Abstract
Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.
Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).
Setting: The study was conducted in the Philippines.
Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.
Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p < 0.000).
Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.
Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.
Keywords: COVID-19; knowledge; attitude; practices; rehabilitation.
Introduction
COVID-19 has spread worldwide and was proclaimed a pandemic by the World Health Organization (WHO) in March 2020. Healthcare workers (HCWs), being either the first responders or having close proximity to those afflicted with COVID-19, are vulnerable to acquiring infection, and the inability to control infection among HCWs may lead to the collapse of the care system. An umbrella review by Chutiyami et al. (2022) showed that the death rate among healthcare workers was between 0.3 and 54.2 per 100 infections with an overall case fatality rate of 0.87% and an infection rate ranging from 3.9% to 11.0%. To date, there are nearly 3.1 million confirmed cases in the Philippines, with a death toll of around 50 000. The country has one of the highest cases of COVID-19 among the Southeast Asian countries. The Philippines is plagued by the increasing economic burden brought by the COVID-19 pandemic. The healthcare system is affected severely as evidenced by a lack of personnel protective equipment (PPE), hospital beds and intensive care units (ICUs) dedicated to COVID patients and vaccinations (De Castro et al. 2021).
A study conducted by Haw et al. (2020) which included the first 8212 COVID-19 cases in the Philippines, showed that healthcare workers had 24.7% of the infection with 35 deaths. Poor sleep quality, skin allergies because of the use of PPE and work-related stress are among COVID-related complications (Chutiyami et al. 2022). Moreover, long COVID symptoms after 6 months of diagnosis which include exhaustion and weakness have been observed in HCWs (Strahm et al. 2022). Therefore, all possible actions must be taken to control the spread of the infection to HCWs, first by identifying the risk factors for infection and then by taking appropriate measures to reduce these risks (De Castro et al. 2021).
Although the primary clinical manifestation of COVID-19 is respiratory distress syndrome, non-pulmonary problems and complications such as acute cerebrovascular disease, Guillain-Barre syndrome, post-infectious myelitis, fatigue myalgia, generalised weakness, myalgia and arthralgia have been reported (El-Kassas et al. 2023; Swarnakar, Jenifa & Wadhwa 2022). These conditions warrant rehabilitation intervention. The rehabilitation team, composed of physiatrists, physical and occupational therapists, and speech pathologists, serves an integral role in this pandemic by restoring functional ability and quality of life among those afflicted with COVID-19 (Haw et al. 2020). Hence it is important that, despite the hazard, rehabilitation services should continue and the risk of infection among the rehabilitation staff be mitigated.
The members of the rehabilitation team become vulnerable to exposure as they come in face-to-face contact with the patients while treating and managing them. They are at high risk from exposure because of the aerosol-generating treatments, such as patient mobilisation or speech therapy or dysphagia evaluation, increased contact time with the patient during consultations and therapy sessions, and the use of physical modalities and employing of exercises which entail actual skin contact with the patients.
The Philippines had implemented the draconian method of national lockdown, which was the longest and strictest in the region. However, the government effort failed in preventing the surge of COVID-19 in the country. The success of the government effort relies on the population’s adherence to the preventive measures, which are affected by knowledge, attitude and practices (KAP). Knowledge, attitude and practices about COVID-19 in different sectors of society are important because imprecise knowledge and negative mindset towards COVID-19 among the community may lead to disturbing concern and anxiety (Puspitasari et al. 2020). Therefore, it is necessary to collect information on KAP from different sectors of the society especially of the healthcare workers.
There are numerous studies that determine the KAP of rehabilitation professionals on COVID-19 and factors associated with it such as age, gender, level of education, workplace setting and regions in the country (Alshahrani et al. 2022; Cage et al. 2022a; Cage et al. 2022b; Ezema et al. 2021; Gunjawate et al. 2021; Kanaan et al. 2021; Kashif 2021; Kashif et al. 2022; Rayos & Ang-Muñoz 2022; Suresh Babu et al. 2024; Silva et al. 2022). However, there is only one study that determined the KAP of rehabilitation medicine residents in the Philippines and its impact on residency training (Rayos & Ang-Muñoz 2022). Furthermore, studies have focussed only on a specific rehabilitation professional as a research participant. In this study, the researchers included all rehabilitation health workers including physiatrists, physical and occupational therapists, and speech pathologists. This study aims to determine the current KAP of the rehabilitation team with regards to COVID-19 prevention in relation to the practice of rehabilitation medicine. It also seeks to determine if there are associations between the factors, that is, age, gender and type of profession which can affect the KAP of the rehabilitation team.
