Physiotherapist workforce density and childhood disability burden: an ecological analysis of rehabilitation-amenable conditions across countries

Abstract

Introduction: Inequities in the rehabilitation workforce across the globe may lead to inequitable access to rehabilitation services for children with disabilities. In the Middle East and North Africa (MENA), uneven distribution of physiotherapists may contribute to differences in childhood disability burden. Objective: To examine the ecological association between physiotherapist density and rehabilitation-amenable childhood disability burden in ten MENA countries, using years lived with disability (YLDs) among children. Methods: A cross-sectional ecological regression analysis was conducted using publicly available data from the World Physiotherapy Census and Global Burden of Disease estimates. Physiotherapist density was defined as the number of physiotherapists per 10,000 population. Childhood disability burden was measured as YLD rates per 100,000 children aged 0–14 years for selected rehabilitation-amenable conditions. Multivariable ordinary least squares regression was used to explore the association between physiotherapist density and childhood YLD rates, adjusting for economic development, physician density, and urbanization. Results: Physiotherapist density showed a significant negative association with childhood YLD rates (β = −220; p = 0.031; adjusted R² = 0.54). Each additional physiotherapist per 10,000 population was associated with a 220-point lower YLD rate per 100,000 children. Economic development was also negatively associated with childhood YLD rates, whereas urbanization and physician density were not significant predictors. Conclusion: Higher physiotherapist density was associated with lower country-level childhood YLD rates for selected rehabilitation-amenable conditions. Because this ecological cross-sectional study cannot establish causality, the findings should be interpreted as hypothesis-generating and require confirmation through longitudinal, subnational, and service-level research.