Over the past century, the field of physical therapy has experienced significant growth, expanding its scope, techniques and environments, as well as the obligations assigned to its practitioners, in response to evolving demography, socioeconomic and political conditions [1,2]. The physiotherapy profession is a dynamic discipline that provides significant prospects for academic study, clinical practice and research advancement. Contemporary physiotherapists are independent practitioners who actively participate in illness prevention, wellness promotion, physical fitness and rehabilitation [3]. Globally, several studies have explored perceptions of the physiotherapy profession among students, healthcare professionals and the general public. However, many of these studies lack a focused investigation into student perceptions within specific cultural and educational contexts, such as Saudi Arabia [4]. Recent literature, such as Makeen et al. [5] and Malhotra et al. [6], has emphasized the importance of early professional awareness and interprofessional education among healthcare students in Saudi Arabia and India, respectively, but has yet to explore these issues specifically within physiotherapy education.   The healthcare profession of physical therapy encompasses the assessment and diagnosis of impairments with the aim of enhancing mobility and thereby improving quality of life. In Saudi Arabia, bachelor’s degree programs in physiotherapy at several institutions integrate professional practice with robust scientific and clinical training [5]. Despite the growing enrollment in physiotherapy programs, limited research exists on how physiotherapy students in Saudi Arabia perceive their profession, particularly in relation to their motivations, challenges and career outlook [6].   Physical therapists must develop a clear understanding of their profession’s purpose, cultivate a strong professional identity and adapt career goals to meet evolving healthcare needs [7]. This process, known as professional socialization, plays a crucial role in shaping long-term engagement and commitment to the field [8]. Understanding the point at which physiotherapy students form professional awareness and align it with career motivation is critical for designing effective educational interventions.   In recent years, there has been limited empirical investigation on the understanding of physiotherapy among students in Saudi Arabia. While general perceptions of physical therapy are positive, the public and even students may not be fully aware of the full range of practice, career pathways and postgraduate opportunities available in the field [9]. Universities in Saudi Arabia play a pivotal role in shaping future physiotherapists, yet few studies have analyzed whether current curricula address the evolving expectations and professional realities faced by students [10]. Recent studies by Aloraini et al. [11] have also highlighted gaps in public and student awareness about professional roles in physical therapy, underscoring the need for enhanced academic and outreach strategies.   Previous literature from countries such as Jordan, Canada and across Europe has evaluated student motivations and perceptions in physiotherapy education; however, comparative insights specific to Saudi Arabia remain sparse. [12-14] Moreover, these studies often overlook external influences such as cultural expectations, family guidance and socioeconomic status, which may significantly shape career decisions in the region.   Therefore, the primary objective of this study is to investigate the knowledge and attitudes of undergraduate physiotherapy students regarding their profession in Saudi Arabia. This includes evaluating their understanding of the scope of physiotherapy practice, the determinants influencing their choice of profession, perceived challenges and expectations regarding career prospects. The study also aims to assess how educational programs contribute to professional development and preparedness for clinical roles.

Study Design A cross-sectional, questionnaire-based study was conducted at the Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Saudi Arabia, to evaluate undergraduate physiotherapy students’ perceptions regarding their profession. The design was chosen for its appropriateness in assessing current opinions and trends among a specific population at a single point in time.   Participants All students enrolled in the undergraduate physiotherapy program at Majmaah University (total population = 250) were invited to participate, from first to final year. A total of 170 students aged between 18 and 28 years completed the questionnaire, yielding a response rate of 68%. Among the respondents, 88 (51.76%) were female and 82 (48.23%) were male. The required minimum sample size of 152 was calculated using the Yamane formula with a 95% confidence level and an acceptable margin of error.   Data Collection An adapted survey questionnaire was developed after reviewing relevant literature and aligning it with the study objectives. The tool included both closed- and open-ended items, designed to assess five key dimensions: (1) Determinants influencing admission into the physiotherapy program, (2) Understanding of services provided by physiotherapists, (3) Perceptions of professional standing, (4) Challenges encountered by students and (5) Satisfaction with educational and career aspects. Questions included Likert-scale ratings, Yes/No items, checkboxes and dropdown responses.   The questionnaire underwent face and content validation by five clinical experts, using a four-point Likert scale to assess clarity, relevance and simplicity. Content Validity Index (CVI) was reported as 0.81. A pilot study established internal consistency with a reliability coefficient of 0.758. However, the validation section could benefit from more detail on the piloting process and question refinement steps.   Ethical approval was granted by the Institutional Research Board of Majmaah University (MUREC-Nov 23/COM-2023/29-9). Written informed consent was obtained from all participants. However, the study did not explicitly describe how participant confidentiality and anonymity were maintained, which may impact the perceived reliability of responses. Data collection was conducted over a five-month period, from 19 December 2023 to 21 April 2024, during the second academic semester. Each participant required 15-20 minutes to complete the survey.   Statistical Analysis Statistical analysis of the study was conducted using IBM SPSS Statistics software for Windows. The descriptive statistics of correct answers to the questionnaire are mean standard deviation, given as frequency and percentage. A chi-square test was used to compare those who preferred the department with those who did not want it. The probability of error was accepted as p<0.05.