Research methods and design
Study design
This is a cross-sectional study.
Setting
The Philippines.
Sample size calculation
The minimum sample size of 200 was determined based on an a priori sample size analysis using G*Power3.1.9.2 (Comrey et al. 1988; Faul et al. 2009; Mayr et al. 2007) and informed recommendations on the nature of outcome measurement and the latent constructs for a targeted population (Comrey et al. 1988; Guadagnoli & Velicer 1988). This study was able to recruit 410 survey respondents. A post hoc sample size power analysis using G*Power3.1.9.2 was determined based on an a priori sample size analysis, and the results indicate that the recruited sample size has a power of 0.99.
Participants
Physiatrists, physical and occupational therapists, speech pathologists living in the Philippines who are currently practising locally, either face-to-face or virtually were included in the study. They could either be practising in hospitals and/or stand-alone clinics. Non-clinicians, faculty members and those not residing in the Philippines were excluded from the study.
Recruitment process
Snowballing and a purposive homogenous convenient sampling procedure were used to identify the targeted population because, during the time of data gathering, the Philippines was still in lockdown. The invitation for the study was posted in the Viber group of the fellows of Philippine Academy of Rehabilitation Medicine which had 250 members. The researchers asked the members if they could extend the invitation to the physical and occupational therapists and speech pathologists employed in the respective rehabilitation centres. Data gathering was held from June 2021 to July 2021.
Formulation of the questionnaire
A systematic search of existing studies and guidelines in the web and electronic data bases concerning knowledge, skills and attitudes on COVID-19 among health professionals was performed.
Most questions on knowledge, skills and practices were adapted from the studies of Raghavan, Jabbarkhail and Ahmady (2020), Bamford et al. (2020), U.S. Centers for Disease Control and Prevention (n.d.) and World Health Organization (2020). The last part evaluated the attitude and beliefs of the healthcare workers towards the use of PPE which was adapted from the study conducted by Alao et al. (2020), Khader et al. (2020) and Saqlain et al. (2020). The research team convened and the questionnaire was modified in order that it was more appropriate for the Philippine setting.
The questionnaire contained 31 questions and was divided into four parts (Appendix 1: Questionnaire). The first part captured demographic information (age, gender, type of rehabilitation professional, workplace setting, region of occupation). The second part, which is composed of nine questions, measured knowledge about COVID-19 related to clinical manifestations, incubation period, source of transmission and means of prevention. Questions for the second portion were answerable with ‘yes or no’ or multiple choice. The third part, composed of nine questions, identified the skills and practices of rehabilitation medicine professionals towards COVID-19 infection prevention and control. This section presented questions that were answerable with ‘yes or no’, multiple choice, number sequencing and Likert scale type of questions. For the following questions 18 and 19 pertaining to the use of PPE in COVID and non-COVID patients, the responses are as follows: ‘Always, as recommended’ means more than 95% of the time; ‘Most of the time’ means 50% or more but not 100%; ‘Occasionally’ means 20% to under 50%; and ‘Rarely’ means less than 20%. The last section of the questionnaire assessed the attitude of health practitioners and had nine questions where answers were Definitely Not, Probably Not, Probably, Possibly, and Definitely with a scoring of 1–5, respectively. The higher the score, the more positive the attitude.
The questionnaire was then sent to four physiatrists, four physical therapists (PTs) and two occupational therapists for content validation. Content validation index of the questionnaire ranged in the Conduct Validity Index for item (I-CVI) = 0.80–1.00 and Conduct Validity Index for scale (S-CVI)/Ave = 0.95. Items with an I-CVI < 0.78 were reviewed and modified based on relevant literature, experts’ recommendations and study authors’ consensus, prior to use in the main study in order to assure the validity of the questionnaire’s items and scale. Item-Content validity index showed that the index was from 0.80 to 1.00 except for Items 7 and 24 which had a score of 0.78. Item 7 pertained to children and adolescents having COVID-19. The collected comments from the raters include thinking that there are no children or adolescent professionals and later realising that the question was relevant because the practice of rehabilitation medicine caters to children and adolescents too. Item 24 which asked ‘Do you feel taking your lab coat home is not harmful?’ was modified to ‘Do you feel taking home your scrub suit worn at the Rehabilitation center is not harmful?’ to make it more understandable because the raters thought that the semantics of the sentence were incomprehensible. The average of the S-CVI was 0.95, which is above the minimum recommendations of 0.90. This reflects a high average congruency percentage.
