Msaad Alzhrani

Background/Objectives: This survey examined referral decisions, the recognition and screening of warning features (red flags) of serious disease, regulatory interpretations, and barriers to direct-access physical therapy in Saudi Arabia. Methods: An English-language cross-sectional convenience survey (May–July 2026) used an investigator-developed questionnaire with 12 clinical vignettes (written patient cases) and 20 warning-feature items paired with screening questions. The primary outcome was choosing medical referral before physical therapy in all four urgent/critical vignettes: suspected gastrointestinal bleeding, cauda equina syndrome, abdominal aortic aneurysm, and spinal infection. This definition was finalised after data collection. Results: Of 131 Saudi physical therapists, 77 (58.8%; 95% confidence interval [CI] 50.2–66.8) chose referral before treatment in all four vignettes. Another 36 included referral in every vignette but would also start treatment while arranging referral in at least one; 18 chose treatment without referral at least once. In an exploratory six-predictor analysis, postgraduate academic qualifications were associated with higher odds of meeting the primary outcome (adjusted odds ratio 4.14, 95% CI 1.63–10.51; Holm-adjusted p = 0.017) and older age with lower odds (0.92/year, 95% CI 0.86–0.98; Holm-adjusted p = 0.047). Across 17 core warning features, 74.0% of responses identified a red flag; 49.1% of screening responses indicated checking often or always. Regulatory views differed: 45.8% believed direct access was permitted in limited settings. The highest-rated barriers concerned policy, law, reimbursement, and physician support. Conclusions: These findings identify priorities for evaluating training, clarifying regulations, and coordinating referral pathways. Vignettes and self-reported practices cannot establish safety in clinical practice, show that qualifications improve decisions, or determine workforce readiness.

Background/Objectives: Physiotherapy practice involves patient handling, sustained or awkward postures, and repetitive manual techniques. This study estimated Neck Disability Index (NDI)-defined neck disability among physiotherapists in Saudi Arabia, examined its demographic and workplace associations, and compared quality of life across NDI levels. Methods: An online cross-sectional convenience survey (April–May 2024) included physiotherapists with ≥1 year of clinical experience. Disability and quality of life were assessed using the NDI and WHOQOL-BREF. Analyses used five-variable multinomial regression with robust standard errors, an expanded 11-factor mean bias-reduced sensitivity model, and Holm-adjusted comparisons. Results: Of 367 participants, 197 (53.7%; 95% CI, 48.6–58.7%) had NDI-defined disability: 156 (42.5%) mild and 41 (11.2%) moderate-or-worse. In the main model, mild disability was associated with female versus male sex (adjusted relative risk ratio [RRR], 2.49; 95% CI, 1.54–4.03) and body mass index (BMI) ≥25 versus 2 (RRR, 2.04; 95% CI, 1.26–3.29); moderate-or-worse disability was associated with pooled non-private versus private rehabilitation settings (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 showed similar sex and workplace associations; only these factors were significant in Holm-adjusted joint tests, and the moderate-or-worse BMI estimate was less precise (RRR, 2.13; 95% CI, 0.96–4.69). All four WHOQOL-BREF domains showed lower medians at higher NDI levels (all omnibus Holm-adjusted p < 0.001), with the largest difference in physical health (ε² = 0.199). Conclusions: Neck-related disability was common and co-occurred with poorer physical, psychological, social, and environmental quality of life. Sex and workplace showed the most consistent adjusted associations. These sample-specific findings warrant representative longitudinal research with direct measurement of occupational exposures and do not establish causality.

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.