A total of 170 individuals (68%) participated in the study. The mean age of the participants was 20.41±1.69 years. Among the respondents, 87 (51.18%) were female and 83 (48.82%) were male. The largest age group was between 19 and 20 years (24.7%), while only 3.53% were aged between 25 and 28 years. Regarding the source of initial information about physiotherapy, family was the most commonly cited (42.94%), followed by friends (25.88%), daily news (20.59%) and social media (10.59%). This suggests a strong role of familial and social networks in shaping early perceptions of the profession (Table 1).   Table 1: Demographic characteristics Demographic characteristics N (%) Age 18 years 16 (9.41%) 19 years 38 (22.35%) 20 years 42 (24.70%) 21 years 35 (20.59%) 22 years 22 (12.94%) 23 years 6 (3.52%) 24 years 5 (2.94%) 25 years 2 (1.18%) 26 years 3 (1.76%) 28 years 1 (0.59%) Gender Male 83 (48.82%) Female 87 (51.18%) Source of information regarding the profession Friends 44 (25.88%) Family 73 (42.94%) Daily news 35 (20.59%) Social media 18 (10.59%)   Figure 1 shows that "Helping People/Patients" was the primary motivator (52.94%) for choosing the physiotherapy program, followed by the desire for an "Independent Profession" (18.82%), "Future Prospects" (16.47%), "Respect in Society" (7.06%) and "Financial Prospects" (4.71%).       Figure 1: Decision to study physiotherapy   In contrast, Figure 2 highlights underlying career choice factors such as "Interest in the Subject" (27.06%), "Family Influence" (27.06%) and "Social Status" (10%). Notably, parental pressure and community service were mentioned by a smaller subset, suggesting internal motivation may outweigh external expectations for many students.       Figure 2: Reasons behind choosing physiotherapy as a career   As shown in Table 2, 55.88% of students were aware of physiotherapy as a medical/therapeutic profession before admission, while 17.06% understood it in terms of future prospects and 15.88% viewed it as an independent profession. Only 4.12% reported having no prior knowledge. This reflects a moderately informed cohort at entry, though awareness of specialized roles within physiotherapy may still be limited.     Table 2: Knowledge about physiotherapy before admission Knowledge before admission Responses Percentage (%) Medical/Therapeutic Profession 95 55.88 Independent Profession 27 15.88 Future Prospects 29 17.06 Specialized profession 12 7.06 I do not know anything 7 4.12     Table 3 outlines participants’ understanding of physiotherapy services. The highest-rated service was "Home Physiotherapy Lessons" (mean = 4.36), followed by "Understanding Patients’ Problems" (mean = 3.95) and "Providing Required Treatment" (mean = 3.87). "Appropriate Medical Advice" and "Treatment Interventions" were rated lower, with mean scores of 3.62 and 3.54, respectively. The overall dimension mean was 3.87, indicating a high evaluation score. However, variation in scores suggests that certain clinical competencies are more strongly associated with the profession than others.     Table 3: Knowledge on type of service offered by physiotherapists Statement Frequency Mean SD Rank Level Home Physiotherapy Lessons 5 4.36 0.96 1 High Understanding Patient’ Problems 4 3.95 0.95 2 High Providing Required Treatment 3 3.87 0.97 3 High Appropriate Medical Advice 2 3.62 1.06 4 Middle Treatment interventions 1 3.54 1.27 5 Middle Overall 3.87 0.79 High     Figure 3a and b reveal that 74.71% of students were satisfied with the profession itself, 70% expressed satisfaction with job opportunities in Saudi Arabia. This disparity points to potential misalignment between educational experience and job market realities, warranting further exploration into employer demand and placement services.     Figure 3(a-b): Satisfaction with the job opportunities and profession   As depicted in Figure 4, 35.29% of participants identified physical stress as the most pressing challenge, followed by extensive education requirements (25.88%), emotional stress (12.36%) and financial investment (12.36%).   Table 4 summarizes students' overall perception of physiotherapy. The profession itself was rated highly (mean = 4.5), as was overall happiness with their career choice (mean = 4.3). Scores declined for perceptions of professional opportunities (mean = 3.01) and community awareness of the field (mean = 2.7). The average across all items was 3.72, indicating a generally positive but varied outlook. Students appear optimistic about their training and identity but remain unsure about long-term societal and employment recognition.     Figure 4: Problems faced in the profession     Table 4: Perception regarding choice of physiotherapy as a career Statement frequency Frequency Mean SD Rank Level The Physiotherapy Profession in general 5 4.5 1.07 1 High Happy with physiotherapy as a career choice 4 4.3 1.05 2 High Able to continue with the requirements of the education 3 3.91 1.02 3 High Extensive Opportunities in the professional field 2 3.01 1.06 4 Middle Community Perception of the Profession 1 2.7 0.92 5 Middle Overall 3.72 0.69 - High