Data collection
Invitations to possible respondents were sent through Viber or e-mail. Informed consent was signed prior to answering the questionnaire. Google Form was used as medium of a questionnaire, and the link for the questionnaire was distributed through Viber, an instant messaging software (Rakuten, Japan), e-mail and Facebook Messenger, whichever platform is available to the participants. Data gathering was done from June 2021 to July 2021.
Treatment of data
The following procedures were implemented in data management for the purpose of statistical analysis.
The participants were divided into four groups: physiatrists, PTs, occupational therapists and speech pathologists because each of the groups had different tasks and exposure time when treating patients. The age of the participants was classified as young if they were less than 34 years old and old if they were more than 34 years old. The classification was based on the median age of the participants. The years of practice were divided into seven groups with 5 years per group beginning 1–5 years of practice to more than 30 years of practice. The practice area was categorised as hospital-based setting, stand-alone rehabilitation centre or both.
The region of practice was divided into the regions of the Philippines. The Philippines is subdivided into 17 regions in the three main islands, with 18 regions in Luzon (regions I–V with Mimmaropa, National Capital Region (NCR) and Cordillera Administration Region), 3 regions in Visayas (Regions VI–VII) and 6 regions in Mindanao (Regions IX–XIII with Bangsamoro Autonomous Region of Muslim Mindanao) (Philatlas.com cited 05 August 2024). The sources of guidelines were written rehabilitation guidelines, Infection Prevention Control Committee (IPCC) guidelines of the hospitals, online guidelines, fellow medical practitioners and social media.
Statistical analysis
Participant characteristics were summarised using descriptive statistics. Knowledge, practices and attitude scores were extracted from their corresponding questions on the survey. COVID-19 knowledge reflected 54 items spread over nine questions (highest possible score = 54). They were scored based on correct responses. COVID-19 practice was summarised from a total of 74 items within nine questions. We assigned scores to responses that reflect correct practices (highest possible score = 165). COVID-19 attitude scores were asked through 10 questions with a Likert scale, where higher scores correspond to more positive attitudes towards the virus (highest possible score = 50).
Group differences were tested using independent t-tests and analyses of variance (ANOVA). Whenever possible, post hoc analyses were conducted using Tukey’s honestly significant difference test to determine pairwise differences. The correlation was tested using Pearson’s and Spearman’s correlation analysis, depending on the variable’s level of measurement. The correlation was rated as 0 with zero correlation, 0.1–0.3 with weak correlation, 0.4–0.6 with moderate correlation, 0.7–0.9 with strong correlation and 1 as perfect correlation (Dancey & Reidy 2007). The critical value was set at α = 0.05. Data management and statistical analysis were performed using Statistical Package for Social Sciences (SPSS) version 23.0 (IBM SPSS Statistical package, United States).
Results
Participant characteristics
A total of 250 physiatrists were invited to the study, and 114 (45.6%) participated in the study. This study was able to recruit 410 rehabilitation professionals with a mean age (years) of 34.43 ± 0.48 years. Of the rehabilitation professionals, 27.8% (n = 114) were physiatrists, 230 (56.1%) were PTs while 14.4% (n = 59) and 1.7% (n = 7) were occupational therapists and speech pathologists, respectively.
The majority of the participants were females (63.40%) and were predominantly based in the NCR (49.02%). The rehabilitation professionals were spread throughout the Philippines, except for Region 9. The 51.71% of the surveyed participants were novice rehabilitation professionals with 1–5 years of practice. The most common source of COVID-19 guidelines was written rehabilitation guidelines based on the IPCC or similar bodies (68.50%) and online guidelines from reputable sources (62.44%) such as those from the WHO and Department of Health (DoH). A complete summary of the participant characteristics is shown in Table 1.
