This research article conducted a SWOT analysis of the physiotherapy profession in Kuwait through 17 key informant interviews. The interviews identified strengths like funding for services and motivated professionals, as well as weaknesses such as lack of education, resources, marketing, and standardized practices. Opportunities mentioned were untapped demand, development of the physiotherapy association, and collaboration. Threats included low public awareness, challenges with interprofessional practice, and cultural views on health. The analysis concluded that opportunities exist to advance the profession through the physiotherapy association advocating for standards, research, and collaboration.

1. RESEARCH ARTICLE
A SWOT Analysis of the Physiotherapy Profession in Kuwait
Meghan M. MacPherson1
, Lauren MacArthur1
, Patrick Jadan1
, Leah Glassman1
,
Fawzi F. Bouzubar2
, Elham Hamdan3
* & Michel D. Landry1,3,4
1
Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
2
Department of Physical Therapy, Faculty of Allied Health Sciences, Kuwait University, Kuwait
3
Fawzia Sultan Rehabilitation Institute, Kuwait
4
Doctor of Physical Therapy Division, Department of Community and Family Medicine, Duke University, Durham, NC, USA
Abstract
Background and Purpose. Since the end of the Gulf War in 1991, Kuwait has become one of the wealthiest countries in
the world and one that has a highly socialized health-care system. This rapid growth and socio-economic development
appears to have had a negative impact on the health of its people. As such, the profession of physiotherapy may be in a
unique position to address this issue by providing health behaviour interventions and promoting healthy lifestyles. The
purpose of this study was to explore the current state of physiotherapy in Kuwait and provide recommendations for future
development and growth. Method. Using a qualitative research approach, we conducted 17 key informant interviews
(clinicians, administrators and other key stakeholders) in Kuwait. The strengths, weaknesses, opportunities and threats
framework was then used to categorize the emerging themes and provide a basis for a strategic direction for the profession.
Results. Informants reported that strengths included funding for services and motivation of professionals. Weaknesses
included education and professional resources, marketing/advocacy, standardization and regulation of practice.
Opportunities discussed were untapped demand for physiotherapy services, internal development and evolution
of the physiotherapy association, along with professional collaboration. Threats addressed included low public
awareness of physiotherapy, challenges with inter-professional practice/communication, and cultural perspectives of
healthy lifestyles. Conclusions. Our research indicates that many unique opportunities exist for physiotherapists in
Kuwait. Further development and evolution of Kuwait’s physiotherapy professional association could facilitate efforts to
advocate for the profession, initiate standards of practice and provide enhanced opportunities for professional collabora-
tion. Copyright © 2012 John Wiley & Sons, Ltd.
Received 29 April 2011; Revised 16 April 2012; Accepted 18 April 2012
Keywords
Kuwait; opportunities; physiotherapy; SWOT
*Correspondence to:
Dr. Elham Hamdan, Fawzia Sultan Rehabilitation Institute, Amaia Residence Building, Baghdad St, Salmiya, Kuwait.
E-mail: elham@rehabinstitutekuwait.com
Published online 15 June 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pri.1527
Introduction
Kuwait is located in the Arabian Gulf, and since its
liberation after the Gulf War in 1991, it has emerged as
one of the world’s wealthiest countries (Metz, 1998;
Encyclopaedia Britannica, 2007). Opportunities are often
disguised as difficult situations, and this truism may be
37
Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.

2. particularly the case for the approximately 2.6 million
people in Kuwait, a nation in the midst of massive social
and economic changes. However, this rapid growth and
socio-economic development appears to have had some
degree of negative impact on the general health of the
Kuwaiti population (Al-Isa, 2003; Chase, 2006; Serour
et al., 2007; Jackson et al., 2008). The World Health
Organization (WHO) lists the leading causes of mortality
and morbidity in Kuwait to be ischemic heart disease,
smoking-related conditions, hypertension, stroke,
diabetes, obesity and cancer; many of which are largely
preventable (WHO, 2005). The WHO advocates for
an integrated management approach, which exploits
cost-effective measures to prevent common health
risks. In particular, the WHO points out that small
investments in prevention and education in Kuwait
could lead to increased quality of life and dramatic
reductions in health-care costs (WHO, 2006).
The evolving public health scenario as described
previously will likely require an equally complex and
multifaceted solution involving many sectors. Given that
the conditions described previously are largely prevent-
able and involve a component of activity and disability,
the role of physiotherapy may be particularly relevant.