The results indicate that the key determinants of respondents' decision to choose physical therapy were their own interest in the subject, as supported by Hall et al. [14], followed by their family influence and to some extent the social status associated with the profession. Familiarity with the work associated with the profession, its independence as a profession and the prospects regarding its future were deciding factors as to why the respondents thought of pursuing physiotherapy as their career. Moreover, according to the respondents, they have the ability to instruct people with dedicated home regimens and help them out. Majority of the respondents were satisfied with the job opportunities as well as the profession of physiotherapy in Saudi Arabia. This discovery supports Turner's claim that the reputation and integrity of the profession are significantly shaped by the common interests of its members [15].   This study confirmed that education and training are essential methods for developing skills and competences in decision-making and problem-solving. The findings of this study align with the results of Lindquist et al. [16] which indicate that older individuals had access to work prospects in physiotherapy and were considered highly trustworthy by other health professionals in practice. Furthermore, the occupation of physical therapy is transitioning into one of the most prestigious professional roles. The physiotherapy profession is currently facing a critical problem of excessive working hours which puts a continuous drain on them both physically and mentally. Optimally, an individual should choose a vocation that corresponds with their particular interests and skills. Recent empirical findings suggest that individuals' concerns about the future impede their capacity to confront the future with confidence and impact their professional choices. They articulate dissatisfaction with the disciplines they have chosen and this dissatisfaction endures even after the completion of their academic pursuits [17].   The significant gap between students' satisfaction with their profession (74.71%) and satisfaction with job opportunities (70%) aligns with findings from recent regional studies suggesting that while academic preparation is perceived positively, the professional landscape may not offer adequate employment options or career advancement opportunities [18,19]. This misalignment may discourage future engagement and contribute to early burnout or emigration among young physiotherapists.   Öhman et al. [20] in Canada investigated the career choices and professional preferences of a cohort of Canadian physiotherapy students studying Physical Therapy and Rehabilitation. The students cited the opportunity to secure a better job and the potential for a higher salary as the reasons for choosing this profession. Kunduracılar et al. [21] found that physiotherapy students choose this department for its work chances and compatibility with their interests. Gotlib et al. [22] investigated the attitudes of European physiotherapy students on their chosen professions.   The influence of family as a primary information source (42.94%) highlights the role of sociocultural factors in shaping career decisions. Studies by Alshahrani et al. [23] and Ramdani and Mohamed [24] emphasize that cultural values, parental expectations and limited high school counseling continue to guide health career choices across the Gulf region. Targeted school-level awareness campaigns and mentorship programs led by practicing physiotherapists could help diversify and inform career choice motivations.   Moreover, the students' moderate understanding of professional services, particularly in areas like treatment planning and clinical advice, suggests that academic programs may need to strengthen clinical integration earlier in the curriculum [24]. Expanding interprofessional learning and simulation-based instruction could enhance real-world readiness.   The physical and emotional stresses reported mirror findings from global research indicating high burnout rates among healthcare students [25,26]. Institutions should consider proactive mental health resources and time-management training to mitigate these challenges and improve academic satisfaction and retention.   Finally, while this study involved only students from Majmaah University, its findings align with national and international studies, suggesting broader applicability. However, to better understand evolving perceptions across Saudi Arabia, future studies should include a more diverse sample from multiple institutions and track students' changing attitudes over time.

This study revealed that physiotherapy students in Saudi Arabia generally hold positive attitudes toward their profession and demonstrate a fair level of knowledge. However, challenges such as limited job opportunities, professional stressors and variable awareness about career pathways remain prominent. To address these concerns, academic institutions should strengthen career counseling, enhance clinical exposure and introduce interprofessional learning early in the curriculum. Educational policy-makers should also focus on building public awareness and improving job market integration for physiotherapy graduates. Future initiatives must consider sociocultural influences, career development strategies and student support services to better align academic training with professional realities.   Limitations This study was limited by its single-university sample and exclusion of postgraduate students, affecting generalizability. Self-reported data may have introduced bias. External influences on career perception, such as peer or societal expectations, were not assessed. Language barriers, question interpretation and participant fatigue during data collection were also not addressed. Future research should involve diverse institutions, include qualitative methods and explore sociocultural and academic factors influencing physiotherapy students’ perspectives for broader, more accurate insights.

The authors extend their appreciation to the Deanship of Postgraduate Studies and Scientific Research at Majmaah University for supporting this study with project No R-2025-1755.