Summary of COVID-19 knowledge, practices and attitude
The total mean score for knowledge is 41.14 ± 3.16 (Table 5). Table 2 summarises the percentage of correct answers in the COVID-19 knowledge. All participants were able to correctly identify that ‘droplets’ from the nose and mouth was a mechanism of COVID-19 spread, as well as the practice of hand hygiene as a preventive measure to stop the spread of the disease in a hospital and/or clinical setting. These were the only items with a 100% correct response. On the other hand, the items with the lowest correct response rates were slurring of speech (13.70%) and numbness of extremities (16.30%) as signs and symptoms of COVID-19 and wearing cloth masks (21.70%) to prevent the spread of the disease in a hospital and/or clinic setting. The scores obtained by the rehabilitation professionals were 41. There was no difference as to gender, age and type of profession.
TABLE 2: Summary of COVID-19 knowledge (N = 410). |
The total COVID-19 practices’ score is 104.54 ± 33.65 (Table 5). The practices are summarised in Table 3. Some items with several choices were assigned ordinal scores where the highest point is assigned to the most correct choice. There are discrepancies in the number of respondents for some items because of the fact that some practices are specific to hospitals or stand-alone rehabilitation centres and the place of practice of the rehabilitation professionals sampled in this study. The most prevalent COVID-19 practices were regular hand hygiene practices, screening and assessing patients, and the use of double-layer gloves during healthcare interaction with a COVID-19-positive patient. The lowest COVID-19 Practice was positioning the COVID-19 patient in a high backrest after prone positioning (6.00%), not using PPEs during rehabilitation consultation and therapy of active COVID-19 patients (7.02%), and therapists positioning the COVID-19 patient in prone positions for more than 1 hour (32.63%).
TABLE 3: Summary of COVID-19 practices questions. |
The total mean score for attitude is 37.13 ± 3.55 (Table 5). Table 4 summarises the attitudes rehabilitation professionals towards COVID-19. The highest responses were recorded for their willingness to put on the highest level of PPE when the need arises, where 84.39% answered definitely. The lowest response rate was seen for the question on the participants’ attitude towards the need to treat COVID-19 patients during acute inpatient rehabilitation care, where only 30.73% agreed. When asked whether their vaccination status will change the practices in using PPE when treating patients, majority of the sampled rehabilitation professionals (55.85%) responded ‘definitely not’.
TABLE 4: Summary of COVID-19 attitude questions (N = 410). |
Group differences on COVID-19 knowledge, practices and attitude
COVID-19 knowledge
Gender, type of profession and age showed no significant effect on COVID-19 knowledge.
COVID-19 practice
Gender showed no statistical effect on COVID-19 practice.
However, the authors found significant results on a one-way ANOVA between the age of rehabilitation professionals (F[44 365] = 1.713, p = 0.005) and their type of professions (F[3406] = 4.492, p = 0.004) on their COVID-19 practice. Physiatrists had higher scores on the COVID-19 practices, suggesting better health practices towards the prevention of COVID-19. Post hoc analyses indicated that the average COVID-19 practice between physiatrists (112.12 ± 37.01) was significantly higher compared to occupational therapists (97.92 ± 27.313) and speech-language pathologists (76.71 ± 31.138). Post hoc tests for the age of the rehabilitation professionals are not performed because at least one group has fewer than two cases. Nevertheless, the results suggest that older rehabilitation professionals have better practices towards the prevention and management of COVID-19.
COVID-19 attitude
There was significant difference in the COVID-19 attitude scores for male and female (37.64 ± 4.027 vs. 36.83 ± 3.21). There was no significant effect of the participants’ professions and age on their COVID-19 attitudes (Table 5).
Discussion
The ‘Knowledge, Practice and Attitude theory’ is a health behaviour change theory, proposed by Western scholars in the 1960s (Kim, Ross & Smith 1969), in which the changes of human behaviour are divided into three successive processes: the acquisition of knowledge, the generation of attitudes and the formation of behaviour. The theory presents the progressive relationship among knowledge, attitudes and behaviour as follows: knowledge is the foundation of behaviour change, and belief and attitudes are the driving force of behaviour change. Therefore, the ‘KAP theory’ and ‘Health belief model’ were adopted to guide the development of guidelines in COVID-19 rehabilitation management approach.