Background/Objectives: Rapid changes, jumping, and high-intensity movements are common among football players and are vulnerable to ankle sprains and functional ankle instability (FAI). This study aimed to determine the prevalence of FAI and assess the correlation with related factors among male football players in southwestern Saudi Arabia. Methods: A cross-sectional observational study was conducted among 364 male football players aged ≥18 years in southwestern Saudi Arabia. Participants completed the Arabic version of the Identification of Functional Ankle Instability (Ar-IdFAI) questionnaire. Descriptive statistics were used to estimate prevalence. Differences in Ar-IdFAI scores across playing positions were examined using analysis of covariance (ANCOVA), adjusted for age, body mass index (BMI), playing experience, and weekly training hours. Multivariable binary logistic regression was used to examine factors associated with IdFAI-defined probable FAI. Results: IdFAI-defined probable FAI was identified in 47.8% (174/364) of participants (95% CI: 42.7–52.9%). After adjustment for age, BMI, playing experience, and weekly training hours, playing position was not significantly associated with Ar-IdFAI score (ANCOVA, F(3,356) = 2.106, p = 0.099). In the exploratory participant-level logistic regression analysis, greater playing experience was associated with lower odds of Ar-IdFAI-defined probable FAI (OR = 0.93, 95% CI: 0.88–0.98, p = 0.018), whereas playing position, age, BMI, weekly training hours, and dominant limb were not statistically associated with the outcome. Conclusions: FAI is prevalent among all male field-position footballers, regardless of their position. Playing position was not independently associated with instability, whereas greater playing experience demonstrated an inverse association with functional ankle instability. Findings highlight the necessity for preventive and rehabilitation approaches targeting all players regardless of position.

Background/Objectives: Saudi evidence on self-reported knee injuries among amateur sport participants is limited. We estimated lifetime knee injury prevalence and associated factors. Methods: This cross-sectional study used non-probability convenience sampling to recruit amateur players aged 18–60 years without chronic disease. Data were collected in 2022 using an Arabic study questionnaire and the Saudi Arabic Knee Injury and Osteoarthritis Outcome Score. The primary outcome was a broadly defined, self-reported lifetime knee injury history. Associations were estimated using logistic and Firth penalized logistic regression. Results: Of 462 submissions after the eligibility gateway, 273 were eligible and internally consistent. Most participants were male (89.4%), and football was the most frequently reported sport (74.7%). Overall, 155 participants reported a lifetime knee injury (56.8%; 95% CI 50.8–62.5%). In the adjusted model (n = 269), football participation (aOR = 2.60, 95% CI 1.35–5.13; p = 0.004) and older age (aOR per year = 1.04, 95% CI 1.01–1.08; p = 0.023) were associated with higher odds. Estimates for male sex and high exercise intensity were imprecise. Conclusions: More than half of this convenience sample reported a lifetime knee injury. Football was the most consistent correlate. These cross-sectional findings are neither causal nor nationally representative.

Background/Objectives: Non-specific low back pain (NSLBP) is the leading cause of disability worldwide. Artificial intelligence (AI) technologies are increasingly being integrated into healthcare interventions for NSLBP, yet their effectiveness remains uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness of AI-based Physical therapy (PT) interventions on pain intensity and disability outcomes in patients with NSLBP. Methods: We conducted a comprehensive search across six electronic databases. Randomised controlled trials (RCTs) evaluating AI-based interventions for NSLBP were only included. Mean differences (MD) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using I² statistics and Cochran’s Q test. Results: Five RCTs (n = 1939) met the inclusion criteria for systematic review. Three RCTs (n = 594 participants) provided data for meta-analysis. AI-based interventions significantly reduced pain (pooled MD −0.721, 95% CI −1.047 to −0.395; z = −4.34, p < 0.001; I² = 9.5%). Disability also significantly improved (pooled MD −1.031, 95% CI −2.020 to −0.042; t(2) = −4.48, p = 0.046; I² = 0%). Neither effect reached the minimal clinically important difference (1.0 for pain, 2–4 for disability). No serious adverse events were reported. Conclusions: AI-based PT interventions produce statistically significant but clinically small improvements in pain and disability for NSLBP. Certainty of evidence is low due to risk of bias and imprecision. Larger, blinded RCTs with standardised outcomes are needed.

High-Intensity Interval Training (HIIT) and Plyometric training are both well-established methods for improving athletic performance. Despite their popular

