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

Abstract

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 <25 kg/m2 (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.