Physical Therapy in Pakistan:
50-Years to Recognition

In Pakistan the physical therapy profession underwent a gradual development, taking around 50 years to reach its current level of education and recognition. The initial steps occurred in 1956 at Jinnah Postgraduate Medical College, through a partnership between the Ministry of Health (MOH) and the World Health Organization (WHO), to establish the nation’s first-ever school of physical therapy in Karachi. The school began with a two-year diploma program in physical therapy, which required candidates to have a matriculation (Science) background for admission.

In 1961, the diploma program was extended to three-year duration, now known as a diploma course in physiotherapy. Subsequently, in 1963, the sole school of physical therapy in Pakistan elevated its three-year diploma program to a Bachelor of Science in Physiotherapy degree course, after forming an affiliation with the University of Karachi. The eligibility criterion for this degree was a Higher Secondary School Certificate (pre-medical). This transition from a diploma to a degree program marked a significant milestone in the field’s professional advancement.

In 1967 the first batch of graduate physiotherapists started physiotherapy practice in the country. In 1986, a second School of Physiotherapy was established at King Edward Medical College, Mayo Hospital Lahore, and later it became affiliated with the University of Punjab. This school offered a three-year Bachelor of Science in Physiotherapy program.

In 1999, the University of Karachi took the bold decision to upgrade the Physical Therapy curriculum to four years BS, PT degree program. There was a significant update to the educational path in the field of physical therapy. This change was implemented in both public and private medical colleges.

In 2007, Doctor of Physical Therapy (DPT) was introduced. In 2008, Riphah College of Rehabilitation Sciences (RCRS) introduced the pioneering Doctor of Physical Therapy (DPT) degree program along with the Post-Professional Doctor of Physical Therapy (PP-DPT) program, ushering in a new era of professional advancement in Pakistan. The DPT program represented a significant stride towards granting professional independence and enabling patients/clients to directly access physical therapists without the unnecessary requirement of a referral. This approach, referred to as direct access, allows patients to seek the services of a physical therapist without a referral from other healthcare practitioners. While this practice is common in many developed countries, it was not widely available in Pakistan. This move fosters a collaborative multi-disciplinary approach and delineates the scope of practice for both physical therapists and other healthcare professionals.

Evolution in Physical Therapy Education and Recognition

Physical therapy education regulation in Pakistan falls under the Higher Education Commission (HEC). HEC and the National Curriculum and Revision Committee (NCRC) have collaboratively endorsed a standardized curriculum for entry-level physical therapy education across the nation. This milestone led to the introduction of a recognized entry-level degree endorsed by HEC, establishing the profession’s autonomy within the country. The HEC-endorsed DPT curriculum spanning over a period of 5years/ 10 semesters and includes a minimum of 175 credit hours. The inception of DPT and PP-DPT programs in 2008 has seen a notable increase in the number of institutions offering these programs within a relatively short timeframe.

Research

In spite of the slow progress and significant challenges, the field of physical therapy has managed to advance considerably and continues its trajectory towards achieving a Doctor of Philosophy (PhD) in Rehabilitation Sciences. Despite the on-going journey, there’s a need for the profession to continue moving forward in order to meet the criteria of a fully developed field. The introduction of a Doctor of Philosophy (PhD) program specifically in Rehabilitation Sciences represents a major milestone in the further development of this crucial profession. Undergraduate DPT degree is considered incomplete without research report writing. Research project is mandatory to complete masters/MPhill and PhD degrees.

Research findings are best disseminated through oral and/or poster presentations in scientific conferences both national and international. 1^st international conference on rehabilitation sciences was hosted by Riphah College of Rehabilitation Sciences, Riphah International University in Lahore in 2014. Since then National and International Physiotherapy and Rehabilitation Sciences conferences have been hosted in Pakistan regularly. National and International experts, speakers, students, institutions, delegates and industry experts participate in these events.