To further achieve scientific credibility and validate
practice, research involving physiotherapy has expanded
worldwide in the last few decades (Robertson, 1995).
However, a literature search on the physiotherapy
profession in Kuwait produced few relevant published
papers, especially as it related to their role in addressing
the most prevalent burden of disease in the country.
Thus, in the absence of research evaluating the state
of physiotherapy in Kuwait, it may be a challenge for
decision-makers and policy-makers to support or
expand this profession. Moreover, it may be equally
difficult for physiotherapy stakeholders to advance
agenda to support such expansions in terms of funding,
delivery or even human resources without some empiri-
cal foundation. This is not to suggest that a strong corre-
lation exists between publication of research outcomes
and the translation of that evidence into policy; in fact,
it has been reported by others that policy formulation
is not always driven by evidence alone and that ideas,
interest and institutions also play a key role (Landry
et al., 2004; Workman, 2010). The link between policy
implementation, decision-making and research evidence
is a precarious one, and as Carter (2010) has argued, the
existence of evidence it is not often translated into policy
or practice and that ‘the capacity of decision-makers to
exercise an evidence-based approach is limited’. Despite
this apparent absence in the link between policy and
research, there continues to be a need to explore and
generate research to, at the very least, inform the
decision-making and policy-formulation process.
The overarching aim of this study was to assess the
status of physiotherapy as a profession in Kuwait. The
purpose was to examine the degree to which physiothera-
pists in Kuwait were prepared to meet emerging societal
needs. The authors were particularly interested in a
research approach that would yield a strategic direction
for the profession in Kuwait; therefore, a strengths,
weaknesses, opportunities and threats (SWOT) frame-
work was used. The SWOT format is an established
research tool, which has unique relevance to the current
research objectives. Other researchers have adopted a
similar methodology (Ervin, 1996; Sharma and Deepak,
2001; Christiansen, 2002; Ansari et al., 2003) in which
the SWOT framework was used as a research tool in
the evaluation of professional roles and health-care
programmes.
Methodology
In this study, the authors conducted a series of key infor-
mant interviews to explore the strengths, weaknesses,
opportunities and threats related to physiotherapy in
Kuwait. This qualitative study was conducted in three
phases: 1) identification and recruitment of key
informants, 2) key informant interviews and 3) data
analysis. Ethics approval for this qualitative study was
obtained from both local institutional research ethics
review panels in Kuwait and the Ethics Review Board at
the University of Toronto.
Phase 1: Identification and recruitment of
key informants
Key informant interviews are in-depth, semi-structured
interviews with people selected for their expert
knowledge regarding a specific topic (Miles and
Huberman, 1994; Howard and Davis, 2002; Flitcroft
et al., 2011). To identify potential informants, the
research team first generated a list of potential indivi-
duals who occupied mid-level to senior-level positions
or people who were considered experts in their fields,
in both publicly funded and privately funded settings,
across Kuwaiti continuum of care. Initially, the research
team developed a list of potential participants across
Physiotherapy in Kuwait M. M. MacPherson et al.
38 Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.

3. three categories: 1) clinicians who could provide a
perspective from those working on the ‘front lines’ of
delivering physiotherapy services, 2) physiotherapy-
related administrative personnel who could provided
insight on issues related to funding and delivery for
physiotherapy services and 3) other key stakeholders
representing funding organizations, and public and
private sector senior management. Once the initial list
was developed, the senior investigators met to discuss
and expand upon this list of potential informants.
Purposive sampling was then used to identify key infor-
mants from the three categories and to obtain what Rice
and Ezzy (1999) referred to as a ‘maximum variation
sampling’ strategy regarding the dimensions and impli-
cations of the issues being examined.
A total of 25 people were invited to participate
through a telephone call or an email correspondence.
To participate, all informants needed to fulfil two inclu-
sion criteria: 1) willingness to participate and ability to
complete interview in a short timeframe and 2) fluency
in English. A total of 18 individuals were able to meet
the inclusion criteria and agreed to participate.
