no linear relationship between level of education and: knowledge of PT (r = 0.03, P = 0.05); knowledge of Dry Needling (r = 0, P = 0.7); practice of Dry Needling (r = 0.05, P = 0.01); attitude to Dry Needling (r = 0, P = 0.8). (Table 3 ) Table 3 Correlation between socio-demographic data and participants' knowledge, attitudes and practices Socio-demographic data TP knowledge Knowledge of DN Practices of the DN Attitudes towards DN Level of study r = 0,03 P = 0,0553 r = 0 P = 0,7242 r = 0,05 P = 0,0139 r = 0 P = 0,8042 Year of experience r = 0 P = 0,5542 r = 0,07 P = 0,0041 r = 0,21 P < 0,0001 r = 0,02 P = 0,1414 Year of graduation r = 0 P = 0,9370 r = 0,05 P = 0,0137 r = 0,19 P < 0,0001 r = 0,01 P = 0,2729 Number of seminars held r = 0,05 P = 0,0158 r = 0,09 P = 0,0009 r = 0,13 P < 0,0001 r = 0,12 P = 0,0001 Correlation between Knowledge, attitude and practice we found that physiotherapists' knowledge of Dry Needling seemed to encourage its use (practice) in patient management (r = 0.43, P < 0,0001). Similarly, the increase in knowledge about this technique seemed to encourage good attitudes (r = 0,15 P < 0,0001). (Table 4) Table 4 Correlation between attitudes, knowledge and practice among participants Practices of the DN Attitudes towards DN TP knowledge r = 0 P = 0,4410 r = 0,03 P = 0,0568 Knowledge of DN r = 0,43 P < 0,0001 r = 0,15 P < 0,0001 Attitudes towards DN r = 0,12 P < 0,0001 TP: Trigger Point; DN: Dry Needling. Discussion This study is the first in Cameroon in particular, and in the world in general, to attempt to explore the knowledge, attitudes and practices of physiotherapists regarding the DN technique used to treat PD. 123 physiotherapists practicing in the country's 10 regions, with the West region predominating, took part in the study, with a participation rate of 51.25%. Most respondents were male (56.1%) with an average age of 34 years. The median year of graduation was 2021, and the majority (36%) worked in a hospital. The gender distribution in this sample seems contradictory to the national distribution for 2022 published by the WP, in which 80% of physiotherapists nationwide would be female. ( 13 ) This difference could be explained by the fact that men were more hostile to participating in the study than women. The dominance of physiotherapists practicing in the western region could be because the principal investigator lived in the region, which would have favoured interaction between him and the region's physiotherapists. In addition, 86.99% of respondents had already taken part in at least one seminar. They had an average of 4 years' experience, with a Bachelor's degree (35%). This could be explained by the fact that the profession in general is less established in Cameroon, in other words, new, and that the cost of training is very high, thus reducing the need for further study. Concerning physiotherapists' knowledge of PT and DN techniques, the results of the study show that 37.40% of physiotherapists have insufficient knowledge of PT and 30.90% of physiotherapists have insufficient knowledge of DN. These results could be explained by the fact that, although PT is one of the main causes of MDS and the primary reason for health consultations, physiotherapists focus more on pain symptoms than on the PT that triggers them ( 14 ). In addition, training programs for physiotherapists in Cameroon do not emphasize PT and the DN technique. With regard to physiotherapists' attitudes towards DN, most (64.23%) suggested that it should be added to training programs for physiotherapists in Cameroon, and that practical seminars and workshops should be organized to retrain physiotherapists already in practice. Considering attitude scores, physiotherapists gave great importance to the DN technique (9.94 ± 5.05 out of 18) with 30.09% having good attitudes towards DN. These results could be explained by the fact that, despite their insufficient knowledge, they nevertheless have a penchant for this practice, which is still new in Cameroon. Furthermore, there were positive correlations between socio-demographic data (year of experience, year of highest diploma, number of seminars attended) and their attitudes. Taking into account the practice scores, it emerges that physiotherapists do not attach great importance to DN practice (3.08 ± 5.55 out of 22), i.e. a practice rate of 24.39%. These results may be justified by the fact that DN is less well known in Cameroon and is not an integral part of the physiotherapist's training program. These results are similar to those obtained in Australia (25%) and China (26.8%), and much lower than those obtained in South Africa (75%) in 2006. ( 6 ) Although the rate of DN practice is similar to that in other countries, we note a long delay in the implementation of this technique in Cameroon. This could be explained by the fact that DN is not legalized in Cameroon as a therapeutic means in physiotherapy. In addition, there was a positive correlation between the number of seminars attended and practice, which could be explained by the fact that physiotherapists practicing DN would have learned at a seminar. Similarly, there was a correlation between knowledge of DN, attitudes towards DN and practice. This could be explained simply by the fact that a good knowledge of a problem will lead to a good perception of it, and in the same way to good practice. Limits of the study Online participation The online method may have excluded potential participants who do not have access to the internet or who are not comfortable with digital technologies, which could affect the representativeness of the results. Selection bias Physiotherapists who chose to participate may have different levels of knowledge, attitudes and practices to those who did not, which could introduce a selection bias. Self-reporting The data collected relies on self-reported responses from participants, which may introduce response bias or inaccuracies due to recall errors or social desirability. Regional diversity Although the study was conducted in all 10 regions of Cameroon, regional differences in access to training and resources may not be fully captured by the study. Limited sample A sample of 123 participants, while large, may not be sufficient to generalise the results to all physiotherapists in Cameroon or other Central African countries. Conclusion The present study was conducted to explore the knowledge, attitudes and practices of physiotherapists in Cameroon regarding the DN technique used to treat TP. It revealed that 33.90% and 