Physiotherapy in Nepal

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Nepal currently only has two physiotherapy programs- available through Kathmandu University and Pokhara University as a bachelor's degree. It is equivalent to four-and-a-half years of full-time study. The minimum level of education to start this program is upper secondary.^[1][2]

Practicing physical therapists[]

The title for a practicing therapist is Physiotherapist and भौतिक चिकित्सक (Vautik Chikitshak) (protected by law).^[1]

According to the World Confederation for Physical Therapy there are an estimated 2,000 practicing physiotherapists as of December 2017.^[1] There are 369 members of the national organization, 42% of them are female.^[1] The WCPT reports that there a total of 153,830 members for the Asian, Western, and Pacific region of the organization. Support personnel are part of the workforce.^[1]

Regulation[]

The scope of practice is defined by the Ministry of Health, and has a regulated code of conduct. There is no legislation to prevent private practice clinics, but patients have direct access, meaning they can self-refer to private practice clinics without referral from another health care professional.^[1]

A physical therapist's scope in Nepal permits:^[1]

• Assessing patients/clients
• Making a diagnosis
• Treatment (interventions, advice, and evaluation of outcome)
• Referrals to other specialists/services
• Offering preventative advice/services

Registration is required to practice as a licensed physiotherapist in Nepal.^[1][3] Under the current code of ethics, continuing professional development is not required for re-registration and membership;^[1] however, an amendment to the code of ethics requires mandatory evidence proving continuing professional development.

Role of physiotherapy after the earthquake[]

On April 25 and May 12, 2015, two major earthquakes measuring 7.8 and 7.3 on the Richter scale struck Nepal.^[4] Out of the 75 districts of Nepal, 14 were severely affected by the earthquakes with an estimated 8,600 deaths, 22,000 injuries and 505,000 homes completely destroyed.^[4] Post-disaster, health care facilities faced shortages in space and resources.^[4] Furthermore, patients facing discharge after acute care faced challenges of accessibility living in remote locations with limited health care services especially those requiring ongoing rehabilitation.^[4] Natural elements such as monsoon season, floods, and landslides made access even more difficult post-earthquake.^[4]

Common injuries included trauma from falling debris and houses collapsing due to poor building construction and high population density.^[4] 70% of injuries were fractures with a large number of patients suffering spinal cord injuries (200-300), amputations (40-60) as well as traumatic brain injuries, crush injuries and neuropraxia.^[4]

During the time of the earthquake, 393 physiotherapists were registered with the majority of therapists located in Kathmandu.^[4] The role of physical therapist in disaster response was poorly defined as the profession is still relatively new.^[4] Many physical therapists at the time worked in facilities treating patients with musculoskeletal conditions followed by neurology and rehabilitation with a small number in intensive care-unit, obstetrics and pediatrics.^[4]

In response to the earthquake, physical therapists worked alongside doctors, nurses and other heath providers overseeing triage, screening and acute care management of patients.^[4] This includes procedures like brace fitting, applying plaster cases, temporary backslabs, skin traction for femoral fractures and hip dislocations, dressing wounds, fitting assistive devices.^[4] Physiotherapists also mobilized patients, prescribed exercises, re-positioned patients to prevent secondary complications such as bed sores and chest complications post-surgery or prolonged bed rest.^[4]

References[]