Phase 2: Key informant interviews
The interview schedule was developed to use both open
and closed-ended questions to explore the opinions
and perceptions regarding the strengths, weaknesses,
opportunities and threats to the profession of physio-
therapy in Kuwait (Appendix A). All interviews were
completed at the workplace of each of the informants
throughout the month of April 2007. The interviews
were conducted by one of the investigators or a trained
research assistant. All interviews lasted approximately
30minutes and were recorded by audiotape. Transcrip-
tion of the audiotapes was completed by an individual
external to the research team as well as two of the
principal investigators.
Phase 3: Data analysis
The transcribed interview data were entered into a
qualitative data analysis software package NVivo (QSR
International Pty Ltd, Doncaster, Victoria, Australia;
http://www.qrinternational.com) for systemic coding.
Content analysis was employed, which involved identi-
fying themes and categories prior to coding the data.
The themes included in the coding were based on collec-
tive knowledge, perceptions and experiences of the
informants that addressed the research objectives. Two
members of the research team completed all of the
coding and generated coding reports for the entire
team to analyse. The remaining two members of the
research team independently reviewed and recoded
15% (three of 18) of the transcripts to validate the
coding. Any discrepancies were discussed, and both
parties reached agreements. Once this process occurred,
the two coding parties reached 100% agreement on
coding of all transcripts.
To categorize the data, a SWOT framework was used.
Ultimately, the SWOT framework provided an overview
of which strengths and opportunities should be
maximized and which weaknesses and threats should
be minimized or eliminated. The research team used a
matrix developed by Houben et al. (1999), alongside
collective knowledge and perceptions of the profession
of physiotherapy to develop operation definitions for
the four SWOT components. As such, ‘strength’ was
identified as a competitive advantage internal to the
profession. For this study, strength was outlined as any
competency of the collective group of physiotherapists
in Kuwait that inspire growth and development of the
profession. Conversely, ‘weakness’ was defined as a
limitation internal to the organization that hindered
progress. This translated to any limitations exhibited by
the collective group of physiotherapists that hampered
development of the profession. ‘Opportunity’ was
defined as any external environmental factor that
promoted the growth of the profession; similarly, ‘threat’
was defined as any environmental factor that could act as
a barrier to the profession.
Once the data were initially sorted as per SWOT catego-
ries, an open-ended coding process was initiated to explore
the nuances within each of the categories. The results of
the SWOT framework were then translated into recom-
mendations for practical strategic directions.
Results
Eighteen informants consented to participate in the
interviews: twelve clinicians, three physiotherapy-related
administrative personnel and three other key stakeholders.
Of the 18 informants, only 17 interviews were used in the
data, as the recording quality of one of the interviews was
insufficient to accurately assess the information provided
(Table 1). Overall, 11 of the 17 included in this study were
Kuwaitis (65%); however, given that a condition for
participation was anonymity, the authors are unable to
M. M. MacPherson et al. Physiotherapy in Kuwait
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Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.

4. provide a list of Kuwaitis and non-Kuwaitis who partici-
pated as it would be possible to identify them given the
other demographical information that is provided.
The main themes obtained from the key informant
interviews are outlined within the structure of the SWOT
framework (Table 2). Each item is ranked on the basis
of the frequency of discussion within the initial key
informant interviews.
Strengths
Access to funding
Informants in all categories remarked that the current
delivery of physiotherapy is facilitated by their ability to
pay for services and/or access to funding through the
public-funded health-care system. As highlighted by one
administrative informant, ‘willingness to pay is not the
issue here’. Similarly, many clinician informants noted
insurance as an established avenue for payment of services
and as a source of strength for the profession. Overall,
there is a wide distribution of socio-economic status across
Kuwait, and most participants suggested that the majority of
Kuwaitis has access to funding for physiotherapy services.
Growth and motivation of professionals
Several informants indicated that the younger genera-
tion of physiotherapists in Kuwait are ‘open minded’ and
‘hard working’ and noted this motivation as a major
strength. The present enthusiasm of the younger genera-
tion was recognized as positive for the profession and
noted by a clinician informant who stated that ‘there are
[physiotherapists] that are willing to do anything for
physiotherapy, willing to work extra hours, willing to give
better proficient treatment, all for the society... they love
the profession’. The professional motivation to expand
the profession was a theme expressed by all participants.