56.91% of physiotherapists had inadequate knowledge of PT and DN respectively. The main needs concerned diagnostic tools and the different types of TP, other names given to DN and the method of practicing DN. On the other hand, 42.29% of physiotherapists had inappropriate attitudes to DN, and 24.39% used DN sometimes alone or in combination with other therapeutic means, for multiple reasons, with results ranging in most cases from effective to very effective. Generally speaking, these data show that physiotherapists have little knowledge of TP and DN and a low level of practice, but nevertheless have positive attitudes, hence the need to conduct investigation and training campaigns among them. However, it would be important in our context to conduct Randomized Controlled Trials (RCTs) to effectively qualify the efficacy of DN and our usual techniques. Recommendations We propose that accredited physiotherapy associations in Cameroon organise training sessions and seminars on trigger point management using recent advances, including the use of dry needling. We also suggest that academic institutions include this technique in the training programme for the nation's future physiotherapists. Abbreviations CASP Cameroon Society of Physiotherapy DN Dry Needling KAP Knowledge, Attitudes and Practice MSDs Musculoskeletal Disorders RCTs Randomised Controlled Trials TP Trigger Point Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from West Regional ethics committee for human health research. All participants provided informed consent before entering the study. Information about the study objectives, procedures and participants' rights was clearly communicated, and participants were given the opportunity to withdraw their consent at any time without consequence. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding We did not receive funding for this study. Authors’ contributions DLNM designed the study project, drew up the questionnaire and supervised the conduct of each stage of the study and the drafting of the manuscript. NN contacted all study participants to obtain their informed consent and participation, and contributed to the drafting of the manuscript. HTG edited the manuscript and contributed to the interpretation of the data. MMM contributed to the drafting of the manuscript and the interpretation of the results. DLN and FCB supervised the correction of the manuscript. Acknowledgment We would like to thank the CASP and its former president, PT Thierry, for their involvement in putting us in contact with physiotherapists in the different regions of the country. We would also like to express our sincere thanks to all the participants in the study, without whom we would not have obtained our results. References Baily F, Foltz V, Rozenberg S, Bruno F, Gossec L. The impact of chronic low back pain is partly related to loss of social role: A quantitative study. Joint Bone Sine. 2015;86(6):437–41. Bouziri H, Descatha A, Roquelaure Y, Jean K, Dab WO. Analyse sati-temporaelles des troubles musculo-squelettiques à partir du Global Burden of Disease, 1990 à 2019. Revue de Santé Publique. 2022 Aoùt; 70(3): S226. Diatta AE, Tougma WS, Diao ML, Ndiaye M. Etude des troubles musculo-squeletttiques par les manutentionnaires d'une industrie textile au Burkina Faso. Medecine d'Afrique Noire. 2021 Octobre; 6810: 589–596. Bita FA, Assengue BR, Owona ML. Prevalence des troubles musculo-squelettiques dans un district de santé au Cameroun. Medecine d'Afrique Noire. 2022 Mars; 6903: 159–168. Poiseau J, Laurent L. Les triggers points et l'hyothese integrée: revue de la litterature. 2020. [memoire]. Dijon: IFMK de Dijon; 2020. p. 87. Jan Dommerholt, Orlando MD, Christian G. Trigger Point Dry Needling. J Man Manip Ther. 2006;14(4):70–87. Casey U, Kathy B, Thomas J, DRY NEEDLING FOR MYOFASCIAL, TRIGGER POINT. Int J Sports Phys Ther. 2015 Juin; 10(3): 402–418. Gattie E, Cleland J, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Metaanalysis. Journal of orthopaedic & sports physical therapy. 2017 March; 47(3): 133–49. Lew J, Kim J, Nair P. Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis. J Man Manipulative Therapy. 2020 September;22:1–11. Navarro-Santana M, Sanchez-Infante J, Gomez-Chiguano G, Cleland J, Lopez-de-Uralde-Villanueva I, Fernandez-de-las-Penas C, et al. effectys of triggerpoint dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clin Rehabil. 2020;34(11):1327–40. Republique du Cameroun. [Online]. [cited 2023 Septembre 06. Available from: prc.cm/fr/le-Cameroun/presentation Cameroon tribune. [Online]. 2023 [cited 2023 Septembre 06. Available from: https://www.cameroon-tribune.cm/article.html/57645/fr.html/populatin-camerounaise Physiotherapy W. Annual Membership Census. 2022 30 June: p. 8. JC S. L’harmonisation des pratiques kinesitherapiques à travers le monde basé sur l'Evidence-Based Practice: exemple du Dry Needling. 2017. [memoire].Pays de la Loire: IFM3R; 2017. 46p. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5814993","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":412726162,"identity":"a6ba82be-1328-477c-81c9-588df41cb369","order_by":0,"name":"Dilane Landry NSANGOU MUNTESSU","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYBACPiCWQOLbADFj4wF8WtjgWtjAZBpISwNJWg6DSfxa2M8evF3Zti1xu3zz4Y8/287brW0/DLSlxiYapxaevGTLs223E3e2saVJ87bdTt52JhGo5VhabgNOh+WYSTYCtWw4xmPGzAjUYnYAqIWx4TBuLfxvYFr4PwMddi7Z7PxDAlokELYwSPC2HbAzu0HIFok3xpYN524bbziWZibNcy45wewG0JYEPH7h588xvNlQdlt2w+HDjz/+KLOzNzuf/vDBhxobnFrAgJENwU4Eq0zApxwM/iCY9gQVj4JRMApGwYgDAED5ZHogm/CVAAAAAElFTkSuQmCC","orcid":"","institution":"University of Dschang","correspondingAuthor":true,"prefix":"","firstName":"Dilane","middleName":"Landry NSANGOU","lastName":"MUNTESSU","suffix":""},{"id":412726163,"identity":"2135f9ad-7b3d-48b5-ad79-8bb9328d1405","order_by":1,"name":"Nicodemos NGueha","email":"","orcid":"","institution":"Foyaguem Higher Institute of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Nicodemos","middleName":"","lastName":"NGueha","suffix":""},{"id":412726164,"identity":"0f7fd9ba-c8e9-4405-a364-b018ae6659fa","order_by":2,"name":"Hyacinte Trésor Ghassi","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Hyacinte","middleName":"Trésor","lastName":"Ghassi","suffix":""},{"id":412726165,"identity":"59c20062-9204-48ce-bbd7-c43a53f3c55f","order_by":3,"name":"Mpatoutou Me Mpatoutou","email":"","orcid":"","institution":"Hope Medical Clinic","correspondingAuthor":false,"prefix":"","firstName":"Mpatoutou","middleName":"Me","lastName":"Mpatoutou","suffix":""},{"id":412726166,"identity":"b471a7dd-1773-47e2-814f-df929b162965","order_by":4,"name":"David