This study was able to show the COVID-19 KAP of Filipino rehabilitation health workers. Knowledge scores on COVID-19 signs and symptoms were good except for having conjunctivitis, skin rash and neurologic manifestation such as numbness and weakness of extremities, and slurring of speech. In a study of Chou et al. (2020) of COVID patients from 13 countries, acute encephalopathy, coma and stroke were the most common neurology syndrome with a prevalence of 49%, 17% and 6%, respectively. The studies concerning KAP of rehabilitation professionals did not include neurological manifestations (Alshahrani et al. 2022; Cage et al. 2022a, 2022b; Ezema et al. 2021; Gunjawate et al. 2021; Kanaan et al. 2021, 2022; Kashif 2021; Silva et al. 2022; Suresh Babu et al. 2024; Rayos & Ang-Muñoz 2022). However, the researchers deemed it necessary to include these symptoms because the rehabilitation professionals may be one of the frontliners that will be consulted with these manifestations.
Like in other studies, skin rash and conjunctivitis were perceived as symptoms of COVID-19 in less than 50% of the rehabilitation professionals (Ezema et al. 2021; Kanaan et al. 2021). They should be made aware that COVID-19 may be present with these symptoms (Al-Namaeh 2022; Wollina et al. 2020). Furthermore, more than 80% of the participants thought that COVID-19 may be acquired through sexual transmission. This belief is erroneous and should be corrected.
One of the methods that Filipinos thought of as a preventive measure for acquiring COVID is the use of ‘suob’ or steam inhalation. Suob is a traditional method of treating respiratory infections because it is hypothesised that heat and steam have an effect on respiratory virus and decrease nasal secretion and inflammation. It was popularised as a treatment during COVID-19 in the Philippines. There is insufficient evidence of its efficacy and could cause scald burns (Uy et al. 2020).
One of the practices implemented by the government is filling a health declaration form prior to entering any institution. This is similar to the steps undertaken by different countries (Ezema et al. 2021; Kanaan et al. 2021; Kashif et al. 2021). However, 74% of respondents performed triage before entering the rehabilitation facility aside from the triage performed before entering the building. These are evidences of the fear of the Filipinos of acquiring COVID-19. Filipino community-based health workers expressed fears on several facets, which included fears of contracting and transmitting COVID-19, fear among community members where they worked and fears around COVID-19 testing, recognising the personal and social implications (Dodd et al. 2022).
Prone positioning is a treatment given to COVID-19 patients. However, the manner of delivery is not in accordance with the protocols recommended by Bamford et al. (2020), which should be maintained for more than one hour, and the patient should be placed on a high backrest after prone positioning. Only 32.62% and 6.0% obtained the correct answers for the duration of prone positioning (> 1 hour) and maintaining high back rest after prone positioning, respectively. In the study composed of ICU PTs, only 41.2% knew about the protocol well (Suresh Babu et al. 2024). This leads to the conclusion that PTs should be trained in the proper techniques of prone positioning.
The study showed that the participants had a positive attitude towards the use of PPE. However, only 60.49% of the participants felt that the present level of knowledge of PPE is adequate. This reinforces the need to include infection prevention in the standard operating procedures of rehabilitation facilities and in the curriculum of rehabilitation professionals. Furthermore, only 37.73% think that they should treat COVID-19 patients. There are differing attitudes towards the care for COVID-19 patients. The majority (92.7%) of ICU PTs agreed that it is essential to treat COVID-19 patients, while 61.2% of audiologists and speech therapists, and 75.0% of PTs from Jordan prefer not to treat them (Gunjawate et al. 2021; Kanaan et al. 2021; Suresh Babu et al. 2024). A study of PTs from 53 countries shows that 55.3% are willing to treat patients with COVID-19. Healthcare workers are shaped by the interaction of fear and care. Even if there is a lingering fear of being afflicted by the disease, they have the feeling of care towards patients. Care becomes a motivation to continue serving the community when ‘you no longer think of yourself’ (Dodd et al. 2022).
Conclusion
Filipino rehabilitation professionals have adequate knowledge about COVID-19 except for conjunctivitis, skin rash and neurological symptoms as presenting manifestations, and sexual transmission as a form of disseminated infection. They also have adequate infection protection practices for the workplace except for the procedures in prone positioning. Generally, they have a positive attitude towards the use of PPE. However, they prefer not to treat COVID-19 patients. It is, therefore, necessary to provide training courses and curriculum modification to further improve the knowledge and practices related to the spread of COVID-19, its symptoms and preventive measures employed.