Weaknesses
Education and professional resources
The majority of key informants, in all categories,
perceived the physiotherapy education system in Kuwait
as a weakness. One clinician informant noted the negative
Table 1. Profile of key informants
Study
ID Sex Professional background Professional role Years since graduation
Global training or clinical
experience outside of Kuwait
A1 M Physiotherapist Director, PT Department 25 United States
A2 F Medical doctor Physiatrist, private practice 30 Bulgaria
A3 M Physiotherapist Home care 8 Philippines
A4 F Physiotherapist Paediatrician 13 India
A5 F Physiotherapist Home care, self-employed 10 Canada
A6 F Medical doctor Physiatrist, public hospital 26 Slovenia
A7 F Physiotherapist Clinician 3 N/A
A8 F Physiotherapist Clinician 29 Egypt
A9 F Occupational therapist Clinician 25 United States
A10 F Medical doctor Pain specialist, private practice 15 Scotland
A11 F Physiotherapist Clinician 12 N/A
B1 M Academic Administrator Administrator N/A United States, Egypt, Australia
B2 M Senior Manager, Logistics Corp. CEO N/A United States
B3 M Academic Administrator Administrator N/A United States
C1 M Client Advocate Client N/A N/A
C2 M Pharmaceutical sales person Pharmacist 20 Egypt
C3 M Client Advocate Client N/A N/A
Table 2. Results of the SWOT framework
SWOT Rank Item
Strengths 1 Access to funding
2 Growth and motivation
of professionals
Weaknesses 1 Education and professional resources
2 Marketing and advocacy
3 Standardization and regulation
of practice
Opportunities 1 Untapped demand
2 Multidisciplinary collaboration
Threats 1 Public awareness
2 Inter-professional practice and
communication
3 Cultural perspective
Physiotherapy in Kuwait M. M. MacPherson et al.
40 Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.

5. ‘ceiling effect’ of the current level of physiotherapy educa-
tion: ‘they don’t have a masters or PhD program for
physical therapy, so you’re stopped where you are’. A
clinician informant mentioned that physiotherapists ‘lack
continuing education programs’ and as a result ‘the
stimulation that would open their minds to other ideas’.
The participants implied throughout that they lack
networking opportunities among themselves within
Kuwait and among those external to the country. Simi-
larly, administrative informants noted that physiothera-
pists lacked structured educational programmes outside
of the entry-level education in the field, stating that ‘they
have the patients, they know how to treat the patients,
but there are so many other things... they don’t have
the input from the outside’. Also, a disparity was noted
by a clinician informant between public and private
sectors: ‘most of the professionals in the private sector
are not aware of the continuing education going on in
Kuwait, so it’s only the public hospitals getting access to
continuing education’.
Similarly, access to professional resources was indi-
cated as an important element in the development of
the profession. One clinician informant noted, ‘without
research the profession will die’. One clinician infor-
mant discussed the lack of professional resources and
stated, ‘we definitely need to have a library where all
physiotherapists have access to it, online access’. In
addition, a lack of equipment availability and high costs
were discussed as consistent barriers to the development
of the physiotherapy profession.
Marketing and advocacy
Many informants noted that one of the most integral
weaknesses of the development of physiotherapy in
Kuwait was a challenge of advocacy. One clinician
informant highlighted the importance of the skills
and education involved with being a physiotherapist
and stated that the public should be made aware.
Improved understanding of the role of physiotherapist
as well as awareness of their skills and scope of practice
was stated by a clinician informant as essential to the
advancement of the profession. Several informants
noted that the development of the profession requires
self-promotion and marketing, and one clinician infor-
mant stated, ‘many people are suffering and they need
something real. If we have something real and very
professional and well advertised, the profession will
grow’. The implication in this quotation is that demand
exists in the community and that if physiotherapy
could begin to address these needs on a larger scale,
then the community would more fully understand the
current and potential role of the profession.
Standardization and regulation of practice
The majority of informants indicated that the lack
of standardization within the profession was a key
weakness. A clinician informant indicated that the regu-
lation of physiotherapy practice is poor and that ‘they
lack standards in Kuwait’. One clinician informant
discussed licensing regulations and noted, ‘if they could
standardize the level of physical therapists in Kuwait it
would be better for the profession’. Another clinician
informant noted the detriment to the profession of
‘people seeking physical therapy or rehab services outside
of the country, because they can’t get quality service
within the country’. Some clinician informants felt that
the standards of practice in Kuwait were not optimal
and that future regulation centred on practice was
essential. This was illustrated by an informant who
noted, ‘there needs to be a change in the system’.