Leonel Noumoe","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Leonel","lastName":"Noumoe","suffix":""},{"id":412726167,"identity":"07f27c4b-cc24-4e55-bd12-e71a4111ff35","order_by":5,"name":"Franklin Chu Buh","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"prefix":"","firstName":"Franklin","middleName":"Chu","lastName":"Buh","suffix":""}],"badges":[],"createdAt":"2025-01-12 18:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5814993/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5814993/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76430326,"identity":"82b93360-2ae1-492b-a688-8e6bc09dbfe6","added_by":"auto","created_at":"2025-02-17 06:38:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":949168,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5814993/v1/7bc2dd22-9d23-4dcd-bfe2-78f0a85259bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge and Using of Dry needling by Physiotherapists in Central Africa in the management of Trigger points: the first cross sectional survey in Cameroon","fulltext":[{"header":"Introduction","content":"\u003cp\u003eConsidered a genuine public health problem, musculoskeletal disorders (MSDs), one of the main causes of which is the Trigger Point (TP), have a negative impact on people's quality of life and socio-professional fulfilment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It affects around 1.71\u0026nbsp;billion people, i.e. 22% of the world's population (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Studies in some African countries and in Cameroon show a prevalence of MSDs in excess of 50%, with preferential regions being the lumbar and cervical spine, hip, knee and wrist (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A TP is a hypersensitive zone, generally in a taut band of skeletal muscle or in the muscle fascia, painful on compression or not, and which may give rise to characteristic tenderness or autonomic phenomena (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In recent years, therapeutic advances have led to Dry Needling (DN), which emerged in the 70s as a proven therapy for the treatment of PD to resolve this health problem. Its use by physiotherapists in developed countries is around 30%: 25% in Australia, 15.7% in France and 26.8% in China; In South Africa, 75% of physiotherapists use it at least once a day (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A number of studies have evaluated the risks of the practice for doctors and physiotherapists, and have all concluded that it is safe (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). We found that the diagnosis of TP as a cause of MSDs was rarely discussed, and the practice of DN as a therapy for TP was not mentioned. However, over the past few years, evidence-based studies have been published with considerable scientific proof of the relevance of DN for the treatment of MSDs, and physiotherapists seem to be using it more and more in their practices. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). According to the literature search in PubMed, PEDro, Cochrane and Google Scholar, studies with high levels of evidence on DN and TP were found, including studies made by: Dommerholt et \u003cem\u003eal.\u003c/em\u003e 2006 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), Gattie et \u003cem\u003eal.\u003c/em\u003e 2017(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), Lew et \u003cem\u003eal.\u003c/em\u003e 2020 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and Navarro et \u003cem\u003eal.\u003c/em\u003e 2020 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Hence the need to investigate the practice of this technique in Central Africa in general, and Cameroon specifically where the techniques used and taught in physiotherapy schools are based on massage, thermotherapy, and electrotherapy, the diagnostic methods for trigger points are either not known or very little known.. The aim of this study was to highlight the level of knowledge and practice of physiotherapists with regard to DN, as well as their attitudes towards this technique in the management of TP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003ewe conducted a quantitative, analytical and cross-sectional study during 6 months, from January 10 to July 10, 2023. It was carried out online throughout Cameroon, i.e. in the 10 regions of Cameroon and among physiotherapists. Cameroon, a Central African country located at the bottom of the Gulf of Guinea, between the 2nd and 13th degrees North latitude and the 9th and 16th degrees East longitude, with an estimated population of 28,647,293 in 2023. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy participants\u003c/strong\u003e \u003cp\u003ePhysiotherapists present and practicing in the 10 regions of Cameroon with at least 1 year's work experience and who had given their consent during the phone calls exchange were included in the study. Those who did not meet the inclusion criteria were not included in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSampling\u003c/strong\u003e \u003cp\u003eWe used non-probability snowball sampling, as we did not have a precise sampling frame at the outset, although the expected sample size was estimated at 250 physiotherapists based on WP data in 2022 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Participants were recruited online, via social networks (fora-WhatsApp) or by e-mail and telephone, for those for whom we had telephone numbers and e-mail addresses.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection tool\u003c/b\u003e: This study used an electronic questionnaire consisting of a header note and 34 questions distributed as follows: Nine (09) questions for socio-demographic data; Twelve (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) questions for knowledge, i.e. 05 questions for knowledge of TP and the various treatment methods and 07 questions for knowledge of DN; Nine (09) questions for DN practices and four (04) questions for attitudes to DN. Notations were made during the analysis (1 point for each correct proposition and 0 for each false proposition) and a total score was obtained for knowledge of TP (score/5) and DN (score/9), attitudes (score/18) and practices (score/22). At the end, mentions were attributed to these different scores as follows: Poor (less than 25% of the total score); Insufficient (between 25 and 50% of the total score); Good (between 50 and 75% of the total score) and Very Good (more than 75% of the total score).