Neck Disability, Associated Factors, and Quality of Life Among Physiotherapists in Saudi Arabia

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Abstract
Background/Objectives: Physiotherapy practice involves patient handling, sustained or awkward postures, repetitive manual techniques, and prolonged standing. This study estimated Neck Disability Index (NDI)-defined neck disability among physiotherapists in Saudi Arabia, examined demographic and workplace associations with disability severity, and compared quality of life across NDI levels.Methods: A cross-sectional online convenience survey was conducted from 2 April to 22 May 2024 through email and professional networks. The invitation denominator was not tracked, so a response rate could not be calculated. Eligible participants had at least one year of clinical experience. The NDI and WHOQOL-BREF were administered in English. Associations were evaluated using exact tests for sparse tables, Holm adjustment, and a five-variable multinomial model with HC0 robust standard errors. An expanded 11-factor mean bias-reduced multinomial model was the principal sensitivity analysis; additional analyses examined age stability.Results: Among 367 participants, 197 had NDI-defined disability (53.7%; 95% CI, 48.6%–58.7%), predominantly mild (156, 42.5%), and 41 had moderate-or-worse disability (11.2%; 95% CI, 8.3%–14.8%). In the five-variable model, mild disability was associated with female sex (adjusted relative risk ratio [RRR], 2.49; 95% CI, 1.54–4.03) and BMI ≥25 kg/m² (RRR, 2.04; 95% CI, 1.26–3.29); moderate-or-worse disability was associated with non-private employment (RRR, 4.47; 95% CI, 2.06–9.73) and BMI ≥25 kg/m² (RRR, 2.25; 95% CI, 1.05–4.84). The expanded model retained the female-sex/mild and workplace/moderate-or-worse patterns, but the latter BMI interval included 1 (RRR, 2.13; 95% CI, 0.96–4.69). WHOQOL-BREF domain medians were lower across higher NDI levels (all four omnibus Holm-adjusted p < 0.001).Conclusions: Neck disability was common in this convenience sample, and higher NDI severity co-occurred with lower quality-of-life scores. Female-sex and workplace associations were consistent across the principal models; BMI findings require caution. The associations are cross-sectional, exploratory, non-causal, and not nationally representative.

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