Background and Objectives: Functional Ankle Instability (FAI) is a sequela of ankle sprains; however, its associated variables in volleyballers have not been studied. This study aimed to determine the prevalence of FAI and the association between FAI and its associated variables in volleyball players. Materials and Methods: An observational study with a sample size of 128 male volleyballers, aged 18 years and older, was conducted using the Arabic-Identification of Functional Ankle Instability (Ar-IdFAI) questionnaire. The prevalence of FAI was analyzed in terms of frequency and percentage. The Mann–Whitney U test, Spearman’s test, and t-test were used to analyze the associations between the demographic variables and the categorical variables, and a logistic regression model was applied to identify the independent associations with FAI. Statistical significance was set at p < 0.05. Results: The prevalence of FAI in the sample was 44.53%. Bivariate analysis and the regression model indicated no significant direct association between FAI and age, Body Mass Index (BMI), playing duration, weekly training hours, or limb dominance in this sample. Conversely, historical injury burden showed strong and statistically significant associations with FAI (Cramér’s V = 0.59–1.00), with “giving way” demonstrating perfect separation. The logistic regression model showed an acceptable fit (p = 0.676) and moderate explanatory power (Nagelkerke R² = 0.540), with excellent discriminatory performance Area Under the Curve (AUC = 0.855) driven primarily by injury-related variables. Conclusions: FAI is highly prevalent among male volleyball players and is linked to injury history rather than demographic or training characteristics. Injury-related characteristics, including previous ankle injury, reinjury, and episodes of ankle “giving way”, demonstrated strong associations with the presence of Functional Ankle Instability, to be interpreted as descriptive associations rather than a causal link due to methodological structure.

Objectives: To explore sport physiotherapists’ perspectives and experiences on the management of anterior cruciate ligament (ACL) injuries in Saudi Arabia and to understand the key challenges that influence rehabilitation practice. Methods: A qualitative semi-structured interviews were conducted with sport physiotherapists recruited from different regions and clinical settings (Public, private and sport clubs) in Saudi Arabia. Eligibility criteria included ≥2 years’ post-qualification experience in ACL injuries management. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. A total of twenty-six sport physiotherapists (18 males; mean age 31 years, range 26–39) participated, including 13 working primarily as clinicians and 13 with combined clinical and research roles. Results: Five themes were identified: (1) disruptions of ACL injury in daily life and sport; (2) managing fear of re-injury and uncertainty in surgical vs. conservative care; (3) guiding rehabilitation through challenges of workload, progression, adherence and supportive tools; (4) variability in protocols, assessment tools, and available resources; and (5) returning to sport is more than just passing a test. These themes demonstrate that ACL injuries rehabilitation in Saudi Arabia is shaped by physical and psychological readiness, cultural expectations, and disparities in resources. Conclusions: Physiotherapists described ACL rehabilitation as a long-term process that needs an integration of physical, psychological, and contextual factors. This study’s findings highlight the need for resource-sensitive, standardized guidelines and the inclusion of psychological readiness assessments within rehabilitation processes. This study provides context-specific evidence that can be used to inform the development of culturally responsive, evidence-based approaches to strengthen ACL rehabilitation in Saudi Arabia.

Background/Objectives: Football poses a high risk of sustaining lower-limb injuries, particularly anterior cruciate ligament (ACL) injuries, owing to the frequent jumping and landing movements. Identifying risk factors for these injuries is crucial to successful prevention. Two-dimensional (2D) video analysis is a commonly employed tool for assessing movement patterns and determining injury risk in clinical settings. This study aims to investigate whether variations in the camera frame rate impact the accuracy of key angle measurements (knee valgus, hip adduction (HADD), and lateral trunk flexion (LTF)) in male football players during high-risk functional tasks such as single-leg landing and 45° side-cutting. Methods: This laboratory-based cross-sectional study included 29 football players (mean (SD) age: 24.37 [3.14] years). The frontal plane projection angle (FPPA), HADD, and LTF during single-leg landing and side-cutting tasks were measured using two different camera frame rates: 30 frames per second (fps) and 120 fps. The 2D kinematic data were analyzed using Quintic Biomechanics software. Results: Significant differences in FPPA scores during single-leg landing were observed between the 30 fps and 120 fps for both the dominant (mean difference = 2.65 [95% confidence interval [CI]: 0.76–4.55], p = 0.008) and non-dominant leg (3.53 [1.53–5.54], p = 0.001). Additionally, the FPPA of the right leg during the side-cutting task showed significant differences (2.18 [0.43–3.93], p = 0.016). The LTF of the right leg during side-cutting displayed a significant variation between frame rates (−2.69 [−5.17–−0.22], p = 0.034). No significant differences in HADD were observed. Conclusions: Compared with a 30 fps camera, a high-speed (120 fps) camera demonstrated a superior performance in delivering accurate kinematic assessments of lower-limb injury risk factors. This improved precision supports injury screening, rehabilitation monitoring, and return-to-play decision-making through determining subtle biomechanical deficits crucial for lower-limb injury prevention and management.