\u003c/p\u003e \u003cp\u003e\u003cb\u003eData collection techniques\u003c/b\u003e : The data collection procedure was carried out as follows: Acquiring authorization from the Director of Foyaguem Health Personnel Institute \u003cb\u003e(\u003c/b\u003eIFPSF) Dschang; Submitting the request for ethical clearance; Putting the questionnaire online and obtaining the link; Obtaining a brochure with the Cameroon Society of Physiotherapist (CASP) office representatives in the different regions and their contacts published on the CASP Facebook page; Calling the different office members (President, Secretary, Treasurer, ...) to submit the study, the questionnaire and to plead to integrate their regional WhatsApp group. In favourable cases, once the group had been integrated, contact was made with the members and the questionnaire was circulated within the group; the contacts of the various group members were listed for individual calls with a view to reaching the participants closely for an individual exchange in order to send them the questionnaire in their personal WhatsApp with notification of the principles, modalities and steps to follow in order to answer, and begging them to share with their colleagues and physiotherapist friends. A reminder was sent to the participant 2 or 3 days later to confirm or deny participation. The participant was free to accept or refuse to take part in the study, and in no case was a participant forced to respond.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData analysis\u003c/strong\u003e \u003cp\u003eEpi Info software version 7.2.5.0 was used, and data were expressed as percentages. Linear regression was used to establish the degrees of association between the dependent and independent variables, which were defined using Pearson's correlation coefficient followed by the P value. Associations were said to be significant for P˂0.05 and r-values between one and one. These results were presented in tables and figures produced using Microsoft (Word and Excel) 2016 software. The Vancouver model was used for bibliographic references.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical consideration\u003c/strong\u003e \u003cp\u003e the confidentiality and anonymity of respondents were respected in accordance with the principles of medical ethics and deontology.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cstrong\u003eSocio-demographic characteristics of respondents\u003c/strong\u003e \u003cp\u003e123 physiotherapists took part in the study out of the 240 contacted, giving an overall response rate of 51.25%. The study revealed that 56.1% (69) of participants were male and 43.9% (54) were female, giving a sex ratio (M/F) of 1.07. The average age of respondents was 29\u0026thinsp;\u0026plusmn;\u0026thinsp;5 years, with extremes of 21 and 50 years. The most represented age group was [26\u0026ndash;31[or 33.33% followed by [21\u0026ndash;26[or 32.52% and the least represented were [41\u0026ndash;46[and [46\u0026ndash;51[or 0.81% each. The average year of experience of respondents was four\u0026thinsp;\u0026plusmn;\u0026thinsp;3 years, with extremes of 1 and 15 years. The most common year of experience was [1\u0026ndash;3 [or 44.72%. Physiotherapists practicing in the West, Centre and Littoral regions were the most represented, at 29.25%, 28.45% and 21.14% respectively; the North, South and Adamaoua regions were the least represented, at 0.81% each. By level of study, physiotherapists with a Bachelor's degree were the most represented, at 51%, followed by those with a BTS or TPMS diploma, at 34%, those with a Master's degree, at 14%, and those with a PhD diploma, at 1%. Most physiotherapists (36%) worked in hospitals, 34% in private practice and 30% in both regimes. The average year of graduation was 2019\u0026thinsp;\u0026plusmn;\u0026thinsp;3 years, with extremes of 2008 and 2023. The most represented year of graduation was [2020\u0026ndash;2024 [or 44.72%. Concerning the place of training, 93.5% were trained in Cameroon and 6.5% abroad. The majority of physiotherapists (86.99%) had attended at least one seminar, while 13.01% had never attended a seminar. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\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\u003eSociodemographic data\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStaff (%)N\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69(56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[21\u0026ndash;26[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(32.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[26\u0026ndash;31[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(33.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[31\u0026ndash;36[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(16.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[36\u0026ndash;41[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(16.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[41\u0026ndash;46[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[46\u0026ndash;51[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eYear of experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1\u0026ndash;3[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(44.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3\u0026ndash;5[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(13.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5\u0026ndash;7[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(13.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7\u0026ndash;9[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(12.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[9\u0026ndash;11[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(9.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[11\u0026ndash;13[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2.44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[13\u0026ndash;15[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[15\u0026ndash;17[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003ePlace (region) of exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(29.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth west\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(4.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth west\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(9.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLittoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(21.