Opportunities
Untapped demand
Many informants recognized the potential for physio-
therapy in currently untapped areas of health-care in
Kuwait. One clinician informant noted that ‘in Kuwait
[you] have a lot of impairment and disability, and
helping theses people or preventing disease. . . will make
our profession strong’. Several informants reported a
lack of physiotherapy services, specifically the ‘great
demand for physiotherapists for chronic pain patients’,
as well as ‘children with scoliosis’ and ‘exercises and back
pain during pregnancy’. Another clinician informant
stated, ‘we don’t have any role in AIDS’. In addition,
geriatrics was noted as a ‘huge population because. . .
there’s no such thing as a geriatrics facility or an institu-
tionalization model’ in Kuwait. Elderly patients are cared
for in the family home, and therefore, there is a ‘need for
services in the home’. Similarly, another administrative
informant suggested that an unmet demand was in the
area of cardiopulmonary physiotherapy stating that
‘cardiac problems are the number one killer in Kuwait’.
One administrative informant noted that the recognition
of the value of physiotherapy would be greatly amplified
if these prospects were investigated.
M. M. MacPherson et al. Physiotherapy in Kuwait
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6. Multidisciplinary collaboration
Many informants noted a discrepancy in collabora-
tion with other health-care professionals. One clini-
cian informant highlighted that long-held beliefs
regarding health-care contributed to lack of inter-
professional collaboration and stated that ‘not only
in Kuwait, but also Arabia. . . we still think in the old
fashion way, of the physician concept model, that
the physician is everything’. Another clinician infor-
mant described the interaction between physicians
and physiotherapists in Kuwait as follows: ‘the
problem is that I don’t communicate with them, the
only thing I do is refer to them and write what I want
from them exactly’. The clinician informant went on
to compare this with an experience while practising
in Europe and stated, ‘but when I was in England we
use to discuss everything in clinic, we would initiate
treatment with them what to do and what not to do,
and I think that is real education’. Many informants
discussed how the flaw of the current situation has
created a clear opportunity to collaborate with
physicians and other health-care professionals.
Threats
Public awareness
Many informants frequently state that the growth
of the profession is hindered by inadequate public
knowledge. One clinician informant indicated, ‘we
have to educate the public regarding the roles and
responsibilities of physiotherapists’. Rehabilitation
services are not well recognized, and as another
clinician informant noted, if ‘the patients knew what
a physical therapist was’, it would help establish the
role of physiotherapists in the health-care system.
According to several clinician informants, many
Kuwaitis poorly understand the scope of practice of
physiotherapy: ‘they think that physiotherapists are
massage therapists’.
Inter-professional practice and communication
Several clinician informants described how a
limited knowledge of the scope of practice has nega-
tively impacted communication between health
professions. One clinician informant expresses this
limitation while noting that physicians ‘don’t know
that much about our profession, they refer patients
to us, they don’t know how much we can do for the
patient’. Another clinician informant noted that
there was a hierarchy that existed, which became an
‘obstacle’, primarily because physicians ‘don’t want
to admit that physical therapists have a role’ in certain
areas of patient care. In addition, many informants in
all categories described language barriers as a major
challenge. One clinician informant noted that
comprehension of ‘the English language is a common
problem’. Another clinician informant stated that
‘weaknesses of physical therapy in Kuwait are first
the language, you have to know how to speak Arabic
and understand it’.
Cultural perspective
Many informants note the Kuwaiti culture itself as
a barrier to healthy lifestyle through attitudes and
cultural practices. One administrative informant
noted that the patients’ ‘sedentary lives, unhealthy
food, and smoking habits’ are all prominent contribu-
tors to ‘Kuwaitis’ unhealthy lifestyle’. Another key
stakeholder pointed out how the traditional cultural
beliefs have affected people’s views on health: ‘people
don’t really see their obese bodies. . . there is this sort
of lack of cultural acceptance of what health is. . .’. An
administrative informant noted that a change in
perspective is necessary and that the society needs to
‘move away from the sort of the pill-popping popula-
tion to the active population, where they actually do
something about their health’.
Discussion
According to Cahalin et al. (2008), physiotherapy in
many countries struggle accreditation, licensure, earning
potential and clinical specialization. Although there is
common ground in comparative terms of the status of
physiotherapy at the macro-level in Kuwait and the
global community, there are particular noteworthy
differences at the micro-level. We have highlighted three
main findings from the data, which are of particular
relevance for Kuwait and which could be strategies that
would build upon the strength and opportunities and
mediate the weaknesses and threats. The strategies
include evolving a national physiotherapy association
into a stronger representative body, establishing regula-
tory standards, and linking demand with supply to meet
societal needs.