Strengths and limitations
The study was able to include a diversity of the participants’ demographic characteristics, which include different rehabilitation professionals, workplace settings and location of residence. However, its limitations include the use of snowballing, convenient sampling method and questionnaire answered online. These limitations could lead to biases and inaccuracy of responses. We were not able to obtain the total number of physical and occupational therapists and speech pathologists residing and working in the Philippines, which could lead to an inadequate sample size for each profession. However, post hoc computation showed our sample size was adequate for the study. Furthermore, the 31-item validated questionnaire was completed in January 2021, and the cross-sectional study was conducted from June to July 2021. The knowledge and practice of the participants, therefore, are dependent on the guidelines and protocols available within that time frame.
Acknowledgements
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Authors’ contributions
G.A.F.I.R. participated during the conceptualisation of the research project. She assisted with the construction of the methodology and is the primary investigator during data collection. She was also instrumental in crafting the original draft as well as editing and reviewing the final report. Together with the team, she was able to complete the formulation of the research protocol and comply with the requirements of the research ethics committee. G.A.F.I.R. also helped with data curation and project execution.
J.A.P.Q. assisted in the project conceptualisation, writing and editing, crafting original drafts and meticulously reviewing and refining content. Furthermore, he contributed to validation, ensuring the accuracy and reliability of project outcomes. Additionally, he provided valuable insights during the investigation phase, driving the acquisition and analysis of essential data.
B.G.C.G. aided in conceptualising the project, contributed to writing and editing by creating initial drafts and carefully reviewing and improving content. Moreover, he played a role in validation, guaranteeing the precision and dependability of project results. Additionally, he offered perspectives throughout the investigation stage, influencing the gathering and examination of crucial data.
A.A.M.A. helped in conceptualising the project, contributed to drafting and editing by producing initial versions and meticulously reviewing and enhancing content. Furthermore, he participated in validation, ensuring the accuracy and reliability of project outcomes. Additionally, he provided insights throughout the investigation phase, impacting the collection and analysis of vital data.
C.B.G.-S. contributed significantly to conceptualisation and method formulation, laying the groundwork for the project’s direction and objectives. She also took charge of project administration, ensuring smooth operations and coordination among team members. Furthermore, she was instrumental in both writing and editing phases, providing original drafts as well as reviewing and refining content. Additionally, she took on the responsibility of supervision, guiding and supporting team members throughout the project’s execution and secured the resources necessary for the project’s implementation and success.
M.A.L.L. assisted with the conceptualisation of the research project. She was also instrumental with the project administration and validation of the data. Her primary contributions were during reviewing and editing the final article.
J.-T.C.C. contributed to conceptualisation, shaping the project’s vision and defining its objectives. His role in project administration ensured completion of documentation and effective coordination among team members. As a supervisor, J.-T.C.C. provided guidance and support, fostering a productive working environment. Additionally, he played a key role in validation, ensuring the accuracy and reliability of project outcomes.
I.N.B.G. was instrumental during the validation of the instrument and formal data analysis. He also ensured rigorous examination and interpretation of project findings. He spearheaded data curation, meticulously organising and managing the project’s data resources as well as formulating tables and graphs. Additionally, he was actively involved in writing and editing the original and final report.
G.C.S. contributed to project conceptualisation and framework. He assisted with the research methodology and aided as a project administrator. As a supervisor, he has provided invaluable guidance and mentorship, especially during project collection, validation and interpretation of data.
M.R.C.E. played a role in the conceptualisation and establishment of the project framework. She helped with crafting the research methodology and served as a project administrator. In her capacity as a project supervisor, she offered guidance and mentorship, during the phases of data collection, validation and interpretation within the project.
R.M.J.C. contributed to the conceptualisation of the project and its objectives. As a project administrator, he oversaw optimising resources and timelines for ideal outcomes. In his role as a supervisor, he provided invaluable guidance ensuring the smooth execution of project tasks.
Ethical considerations
Ethical approval to conduct this study was obtained from the Philippine Orthopaedics Center Ethics Review Board University of Santo Tomas Hospital Research Ethics Committee (No. mREC-2021-01-006-TR).
Funding information
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors have nothing to disclose and this study was supported by the research funds of the two contributing institutions, University of Santo Tomas Hospital and Philippine Orthopaedic Center.
Data availability
Data supporting the findings of this study are available from the corresponding author, C.B.G.-S., on request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.
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Appendix 1: Final Questionnaire
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