Association of Footwear and Attire with Work-Related Musculoskeletal Disorders Among Clinical Physiotherapists in Peshawar: An Analytical Cross-Sectional Study

Background: Work-related musculoskeletal disorders represent a major occupational health challenge among healthcare professionals, particularly clinical physiotherapists who routinely perform physically demanding tasks such as patient handling, manual therapy, repetitive movements, and prolonged standing. Objective: To determine the association of footwear and attire with work-related musculoskeletal disorders among the clinical physiotherapists in Peshawar. Methodology: A cross-sectional study was conducted from March to August 2025 in tertiary care hospitals of Peshawar, Pakistan. A total of 106 clinical physiotherapists, both male and female, aged between 24 and 45 years, with a minimum of one year of professional clinical experience, were included in the study. Physiotherapists working exclusively in non-clinical or academic roles, those with less than one year of professional experience, a history of recent trauma or surgery, congenital deformities, soft tissue malignancies, were excluded. Prior to data collection, ethical approval was obtained from the Graduate Studies Committee, RCRS. Data were collected using the Standard Nordic Musculoskeletal Questionnaire, a widely used and validated instrument for assessing musculoskeletal symptoms across different body regions. Participants were categorized based on the type of footwear and attire they commonly wore during work. Continuous variables were expressed as mean and standard deviation, while categorical variables were presented as frequencies and percentages. The chi-square test was applied to assess the association between categorical variables related to footwear, attire, and the prevalence of work-related musculoskeletal disorders. Results: Significant association was found between working hours and elbow pain (p=0.000) and knee pain (p=0.03), as well as between age and work experience with wrist/hand discomfort (p=0.005 and p=0.000). No statistically significant association was observed between work-related musculoskeletal disorders and type of footwear or attire (p>0.05). Conclusion: Work-related musculoskeletal disorders are highly prevalent among clinical physiotherapists in Peshawar. Although footwear and attire were not statistically associated with work-related musculoskeletal disorders, occupational workload factors such as long working hours and early-career clinical exposure play a significant role.