Establishing a Need for Adding Physical Activity and Exercise Therapy Course to the Student Curriculum of the BSc Physical Therapy Program at King Abdulaziz University (KAU)

Implementation of exercises and physical activity as a preventative management strategy in public health, which is in turn connected to undergraduate teaching in order to place physiotherapists as exercise experts in clinical practice, has become one of the essential areas for building comprehensive knowledge in a physiotherapy education program. As physiotherapists are experts in biomechanics, with a knowledge of pathology and its effects on body systems, they are the ideal professionals to meet the challenge of ensuring exercise expertise. An exercise therapy course could develop the content of the entry-level curriculum (BSc degree) in physiotherapy professional education programs to meet the current national and international needs of healthcare professionals who promote, guide and manage effective exercise strategies. In addition, the implementation of this course would improve the services provided by physiotherapy graduates in healthcare, thus emphasising the significant role of exercise as a physiotherapy intervention in prevention and management. Key to this process is analysing and reviewing existing physical activity and exercise therapy course and reporting the topics that will need to be implemented in the undergraduate physiotherapy program in KAU. Implementation of this course in the undergraduate curriculum requires the engagement of academic staff, clinical tutors in the ‡ © Astek A. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. physical therapy department, Faculty of Applied Medical Science (FAMS), KAU and community health centre staff, in order to establish and deliver the course content to students via lectures, lab sessions and clinical visits.


Background
The utilisation of exercise as an intervention for prevention and management of injuries and chronic diseases in individuals across their lifespan has grown recently in clinical practice within the field of physiotherapy Sallis 2009. Ideally, the profession of physical therapy should enhance the knowledge, skills and delivery of care across multiple domains, including health development, physical activity among different age groups and exercise expertise (American Physical Therapy Association Education Strategic Plan 2006; World Confederation of Physical Therapy 2009).As a result, it is recommended to address the demands put in place by these requirements on the educational plans of undergraduate physiotherapists in order to cope with the global shift in healthcare from treating injuries and disease to health promotion and illness prevention (Health Services Executive 2007). Furthermore, undergraduate teaching should consider exercise guidelines and strategies for public health in the curriculum in addition to its focus on disability, injury and impairment. Substantial work has been done on analysing physiotherapy undergraduate curriculums worldwide, after which the implementation of exercise prescription content has been recommended due to the increasing demand for exercise expertise in clinical practice (Dean 2009;O'Donoghue et al. 2011;O'Donoghue et al. 2012). This work includes a study conducted by a member (AlHendy 2012) at the physical therapy department in KAU. This study took the form of a student survey and recommended the development of clinical education in the physical therapy department by providing courses in prescribing exercises from start to finish relating to public health. Therefore, this proposal will present a plan for the implementation of Physical Activity and Exercise Therapy courses in the BSc physical therapy programme in KAU.

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The purpose of the project is to establish the knowledge and skills of undergraduate physiotherapy students as exercise experts. This means that physical activity and exercise prescription and promotion will become a domain of the curriculum design and delivery in the physical therapy department, in line with KAU's principle of aiming to create graduates who are highly trained to meet the needs of society. • The project aims to enhance students' ability to design exercise programs for individuals according to their conditions, theoretically and practically, through lectures and clinical sessions respectively. This could potentially align with KAU's strategy of placing graduates as experts in clinical practice. • The project would cover a new domain in physical therapy intervention as part of the academic program, giving KAU the capability to fulfil the national and international standards benchmark in the field of physical therapy. • The project will give more opportunity to students in future employment to be engaged in health community centres and private clinics instead of focusing on hospital settings.This would enhance the quality of the physical therapy department at KAU, as it contributes to creating graduating professionals who meet current national and international demands. • Developing the content of the BSc programme in order to meet current national and international demands would enhance the academic reputation of the physical therapy department at KAU. According to the National Qualification Frameworks (NQF) for higher education 2015, adding credits to the bachelor degree programme is required in order to cover professional study requirements in the professional field and reflects the comprehensive knowledge of the programme.

External Dependencies
• In order to achieve the specific objectives of the project, the delivery of clinical skills, permission and signed approval, should be provided by the head of the external agencies, namely the community health centres in Jeddah including Alrehab Public Centre and King Faisal Residential City Clinic. • KAU Accreditation Unit approval will depend on the review of two external referees, each from an American or European university.

