Physiotherapy is a rapidly growing allied-health profession that plays a vital role in the prevention, treatment and rehabilitation of musculoskeletal, neurological, cardiopulmonary and sports-related conditions. Despite its expanding scope and increasing relevance in modern healthcare, public awareness of physiotherapy as a distinct treatment modality remains limited, particularly among the younger population. College students represent an important segment of the population who are prone to musculoskeletal problems such as low back pain, neck pain and sports-related injuries owing to prolonged sitting, poor study posture and the increasing use of digital devices.¹Z Despite constant exposure to such risk factors, awareness of the role of physiotherapy in the prevention and management of these conditions is often inadequate among college-going youth. Misconceptions — such as equating physiotherapy with massage or regarding it as a last resort after failed medical treatment — are common in the general population and may be equally prevalent among students. In India, physiotherapy-awareness studies have largely focused on patient populations in clinical settings, with relatively limited data on awareness among students, who represent both potential patients and future health-conscious citizens. Early awareness could promote timely self-referral, prevent the chronicity of musculoskeletal complaints and encourage healthier lifestyle practices. A questionnaire-based approach is a validated and cost-effective method for assessing awareness in large student populations. Given the paucity of institution-specific data from this region, the present study was undertaken to assess the level of awareness regarding physiotherapy among college students in Mandya city and to identify the factors influencing this awareness, thereby providing an evidence-based platform for targeted awareness programmes in educational institutions.

Study design and setting This was a descriptive, cross-sectional, questionnaire-based study conducted among college students in Mandya city, under the aegis of the Department of Orthopaedics, Mandya Institute of Medical Sciences (MIMS), a tertiary health centre in Mandya, Karnataka. Students from three institutions in the city — Government College, Mandya; PES Degree College, Mandya; and Mandya University — were included. Sample size The sample size was calculated on the basis of a 42% prevalence of adequate awareness of physiotherapy reported by Sharma R et al. (2019),¹ using the formula n = ZZpq/dZ, with a 95% confidence level (Z = 1.96) and an absolute precision (d) of 8%. This yielded a minimum required sample of approximately 146, which was rounded up to 154 participants to allow for incomplete responses. Inclusion and exclusion criteria College students of either sex who were willing to participate and provided informed consent were included. Students who declined consent or submitted incomplete forms in critical fields were excluded from the corresponding analyses. Data collection tool A structured, pre-tested proforma was used to record the participant's demographic profile (age, sex, education, college and year of study), prior awareness of physiotherapy, the principal source of information, and any history of having consulted a physiotherapist. Awareness was quantified using a physiotherapy knowledge score ranging from 0 to 10, and participants' attitude toward physiotherapy (positive, neutral or negative) and willingness to seek physiotherapy care if required were also recorded. In keeping with the reference literature, a knowledge score of ≥ 5 out of 10 was taken to indicate adequate awareness.¹ Statistical analysis Data were entered into a master chart (Microsoft Excel) and analysed using standard statistical methods. Categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± standard deviation. The chi-square test was used to examine associations between categorical variables; the independent-samples t-test and one-way analysis of variance (ANOVA) were used to compare mean knowledge scores across groups; and binary logistic regression was used to identify independent predictors of adequate awareness. A p-value < 0.05 was considered statistically significant. Ethical considerations The study was conducted after obtaining approval from the Institutional Ethics Committee of MIMS, Mandya, and written informed consent from every participant. Participation was voluntary, participants incurred no cost, and confidentiality of the collected information was maintained throughout.

