Re: Marwaha K, Horobin H and McLean SM (2010) Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations.


I wish to congratulate Marwaha et al (2010) for bringing out a valid exposition on a novel direction of thought, with special consideration on Indian physiotherapy practice scenario. The study is the first of its kind in relation to the geographical pattern of patient-related barrier adherence and the therapists’ views using a qualitative approach.

What is most surprising is the fact how the authors aimed at generalizing their study findings to the real life situations in Indian physiotherapy clinical practice. The study was conducted at a hospital in Delhi (name of hospital is unknown) and included only six participants with their clinical experience that ranged from (unknown or three years minimum) to 30 years. The participant characteristics were incomplete, which I feel would determine to a very large extent their perceptions about practice-related barriers of patients. The factors that need to be elaborated are their level of education (under-graduate, post-graduate), area of clinical practice (orthopedics, neurology, pediatrics, and geriatrics), type of work setting (private clinic, government hospital, and private hospital), and number of patients seen per day, type of patients (age group, gender, and clinical characteristics). Even if these were addressed, the authors extrapolated their findings from a very small sample size (obtained by convenient sampling which the authors felt necessary due to time constraints) of just six physiotherapists, not stating this in their study’s limitations among many.

Though McLean et al (2010) showed motivational cognitive-behavioral interventions enhanced treatment adherence during exercise sessions, Marwaha et al (2010) overlooked their own study (which I mean in their same academic setting/ university) that was neither cited nor implied to in their suggestion for future studies.

There were serious ethical issues related to this published paper.

1. The ethical approval was obtained from UK while the study was conducted at New Delhi. The approval should have been obtained from the hospital instead. If the approval was obtained from Dissertation management group of the University, then does it imply that the study is one of the authors’ dissertation work during their post-graduation? This should be stated in disclosures or in acknowledgments.

2. There was no mention of authors obtaining written informed consent from the participants.

3. Being a reader of both the journals (Manual Therapy and IJPTR) which published the two referenced works, how could any author probably avoid citing another related published work when online-ahead versions of the draft is made available by Manual Therapy much earlier with appropriate digital object identifier (DOI). I could only believe such an act was truly unintentional.

4. There should also be a statement in conflicts of interest that the third author in Marwaha et al (2010) is the chief editor of IJPTR and should be explicitly stated that he was not involved in the peer-review or decision-making for this manuscript.

As a physiotherapist and a colleague, I put forward my opinions and views which as a reader of any good scientific publication demands these days of evidence-informed paradigm-shift in our physiotherapy profession (Kumar, 2010).


Kumar SP (2010) Physical therapy: past, present and future- a paradigm shift. Journal of physical therapy, 1(2); 58-67.

Marwaha K, Horobin H and McLean SM (2010) Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations. International journal of physiotherapy and rehabilitation, 1(1); 9-18.

McLean SM, Burton M, Bradley L and Littlewood C (2010) Interventions for enhancing adherence with physiotherapy: A systematic review. Manual therapy, 15(6); 514-521.

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