Physiotherapy in Kuwait M. M. MacPherson et al.
42 Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.

7. Evolving the national physiotherapy
association into a stronger representative
body
On the basis of our data, the national association
called the Kuwait Physical Therapy Association
(KPTA) may not have yet developed firm roots in
the country as several clinician informants were
unaware of its existence. Klinger (2000) explored the
importance of professional organizations for lifelong
learning and noted that perhaps the most relevant
use is for professional networking. On the basis of
their respective websites, India, Saudi Arabia, Iran
and the United Arab Emirates all use their physio-
therapy associations to provide opportunities for such
networking, as well as to provide continuing education,
research forums and annual conferences. The challenges
presented of these networking and educational opportu-
nities were mentioned by the informants to be one
of the major weaknesses of physiotherapy in Kuwait.
Professional associations also provide a mechanism for
voices to be heard collectively (Zuyderduin et al., 2010),
foster participation in inter-disciplinary efforts to shape
health-care policy and give the opportunity to influence
public views (Levitt, 1996), and grow leaders from within
(Shekleton et al., 2010). Many of these proposed benefits
could be helpful in Kuwait given the difficulty of public
knowledge regarding physiotherapy as cited by many
informants. There exists an opportunity to improve
awareness of the profession. Through the association,
the scope of practice and role of the physiotherapist can
be highlighted publicly to breakdown false perceptions
and promote optimal use of their services. The KPTA
has been evolved rapidly to meet member needs, and
the results of this study suggest the need to strategically
and aggressively continue in that direction.
Establishing regulatory standards
The second major finding that emerged was the variety
in educational levels possessed by physiotherapists
practising in Kuwait. This is likely tied to the fact
that there is a large percentage of foreign trained
physiotherapists practising in Kuwait, and most infor-
mants interpreted this as a weakness, which led to the
current lack of practice standards. For the profession
to move forward and sustainably evolve in Kuwait, it
will be important to change these demographics and
produce more Kuwaiti physiotherapists. Strengthening
the profile of the national physiotherapy association
could help in this regard by promoting the profession
as a promising career option. Additionally, the associa-
tion could advocate for increasing the number of spots
in the current bachelor degree programme at Kuwait
University. Although relatively simple in scope, these
initiatives may lay the groundwork for the training of
more domestic physiotherapists.
The lack of adequate regulatory standards for
physiotherapists in Kuwait was mentioned specifically
by several informants and was consistently cited as the
main reason for the inconsistencies of practice in Kuwait.
The association could aid in the development of a sepa-
rate regulatory agency. A starting point for this regulatory
body might be to draft up entry-level standards for
all domestic physiotherapists and foreign-trained
physiotherapists alike. At the very least, this would ensure
that any physiotherapists entering the country would
meet standard criteria.
Linking demand with supply to meet
societal needs
The third major issue that surfaced was the large source
of untapped demand for physiotherapy services, an area
unanimously cited as an opportunity by the informants.
Dean (2008) stated that it is the responsibility of
every health-care practitioner in Kuwait, including
physiotherapists, to find ways to prevent common health
risks. As mentioned by many informants, there are
additional opportunities in areas where physiotherapy
skills are not yet widely developed, such as the treatment
of neuromuscular conditions and paediatrics. Such
opportunities could be exploited by setting up specialty
courses and continuing education programmes.
It is essential that physiotherapists maintain clinical
competence and improve their general knowledge
throughout their careers to meet the demands of a
changing scope of practice. Professional education
should be considered as a continuum and should
not end after the completion of undergraduate studies
(Al-Refai, 1995). Continuing education plays a vital role
in assisting physiotherapists to meet these demands by
enabling them to be educated and aware of changes in
clinical practice and research (Higgs, 1998). Simply
uniting professionals through an association allows
sharing of resources and knowledge. This dissemina-
tion of information better equips clinicians in their
treatment and provides a support system to push the
scope of practice to new levels. When taken together,
M. M. MacPherson et al. Physiotherapy in Kuwait
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8. these steps could help the profession to take advantage
of the large segment of untapped demand for physio-
therapy services.