A total of 154 college students from three colleges in Mandya city participated in this cross-sectional study, meeting the pre-calculated sample size. The findings are presented below. Demographic profile The mean age of the participants was 20.95 ± 1.92 years (range 18–27 years). The demographic characteristics of the study population are summarised in Table 1. Table 1. Demographic characteristics of the study participants (N = 154) Characteristic Category n % Age (years) Mean ± SD 20.95 ± 1.92 (range 18–27; n = 152) – – Sex Male 78 51.7 Female 72 47.7 Other 1 0.7 College Government College, Mandya 59 38.3 Mandya University 55 35.7 PES Degree College, Mandya 40 26.0 Year of study First year 70 45.5 Second year 54 35.1 Third year 30 19.5 SD, standard deviation. Percentages for age denominators are based on valid responses (n = 152). Prior awareness and exposure to physiotherapy Of the 152 participants who responded to this item, 144 (94.7%) reported having heard of physiotherapy before, whereas 8 (5.3%) had not. The most common source of information was the internet/media (54, 36.5%), followed by family or friends (49, 33.1%), the college curriculum (29, 19.6%) and doctors (16, 10.8%). Despite this high level of prior exposure, only 17 of 152 participants (11.2%) had ever personally consulted a physiotherapist, while the remaining 135 (88.8%) had not (Table 2). Table 2. Prior awareness, source of information and consultation history Variable Category n % Heard of physiotherapy (n = 152) Yes 144 94.7 No 8 5.3 Source of information (n = 148) Internet / media 54 36.5 Family / friends 49 33.1 College curriculum 29 19.6 Doctor 16 10.8 Ever consulted a physiotherapist (n = 152) Yes 17 11.2 No 135 88.8 Physiotherapy knowledge, attitude and willingness The mean physiotherapy knowledge score was 5.05 ± 2.41 (median 5; range 1–10; n = 146). Applying the pre-defined cut-off, 90 of 146 participants (61.6%) demonstrated adequate awareness (score ≥ 5/10), while 56 (38.4%) had inadequate awareness. Most participants held a positive attitude toward physiotherapy (100, 66.7%), with 45 (30.0%) neutral and 5 (3.3%) negative. A large majority (127, 85.2%) were willing to seek physiotherapy care if required (Table 3). Table 3. Knowledge, attitude and willingness to seek physiotherapy care Variable Category n % Awareness category (n = 146) Adequate (≥ 5/10) 90 61.6 Inadequate (< 5/10) 56 38.4 Attitude (n = 150) Positive 100 66.7 Neutral 45 30.0 Negative 5 3.3 Willingness to seek care (n = 149) Yes 127 85.2 No 22 14.8 Mean knowledge score = 5.05 ± 2.41 (median 5; range 1–10; n = 146). Factors associated with adequate awareness Adequate awareness was not significantly associated with sex (χ² = 0.721, df = 1, p = 0.396) but was significantly associated with the college attended (χ² = 6.868, df = 2, p = 0.032) and the year of study (χ² = 8.253, df = 2, p = 0.016). The proportion of students with adequate awareness was highest at Government College (75.0%), followed by PES Degree College (54.1%) and Mandya University (52.8%); by academic stage, adequate awareness was highest among first-year students (73.8%), followed by third-year (58.6%) and second-year (48.1%) students (Table 4). Comparison of mean knowledge scores yielded concordant results. Scores did not differ significantly between male and female participants (t = −0.117, p = 0.907) but differed significantly across colleges (one-way ANOVA, F = 4.076, p = 0.019), with Government College recording the highest mean score (5.73 ± 2.29) compared with PES Degree College (4.84 ± 2.53) and Mandya University (4.47 ± 2.31). The difference in mean scores across years of study did not reach significance (F = 2.276, p = 0.106). Prior awareness of physiotherapy was not significantly associated with having actually consulted a physiotherapist (χ² = 0.487, df = 1, p = 0.485). Table 4. Association of adequate awareness with sex, college and year of study Variable Category Adequate awareness (%) χ² (df) p Sex Male vs Female – 0.721 (1) 0.396 College Government College 75.0 6.868 (2) 0.032* PES Degree College 54.1 – – Mandya University 52.8 – – Year of study First year 73.8 8.253 (2) 0.016* Second year 48.1 – – Third year 58.6 – – * Statistically significant (p < 0.05). df, degrees of freedom. Attitude and willingness to seek care A highly significant association was observed between attitude toward physiotherapy and willingness to seek physiotherapy care (χ² = 32.122, df = 2, p < 0.001): willingness was near-universal among participants with a positive attitude and progressively lower among those with neutral or negative attitudes. Independent predictors of adequate awareness On binary logistic regression (n = 144; model likelihood-ratio p = 0.016; pseudo-R² = 0.082) with age, sex, college and year of study entered simultaneously, college affiliation and year of study emerged as independent predictors of adequate awareness, whereas age and sex did not. Relative to Government College, the odds of adequate awareness were significantly lower at PES Degree College (adjusted OR 0.18; 95% CI 0.04–0.75; p = 0.018) and Mandya University (adjusted OR 0.20; 95% CI 0.04–0.98; p = 0.047). Relative to first-year students, third-year students had significantly lower odds of adequate awareness (adjusted OR 0.19; 95% CI 0.04–0.87; p = 0.032) (Table 5). Table 5. Binary logistic regression: predictors of adequate awareness (n = 144) Predictor Adjusted OR 95% CI p Age 1.01 0.77–1.33 0.924 Sex: Male (ref. Female) 0.72 0.34–1.51 0.389 College: Mandya University (ref. Government) 0.20 0.04–0.98 0.047* College: PES Degree College (ref. Government) 0.18 0.04–0.75 0.018* Year: Second (ref. First) 0.61 0.26–1.44 0.257 Year: Third (ref. First) 0.19 0.04–0.87 0.032* * Statistically significant (p < 0.05). OR, odds ratio; CI, confidence interval; ref., reference category.