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtreme-north\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2.44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdamaoua\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCenter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(28.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLevel of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHnd/tms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eExercise regime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44(36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe two\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiberal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of formation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbroad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e08(6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn cameroon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115(93.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eYear of obtaining the last diploma (in relation to physiotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2008\u0026ndash;2012[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2012\u0026ndash;2016[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(16.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2016\u0026ndash;2020[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(18.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2020\u0026ndash;2024[\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(61.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eNumber of seminars participate to date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo one\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(13.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(16.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(11.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(10.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(10.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBetween six and ten\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(13.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than ten\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(20.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRespondents' knowledge of triggers points and dry needling\u003c/strong\u003e \u003cp\u003eOf the 123 physiotherapists questioned, the majority (37.40%) had insufficient knowledge, 30.08% had very good knowledge, 26.02% had good knowledge and 6.50% had poor knowledge of TP and the various treatment methods. Furthermore, 14.63% had no knowledge of DN, 11.38% had poor knowledge, 30.9% had poor knowledge, 26.83% had good knowledge and 16.26% had very good knowledge.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRespondents' attitudes and practices towards Dry Needling\u003c/strong\u003e \u003cp\u003eOf the 123 physiotherapists surveyed, 1.63% had a neutral attitude towards DN, 21.96% had weak attitudes, 18.7% had insufficient attitudes, 30.09% had good attitudes and 27.64% had very good attitudes. With regard to respondents' DN practices, 75.61% of respondents were not active, 7.32% were slightly active, 16.26% were active and 0.81% were very active. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\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\u003eknowledge, attitudes and practices of DN and TP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStaff (%)N\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eKnowledge of TP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(6.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46(37.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32(26.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery Good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37(30.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eKnowledge of DN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(14.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(6.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(4.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19(15.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19(15.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(12.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(14.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVery Good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(9.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"17\" rowspan=\"18\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(1.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWeak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(1.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(18.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(1.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(2.44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(4.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(5.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(4.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(8.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(7.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(9.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eVery Good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(6.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(4.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(8.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(4.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93(75.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSlightly active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(2.44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(4.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(6.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(1.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(4.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(3.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(0.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTP:\u0026nbsp;\u003c/strong\u003eTrigger Point\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDN:\u0026nbsp;\u003c/strong\u003eDry Needling\u003c/p\u003e\n \u003cp\u003e \u003cb\u003eCorrelation between KAP and sociodemographic characteristic\u003c/b\u003e: We found that there was no linear relationship between level of education and: knowledge of PT (r\u0026thinsp;=\u0026thinsp;0.03, P\u0026thinsp;=\u0026thinsp;0.05); knowledge of Dry Needling (r\u0026thinsp;=\u0026thinsp;0, P\u0026thinsp;=\u0026thinsp;0.7); practice of Dry Needling (r\u0026thinsp;=\u0026thinsp;0.05, P\u0026thinsp;=\u0026thinsp;0.01); attitude to Dry Needling (r\u0026thinsp;=\u0026thinsp;0, P\u0026thinsp;=\u0026thinsp;0.8). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between socio-demographic data and participants' knowledge, attitudes and practices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-demographic data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTP knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKnowledge of DN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePractices of the DN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttitudes towards DN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,03\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,0553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,7242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,05\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,0139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,8042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,5542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,07\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,0041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0,21\u003c/b\u003e\u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,02 P\u0026thinsp;=\u0026thinsp;0,1414\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of graduation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,9370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,05 P\u0026thinsp;=\u0026thinsp;0,0137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0,19\u003c/b\u003e P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,01 P\u0026thinsp;=\u0026thinsp;0,2729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of seminars held\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,05 P\u0026thinsp;=\u0026thinsp;0,0158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,09 P\u0026thinsp;=\u0026thinsp;0,0009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0,13\u003c/b\u003e P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0,12\u003c/b\u003e P\u0026thinsp;=\u0026thinsp;0,0001\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\u003e \u003cstrong\u003eCorrelation between Knowledge, attitude and practice\u003c/strong\u003e \u003cp\u003ewe found that physiotherapists' knowledge of Dry Needling seemed to encourage its use (practice) in patient management (r\u0026thinsp;=\u0026thinsp;0.43, P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001). Similarly, the increase in knowledge about this technique seemed to encourage good attitudes (r\u0026thinsp;=\u0026thinsp;0,15 P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001). (Table\u0026nbsp;4)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable 4\u003c/strong\u003e Correlation between attitudes, knowledge and practice among participants\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractices of the DN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAttitudes towards DN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTP knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,4410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,03 P\u0026thinsp;=\u0026thinsp;0,0568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of DN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,43 P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,15 P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitudes towards DN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0,12 P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \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\u003eTP: Trigger Point; DN: Dry Needling.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the first in Cameroon in particular, and in the world in general, to attempt to explore the knowledge, attitudes and practices of physiotherapists regarding the DN technique used to treat PD. 123 physiotherapists practicing in the country's 10 regions, with the West region predominating, took part in the study, with a participation rate of 51.25%. Most respondents were male (56.1%) with an average age of 34 years. The median year of graduation was 2021, and the majority (36%) worked in a hospital. The gender distribution in this sample seems contradictory to the national distribution for 2022 published by the WP, in which 80% of physiotherapists nationwide would be female. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) This difference could be explained by the fact that men were more hostile to participating in the study than women. The dominance of physiotherapists practicing in the western region could be because the principal investigator lived in the region, which would have favoured interaction between him and the region's physiotherapists. In addition, 86.99% of respondents had already taken part in at least one seminar. They had an average of 4 years' experience, with a Bachelor's degree (35%). This could be explained by the fact that the profession in general is less established in Cameroon, in other words, new, and that the cost of training is very high, thus reducing the need for further study.\u003c/p\u003e \u003cp\u003eConcerning physiotherapists' knowledge of PT and DN techniques, the results of the study show that 37.40% of physiotherapists have insufficient knowledge of PT and 30.90% of physiotherapists have insufficient knowledge of DN. These results could be explained by the fact that, although PT is one of the main causes of MDS and the primary reason for health consultations, physiotherapists focus more on pain symptoms than on the PT that triggers them (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In addition, training programs for physiotherapists in Cameroon do not emphasize PT and the DN technique.\u003c/p\u003e \u003cp\u003eWith regard to physiotherapists' attitudes towards DN, most (64.23%) suggested that it should be added to training programs for physiotherapists in Cameroon, and that practical seminars and workshops should be organized to retrain physiotherapists already in practice. Considering attitude scores, physiotherapists gave great importance to the DN technique (9.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05 out of 18) with 30.09% having good attitudes towards DN. These results could be explained by the fact that, despite their insufficient knowledge, they nevertheless have a penchant for this practice, which is still new in Cameroon. Furthermore, there were positive correlations between socio-demographic data (year of experience, year of highest diploma, number of seminars attended) and their attitudes.