Scientific publications are a hallmark of research. Nonetheless, the Journal of Physiotherapy and Sports Medicine (JOPSM) marked the 1^st  peer-reviewed journal in Pakistan, succeeded by the inception of the International Journal of Rehabilitation Sciences (IJRS). JOPSM and IJRS, both were introduced in 2012and published bi-annually. Further development, in the field of research in rehabilitation making strides with the launch of the Journal of Riphah college of Rehabilitation Sciences (JRCRS). In recent years’ number of physiotherapy and rehabilitation sciences journals have emerged and are getting popularity.

Associations and Organizations

Despite 60 years since its establishment, there was no governing body overseeing physical therapy in Pakistan. Pakistan was lacking a central regulatory authority or professional council for Physiotherapists which is overcome by Allied health council of Pakistan notified on 3^rd March, 2022, under the administrative control of Ministry of National Health Services, Regulations and Coordination, Islamabad.

Previously local associations and societies such as the Pakistan Physical Therapy Association (PPTA) Islamabad, Chartered Society of Physical Therapy (CSP) Faisalabad, and Pakistan Physiotherapy Society (PPS) were registering physiotherapist which was accepted internationally in various countries.

Establishing Regulation and Vision for the Profession

In Pakistan, the Pakistan Physical Therapy Association (PPTA), formed in 2008, is actively working to elevate and regulate the profession at both professional and governmental levels. PPTA is dedicated to creating the “Pakistan Physical Therapy Council (PPTC)” that is expected to oversee the profession’s regulation at the government level. After persistent efforts, the draft for PPTC was approved by the Federal cabinet in May 2018. But with the activation of AHCP, separate PPTC seems challenging goal to achieve.

PPTA, functioning for a decade, stands as the sole professional representation for Physical Therapists in Pakistan. With 2,510 current members across the Islamabad capital territory and provinces of Punjab, Sindh, Khyber Pakhtunkhwa, and Baluchistan, PPTA gained international representation by becoming a member of the World Confederation for Physical Therapy (WCPT) in 2011, connecting the profession globally.

Government Oversight and Educational Challenges

Government bodies regulating physical therapy ensure safe, quality care by focusing on practice licensure, professional standards, education, and financial stability. The Higher Education Commission (HEC) in Pakistan has worked on a unified curriculum for entry-level Doctor of Physical Therapy (DPT) programs, addressing the need for consistent standards. However, the lack of criteria for starting PT education institutions has led to an influx of substandard institutions, with around 150 new ones emerging in the last decade.

Previously, PT care was confined to major cities, but now it’s expanding to district and tehsil levels in some provinces. Despite progress, challenges persist in private PT practice regulation, with private clinics not yet covered by government registration, although PPTA is advocating for this. PPTA and HEC have made commendable efforts in advancing the PT profession, but the necessity for an independent PT regulatory body (PPTC) remains vital.

Conclusion

The evolution of Physical Therapy (PT) in Pakistan spans several decades, from its inception in the 1950s to its current state of professional growth. The journey from simple diplomas to the establishment of Doctor of Physical Therapy (DPT) programs has been marked by challenges and progress. Pioneering institutes such as Jinnah Postgraduate Medical Centre (JPMC) and school of Physiotherapy, King Edward Medical College, Mayo Hospital Lahore have played crucial roles in shaping the landscape of PT education in the country. The emergence of private bodies like the Pakistan Physiotherapy Society (PPS) and the Pakistan Physical Therapy Association (PPTA) further underscores the commitment to professional advancement. As the field continues to evolve, it is hoped that increased autonomy, direct patient engagement, interdisciplinary collaboration, and greater public awareness will further elevate the status and impact of physical therapy across the nation.

Posted by Wajida Perveen

Dr. Wajida Perveen is a Physical Therapist from PAKISTAN with diverse experiences as academician, clinician and a researcher with professional experience in Musculoskeletal Rehabilitation. She is an eminent scholar and reviewer in many national and international peer reviewed journals and conferences. Within World Physiotherapy, she is an active member of subgroups and global communities of physiotherapy practice.

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