Scientific and technical challenges
Preferred options below are labelled 'option 1', while options labelled 'option 2' are just alternatives.
Option 1: approval from community health centres in Jeddah to cooperate in facilitating the clinical practice of the students. Alrehab Public Centre and King Faisal Residential City Clinic are primary healthcare centres providing public health services for chronic conditions. In this way, students will have the opportunity to deal with different cases in public health services; however, arrangement of transportation dates and times should be taken into consideration.

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Option 2: visiting the clinics of chronic cases in KAU hospital, for which the department already has approval. The hospital is located in the student campus, meaning that there is no need to arrange transportation; however, these clinics deal with acute cases and hence not with the target population, unlike the cases in community health centres.

Time spent by external agencies:
1. Option 1: Staff at the community health centres will take time to arrange schedules and report an overview of the cases to be seen by students during the visits. Advance meetings with staff should be held to avoid clashes with the students' curriculum.

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Option 2: Staff at the KAU hospital clinics will take time to select appropriate cases to be seen by students during the visits. In this case, reports about the available target cases should be sent in advance to the department.
The year at which this course is offered: 1.
Option 1: implementation of the course in the 3rd and 4th year curriculum (Suppl. material 1) by dividing the content between the first and second semester of each year. This is to establish course content that is aligned with the content of other courses in both semesters.

2.
Option 2: implementation of the course in the 3rd year (first and second semester) and the first semester of the 4th year. This will give students substantial time to work on their research project, which takes place in the second semester of the 4th year. However, some sections of the exercise prescription content should be taught in line with the neurology course content, which is taught in the second semester of the 4th year (Suppl. material 1).
Option 1: An exercise therapist will be hired as a part-time instructor.Salary will be according to the KAU's employment scale system, under the Ministry of Higher Education guidelines. This will increase the efficacy of the content as it will be delivered to the students by an expert. However, this will require the therapist's monthly salary to be factored in to the budget, in addition to arranging interviews with the head of the department and the faculty team in order to select him/her.

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Option 2: Provide exercise therapy courses to the current physical therapy staff in order to prepare them for teaching this course. This will save on paying a salary for the parttime instructor. However, the cost of these courses for the current staff and the additional hours of teaching should be taken into consideration.

Impact
• Students will be able to identify the principles of exercise in relation to physiology, biomechanics and measurement. This will be achieved through studying lectures, online references, cited books and the experiences of the exercise therapist in this field. The students will be assessed through mid-term and final exams in each semester, according to the department's exam policy. • Students will be able to identify issues surrounding physical activity locally and globally through lectures and online references. This will be assessed through midterm and final written exams in each semester, according to the department's exam policy. • Students will be able to explain the role of physical activity and exercise in chronic illness and certain clinical conditions. This will be achieved through lectures and lab sessions and assessed through written exams and an Objective Structured Practical Examination (OSPE) in each semester according to the department's OSPE regulations and policies. • Students will be able to demonstrate appropriate clinical skills in planning and prescribing exercises in the public health sector. This will be accomplished through clinical visits in order to apply the theoretical content in practice. The efficacy of these clinical skills will be measured through Objective Structured Clinical Examination (OSCE) in each semester, according to the department's OSCE regulations and policies. • Students will be able to see, evaluate and design individual exercise plan for different cases, including chronic conditions (i.e. preventative measures as well as treatment). This will be achieved by clinical visits and measured through an assignment at the end of each semester.

Implementation
This is a department project, relating to enhancing the theoretical and clinical content of the undergraduate curriculum (Suppl. material 1) to be in line with current national and international needs. The physical activity and exercise therapy content will be identified based on an analysis of the current content in the literature (O'Donoghue et al. 2011;O'Donoghue et al. 2012) or other existing courses. A sample of exercise therapy course syllabus and its relation to the current undergraduate curriculum is attached (Suppl. material 2); however, this will require further investigation by the head and staff of the physical therapy department. Basic information related to implementation of the course is presented in Table 1 Basic Course Information

Details
Title of the course Physical Activity and Exercise Therapy Title and code of the course for transcript Exercise Therapy, PHTHXXX Course prerequisites PHTH221, PHTH222, PHTH223, PHTH224, PHTH228 (Suppl. material 1) .These courses will be pre-requisites because they identify the basics of exercises, movement and measurements. The courses and their content will be required to be passed and understood by students prior to their enrolment in levels 5, 6, 7 and 8.
Course corequisites Basic information related to implementation of the course

Budget
The proposed exercise therapy course would be funded by KAU under the FAMS. Table 2 presents the estimated financial cost, including the annual cost for employing the exercise therapist according to his/her job description (Suppl. material 4) as a part-time instructor in addition to the funding for the facilities and resources required to achieve the project objectives.