Implications
Kuwait may be a ‘land of opportunity’, and this may be
particularly true in regard to the growth and develop-
ment of the physiotherapy profession. Our analysis
emphasizes that there is ample opportunity that exists
in Kuwait to enhance the practice of physiotherapy. In
particular, the result of our SWOT analysis highlights
the importance of prioritizing development and growth
of the national physiotherapy association to guide the
profession. Such an organization direction could help
minimize the negative impact of limited public knowl-
edge by conducting a marketing campaign targeted at
the general public. Furthermore, by establishing a regula-
tory body and standards of practice, the national associ-
ation can limit frustrations that clinicians have with
ambiguous boundaries of practice.
Finally, the association could help develop the
untapped demand for physiotherapy services by advo-
cating for the role of physiotherapists in new strategies
to combat the health concerns and lifestyle choices of
Kuwaitis. With the use of these recommendations as a
guide, the profession has the potential to build a stronger
role in the health-care system in Kuwait — one that is
able to more fully respond to the needs of its people.
Moreover, given the emerging health disparities
and prevalence of burden of disease and disability
related to cardiac, respiratory and metabolic systems,
there is likely a significant role for physiotherapists.
However, the simple presence of a prospect to grow
and expand a profession rarely translates into real
opportunity with a health-care setting, without
ensuring that the appropriate structure is in place.
According to the classic Donabedian framework for
quality of care (Donabedian, 2005), positive outcomes
can only be achieved if appropriate processes are in
place; and paradoxically, appropriate processes can
only be implemented if a suitable structure is in
place. It may be appropriate to use this systematized
‘structure–process–outcome’ dynamic to develop a
strategy to further evolve physiotherapy in Kuwait so
as to strategically and meaningfully address the phys-
iotherapy needs in Kuwait. Although this was a study
of Kuwait, this principle is applicable across the
continuum of all high-income, middle-income and
low-income countries that seek to address the
emergent burden of disease through physiotherapy
services.
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Appendix A: Study interview
questions and associated prompts
Section I — Personal profile
1. What is your age?
2. What is your country of origin?
3. Do you have any formal education?
[If respondent is a clinician, we ask the following
questions. If not, we go to Section II.]
4. What level of health professional education do you
hold?
5. Where did you graduate?
6. When did you graduate?
7. How many years have you been practising?
Section II — Experiences in Kuwait
8. Can you briefly describe your work experience in
Kuwait? [Prompt: Do you work, and if so, what
type of work do you do? How many hours a week
do you work?]
9. What do you think about the health-care system in
Kuwait? [Prompt: Do you have generally positive
or negative view of the health system? What
and why not? Have you needed to use the system,
and how would you judge the system based on
that experience?]
10. [If respondent is a health professional, we ask the
following question.] What were your primary
motivations for deciding to work as a health pro
fessional?
11. [If respondent is a physiotherapist, we ask the
following question.] What has been your experi
ence with physiotherapists in Kuwait?
Section III — Perspective on physiotherapy
in Kuwait
1. In your opinion, what are the strengths of physio-
therapy profession in Kuwait? [Prompt: a) Health-
care can be a politically charge environment; how
well do physiotherapists advocate? b) In general,
how well do physiotherapists meet the needs of
patients in the country? c) What are the factors that
allowed physiotherapists to be effective, or efficient,
in meeting patient needs?]
M. M. MacPherson et al. Physiotherapy in Kuwait
45
Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.

10. 2. From your perspective, what would you say are the
weaknesses of physiotherapy in Kuwait? [Prompt: a)
What are the areas or factors that could be improved
to better meet patient needs? b) Where do physio-
therapists seem to struggle in meeting patient needs
or in advocating for patient interests?]
3. On the basis of your experiences, what are the areas
that represent potential growth for physiotherapists
in Kuwait? [Prompt: a) What are the opportunities
that you think are facing physiotherapists? b) What
are the environmental factors that will allow phy-
siotherapists to grow in the future?]
4. What are the barriers of further development of
physiotherapy in Kuwait? [Prompt: a) Where are
the significant barriers to achieving success of full
potential? b) Are there people and/or institutions
that stand in the way further evolving physiotherapy
as a profession in Kuwait?]
Physiotherapy in Kuwait M. M. MacPherson et al.
46 Physiother. Res. Int. 18 (2013) 37–46 © 2012 John Wiley & Sons, Ltd.