\u003c/p\u003e \u003cp\u003eTaking into account the practice scores, it emerges that physiotherapists do not attach great importance to DN practice (3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55 out of 22), i.e. a practice rate of 24.39%. These results may be justified by the fact that DN is less well known in Cameroon and is not an integral part of the physiotherapist's training program. These results are similar to those obtained in Australia (25%) and China (26.8%), and much lower than those obtained in South Africa (75%) in 2006. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Although the rate of DN practice is similar to that in other countries, we note a long delay in the implementation of this technique in Cameroon. This could be explained by the fact that DN is not legalized in Cameroon as a therapeutic means in physiotherapy. In addition, there was a positive correlation between the number of seminars attended and practice, which could be explained by the fact that physiotherapists practicing DN would have learned at a seminar. Similarly, there was a correlation between knowledge of DN, attitudes towards DN and practice. This could be explained simply by the fact that a good knowledge of a problem will lead to a good perception of it, and in the same way to good practice.\u003c/p\u003e\n\u003ch3\u003eLimits of the study\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eOnline participation\u003c/strong\u003e \u003cp\u003eThe online method may have excluded potential participants who do not have access to the internet or who are not comfortable with digital technologies, which could affect the representativeness of the results.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSelection bias\u003c/strong\u003e \u003cp\u003ePhysiotherapists who chose to participate may have different levels of knowledge, attitudes and practices to those who did not, which could introduce a selection bias.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSelf-reporting\u003c/strong\u003e \u003cp\u003eThe data collected relies on self-reported responses from participants, which may introduce response bias or inaccuracies due to recall errors or social desirability.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRegional diversity\u003c/strong\u003e \u003cp\u003eAlthough the study was conducted in all 10 regions of Cameroon, regional differences in access to training and resources may not be fully captured by the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimited sample\u003c/strong\u003e \u003cp\u003eA sample of 123 participants, while large, may not be sufficient to generalise the results to all physiotherapists in Cameroon or other Central African countries.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study was conducted to explore the knowledge, attitudes and practices of physiotherapists in Cameroon regarding the DN technique used to treat TP. It revealed that 33.90% and 56.91% of physiotherapists had inadequate knowledge of PT and DN respectively. The main needs concerned diagnostic tools and the different types of TP, other names given to DN and the method of practicing DN. On the other hand, 42.29% of physiotherapists had inappropriate attitudes to DN, and 24.39% used DN sometimes alone or in combination with other therapeutic means, for multiple reasons, with results ranging in most cases from effective to very effective. Generally speaking, these data show that physiotherapists have little knowledge of TP and DN and a low level of practice, but nevertheless have positive attitudes, hence the need to conduct investigation and training campaigns among them. However, it would be important in our context to conduct Randomized Controlled Trials (RCTs) to effectively qualify the efficacy of DN and our usual techniques.\u003c/p\u003e"},{"header":"Recommendations","content":"\u003cp\u003eWe propose that accredited physiotherapy associations in Cameroon organise training sessions and seminars on trigger point management using recent advances, including the use of dry needling. We also suggest that academic institutions include this technique in the training programme for the nation's future physiotherapists.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCASP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCameroon Society of Physiotherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDry Needling\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKnowledge, Attitudes and Practice\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMSDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMusculoskeletal Disorders\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCTs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandomised Controlled Trials\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTrigger Point\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from West Regional ethics committee for human health research. All participants provided informed consent before entering the study. Information about the study objectives, procedures and participants\u0026apos; rights was clearly communicated, and participants were given the opportunity to withdraw their consent at any time without consequence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe did not receive funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDLNM designed the study project, drew up the questionnaire and supervised the conduct of each stage of the study and the drafting of the manuscript. NN contacted all study participants to obtain their informed consent and participation, and contributed to the drafting of the manuscript. HTG edited the manuscript and contributed to the interpretation of the data. MMM contributed to the drafting of the manuscript and the interpretation of the results. DLN and FCB supervised the correction of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the CASP and its former president, PT Thierry, for their involvement in putting us in contact with physiotherapists in the different regions of the country. We would also like to express our sincere thanks to all the participants in the study, without whom we would not have obtained our results.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBaily F, Foltz V, Rozenberg S, Bruno F, Gossec L. The impact of chronic low back pain is partly related to loss of social role: A quantitative study. Joint Bone Sine. 2015;86(6):437\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouziri H, Descatha A, Roquelaure Y, Jean K, Dab WO. Analyse sati-temporaelles des troubles musculo-squelettiques \u0026agrave; partir du Global Burden of Disease, 1990 \u0026agrave; 2019. Revue de Sant\u0026eacute; Publique. 