This cross-sectional study assessed physiotherapy awareness among 154 college students in Mandya city and identified the demographic and institutional factors associated with it. Two findings stand out: a high level of conceptual familiarity with physiotherapy coexisting with strikingly low actual utilisation, and the dominance of institution-level factors over individual demographic characteristics in determining the depth of awareness. Although 94.7% of participants had heard of physiotherapy, only 11.2% had ever consulted a physiotherapist — a clear awareness–utilisation gap. Recognition of a discipline does not translate automatically into appropriate health-seeking behaviour, a pattern also noted by Rekha K et al. (2018), who reported that only about a third of students were aware that physiotherapy could be accessed directly without a physician's referral.3 The mean knowledge score of 5.05 ± 2.41, with 61.6% of participants classified as having adequate awareness, is higher than the 42% reported by Sharma R et al. (2019)¹ and the 48% reported by Basnet B et al. (2020),⁷ which may reflect the growing penetration of digital health information and the specific student population sampled here. Consistent with Basnet B et al. (2020),⁷ the internet/media rather than the formal curriculum was the leading source of information (36.5% vs 19.6%), underscoring the increasing role of digital platforms in shaping health awareness among young people. Awareness was significantly associated with the college attended and the year of study, but not with sex — a pattern only partly concordant with Fernandes S et al. (2019), who additionally reported a gender difference and higher awareness among final-year students.⁶ In the present study, the institution emerged as the strongest determinant, remaining an independent predictor after adjustment for age, sex and year on logistic regression. This mirrors the observation of Alshehri MA et al. (2020) that the academic environment — particularly exposure to health-related content — substantially influences awareness scores.⁴ The relatively higher awareness among first-year students is noteworthy and may reflect recent, more health-oriented schooling or differences in course composition across the sampled institutions rather than a true decline with academic progression. Attitude was the strongest correlate of the willingness to seek physiotherapy care (p < 0.001): participants with a positive attitude were almost uniformly willing to seek care, whereas willingness fell sharply among those with neutral or negative attitudes. This highlights that improving awareness alone may be insufficient; interventions must also cultivate favourable attitudes to translate knowledge into care-seeking behaviour. Collectively, these findings support the case, argued by Al-Eisa E et al. (2016)Z and others, for structured, institution-based awareness initiatives that address not only knowledge of the scope of physiotherapy but also misconceptions and attitudes. LIMITATIONS • Participants were enrolled through a questionnaire-based survey rather than strict stratified random sampling, introducing a potential for selection bias and limiting the generalisability of the findings. • Awareness was captured as a single composite knowledge score; individual knowledge sub-domains (general knowledge, benefits, scope and conditions treated) were not analysed separately. • The ≥ 5/10 cut-off for adequate awareness was adopted from the reference literature and was not independently validated in this population. • The cross-sectional design permits the identification of associations but not causal inference.

In this cross-sectional study of 154 college students in Mandya city, awareness of physiotherapy was conceptually high — nearly 95% had heard of the discipline and 61.6% demonstrated adequate knowledge — yet this was accompanied by a pronounced awareness–utilisation gap, with only about one in nine students having ever consulted a physiotherapist. Awareness was determined more by the institution attended and the academic stage than by individual demographic characteristics such as age and sex, and these institutional factors remained independent predictors of adequate awareness on multivariable analysis. The internet and media have overtaken the formal academic curriculum as the principal source of information, and a positive attitude was the single strongest correlate of the willingness to seek physiotherapy care. These findings indicate that efforts to promote physiotherapy should move beyond simply raising recognition of the discipline toward closing the gap between awareness and appropriate utilisation. Targeted, institution-specific awareness campaigns — tailored to the college and year of study, integrated within the academic curriculum, delivered through credible digital channels, and explicitly designed to correct misconceptions, foster positive attitudes and encourage timely self-referral — are recommended. Larger, multi-institutional studies employing probability sampling are warranted to confirm these observations and to further clarify the determinants of physiotherapy awareness among the student population.

1. Sharma R, et al. Awareness of physiotherapy among undergraduate college students. Int J Physiother Res. 2019;7(4):3123-8. 2. Al-Eisa E, et al. Knowledge and awareness of physiotherapy among university students in Saudi Arabia. J Phys Ther Sci. 2016;28(6):1721-6. 3. Rekha K, et al. Awareness and perception about physiotherapy among college students in Karnataka. Indian J Physiother Occup Ther. 2018;12(3):45-9. 4. Alshehri MA, et al. Comparison of physiotherapy awareness among health and non-health science students. Saudi J Sports Med. 2020;20(2):88-94. 5. Patel N, Desai H. Awareness of physiotherapy in the management of musculoskeletal pain among college students. Natl J Community Med. 2021;12(5):142-6. 6. Fernandes S, et al. Gender and academic-year based differences in physiotherapy awareness among South Indian college students. J Clin Diagn Res. 2019;13(7):YC01-4. 7. Basnet B, et al. Awareness regarding physiotherapy among university students in Nepal. J Nepal Health Res Counc. 2020;18(2):301-6. 8. Hoy D, et al. The global burden of low back pain. Ann Rheum Dis. 2014;73(6):968-74. 9. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56. 10. World Confederation for Physical Therapy. Description of physical therapy: policy statement. London: WCPT; 2019.