Concussion Knowledge, Practice and Physical Therapy Referral Among Physicians and Physical Therapists in Saudi Arabia

Objective: To assess concussion knowledge and practices among physicians and physical therapists in Saudi Arabia and to examine beliefs about physical therapy, referral patterns and the belief-practice gap. Methods: An analytical cross-sectional web-based survey used a 37-item Qualtrics questionnaire disseminated through social media to physicians and physical therapists practicing in Saudi Arabia. It assessed demographics, general concussion knowledge (17 items), assessment practices, return-to-play knowledge, beliefs regarding physical therapy and physician referral behavior. Analyses used descriptive statistics, analysis of variance, Mann-Whitney U tests and correlation analyses. Because recruitment was through open social media, a response rate could not be calculated and analyses were exploratory. Results: Among 256 participants (112 physicians, 144 physical therapists), mean knowledge scores were 9 ± 2 and 8 ± 2 of 17. The Sport Concussion Assessment Tool was used by 2% and 8% and the Balance Error Scoring System by 0% and 5%. No physician and only 13% of physical therapists identified slower pediatric recovery, and 29% and 24% knew same-day return to play is never acceptable. Although 76% of physicians and 89% of physical therapists endorsed physical therapy within the concussion team, only 62.5% of physicians reported referring, driven by muscle weakness (62%) more than cognitive symptoms (2%). Knowledge was not associated with referral (r = 0.154, p = 0.106). Conclusions: Knowledge was moderate but use of evidence-based assessment tools was limited, with a substantial belief-practice gap in physical therapy referral. Targeted continuing education, curriculum development, interprofessional training and structured referral pathways are warranted to improve access to concussion rehabilitation.