2022 Ao\u0026ugrave;t; 70(3): S226.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiatta AE, Tougma WS, Diao ML, Ndiaye M. Etude des troubles musculo-squeletttiques par les manutentionnaires d'une industrie textile au Burkina Faso. Medecine d'Afrique Noire. 2021 Octobre; 6810: 589\u0026ndash;596.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBita FA, Assengue BR, Owona ML. Prevalence des troubles musculo-squelettiques dans un district de sant\u0026eacute; au Cameroun. Medecine d'Afrique Noire. 2022 Mars; 6903: 159\u0026ndash;168.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoiseau J, Laurent L. Les triggers points et l'hyothese integr\u0026eacute;e: revue de la litterature. 2020. [memoire]. Dijon: IFMK de Dijon; 2020. p. 87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJan Dommerholt, Orlando MD, Christian G. Trigger Point Dry Needling. J Man Manip Ther. 2006;14(4):70\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasey U, Kathy B, Thomas J, DRY NEEDLING FOR MYOFASCIAL, TRIGGER POINT. Int J Sports Phys Ther. 2015 Juin; 10(3): 402\u0026ndash;418.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGattie E, Cleland J, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Metaanalysis. Journal of orthopaedic \u0026amp; sports physical therapy. 2017 March; 47(3): 133\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLew J, Kim J, Nair P. Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis. J Man Manipulative Therapy. 2020 September;22:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNavarro-Santana M, Sanchez-Infante J, Gomez-Chiguano G, Cleland J, Lopez-de-Uralde-Villanueva I, Fernandez-de-las-Penas C, et al. effectys of triggerpoint dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clin Rehabil. 2020;34(11):1327\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRepublique du Cameroun. [Online]. [cited 2023 Septembre 06. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eprc.cm/fr/le-Cameroun/presentation\u003c/span\u003e\u003cspan address=\"http://prc.cm/fr/le-Cameroun/presentation\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCameroon tribune. [Online]. 2023 [cited 2023 Septembre 06. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cameroon-tribune.cm/article.html/57645/fr.html/populatin-camerounaise\u003c/span\u003e\u003cspan address=\"https://www.cameroon-tribune.cm/article.html/57645/fr.html/populatin-camerounaise\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhysiotherapy W. Annual Membership Census. 2022 30 June: p. 8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJC S. L\u0026rsquo;harmonisation des pratiques kinesitherapiques \u0026agrave; travers le monde bas\u0026eacute; sur l'Evidence-Based Practice: exemple du Dry Needling. 2017. [memoire].Pays de la Loire: IFM3R; 2017. 46p.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"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":"Knowledge, attitudes, practices, Dry Needling, Cameroon, physiotherapists, and trigger point","lastPublishedDoi":"10.21203/rs.3.rs-5814993/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5814993/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDry Needling (DN) emerged in the 1970s as a therapeutic breakthrough, proving effective in the treatment of Trigger Points (TP). Despite its worldwide application, there is little data on the knowledge, attitudes and practices (KAP) of physiotherapists in Central Africa, particularly in Cameroon. This study aims to fill this gap by exploring the knowledge, attitudes and practices of Cameroonian physiotherapists in relation to pressure point management. Understanding their current levels of CAP is essential for identifying educational needs and developing strategies to improve DN practice in the region.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quantitative, analytical, cross-sectional survey was carried out online in the 10 regions of Cameroon over a six-month period. All practicing physiotherapists with at least one year's work experience and who had given their consent were included. They were asked KAP questions relating to DN and TP. Pearson correlations were performed between KAP domains together and with sociodemographic data, Using Epi Info software version 7.2.5.0.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e123 physiotherapists participated. The majority were male (56.1%), with an average age of 29\u0026thinsp;\u0026plusmn;\u0026thinsp;5 years and a mean year of experience of 5\u0026thinsp;\u0026plusmn;\u0026thinsp;2 years. The majority of physiotherapists obtained scores\u0026thinsp;\u0026lt;\u0026thinsp;50% of the total score allocated to the domain for knowledge of TP and DN and practice of DN, thus indicating insufficient knowledge and weak practices. However, they had positive attitudes, i.e., a score\u0026thinsp;\u0026gt;\u0026thinsp;50%.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study highlights a significant need for educational initiatives in the field of Trigger Point and Dry Needling among physiotherapists in Cameroon. The results reveal a lack of knowledge and practice, despite a positive attitude towards the technique. Addressing this need for training is essential to improving the quality of patient care and the effectiveness of trigger zone management. The data collected provides a solid basis for the development of targeted training programmes and resources to equip physiotherapists with the necessary skills and knowledge. Such efforts will ultimately contribute to the advancement of physiotherapy practice in Cameroon and Africa as a whole.\u003c/p\u003e","manuscriptTitle":"Knowledge and Using of Dry needling by Physiotherapists in Central Africa in the management of Trigger points: the first cross sectional survey in Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-17 06:29:55","doi":"10.21203/rs.3.rs-5814993/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":"7f9bc122-29f2-4479-ba10-e9b40c6beedc","owner":[],"postedDate":"February 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-17T06:29:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-17 06:29:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5814993","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5814993","identity":"rs-5814993","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}