The Estimated Financial Cost
Establishing a Need for Adding Physical Activity and Exercise Therapy Course ...

Risks
The risks which are associated with the project are presented, along with proposed mitigation actions, in the following Realign project objectives to be integrated with significant policy changes. Table 3.

Timescale
The implementation of the project will require approximately one and a half years (see Gantt Chart, Suppl. material 5): Year 1 The first four months will be an initiation process, preparing this project as an academic case. This will involve setting up the key individuals for delivery and identifying the project management group from internal staff. Links will be established with other key committees, including the curriculum development committee, department council and FAMS council. Year 2 (First six months) The implementation phase will be the main focus of the six months after final approval is secured.

Key aspects:
• Running interviews for candidates for part-time instructor position. • Meetings to implement the course in students' schedules, including with 3rd and 4th year staff, the employed part-time instructor, curriculum director and course coordinator. • Inspection visit for the biomechanics and exercise therapy labs to ensure that all items meet course requirements. • Obtaining signed letter from Department of Student Transportation with fixed timetable for buses in order to transfer students from the main campus to the Community Health Centre. • Review of course syllabi by the department board to ensure compliance with the department's needs. • Monitoring the course by having regular monthly meetings with the course coordinator.

Project Quality
The quality expected from the project would be based on the suitable and measurable course learning outcomes under five domains provided by the National Qualification Frameworks (NQF) for higher education 2015 in accordance with the National Commission for Academic Accreditation & Assessment standards 2013 templates (Table 4). According to NCAAA, theintended learning outcomes should be supported by teaching strategies that fit and align with the assessment methods. Othercomponents to ensure the quality of the project include regulation for student assessment, verification for standards, selection and preparation of the new staff, and course planning, monitoring and review.

Five domains provided by National Qualification Framework
Identify the basic platform of exercises from a physiological, anatomical, biomechanical and neurological perspective. Recognise the physiological, biomechanical and anatomical changes due to exercise prescription and the related clinical features of conditions commonly encountered in public health services.
Describe the rules for a physical therapist, as an exercise therapist, in assisting both healthy and clinical populations with the following: designing an exercise plan, performing exercises for prevention and being in home and work environment at the highest possible level of self-sufficiency.
List the principles of research-and evidence-based exercise therapy practice.
Recall clinical reasoning, problem solving approaches and research awareness in the selection, justifications and review of exercise methods.

Cognitive Skills:
Justify clinical data based on basic knowledge of physiology, anatomy, pathology and biomechanics.
Interpret the collected data to make decisions about the clinical progress of cases.
Develop individualised exercise therapy approaches for different conditions.
Plan assessment, exercise design, goals and discharge strategies for different conditions.

Interpersonal Skills & Responsibility:
Demonstrate engagement in appropriate self-directed learning.

1-Regulation for student assessment and verification of standards
According to the Physical Department, KAU policy,a sample of 10 % of exams for each course should be marked by another member in the department to confirm the standards of marking . In addition, each student is evaluated by more than one instructor. An International team visits the faculty every three years in order to evaluate the standard of students work and grades against to international standards.

2-Selection and preparation of new staff
The following process for recruiting new faculty and teaching staff will be implemented to ensure that he/she is highly qualified and experienced for teaching responsibilities: • Applicants should be graduates of a well-recognised program. • Applicants should have acquired a directly related speciality.

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Grade of bachelor qualifications should be not less than grade B. • Recommendation letters from people he/she worked with should be provided. • Applicants should pass the interview process conducted by a select committee of faculty members, including oral presentation. • Qualifications should be verified before interviews take place.
The following process will be used for orientation of part-time staff to ensure full understanding of the program and the role of the course he/she teaches as a component within it: • Presentation of the program and faculty systems (on a CD). • Lectures of senior faculty members should be attended by the new staff. • Clinical sessions of senior faculty members should be attended by the new staff. • First teaching lecture of the new staff should be assessed by senior faculty member.

3-Course planning, monitoring and review
This process requires the involvement of the project management team, including teaching staff, in monitoring course quality, annual review and planning for improvement.
• Regular meeting with course coordinators for discussing students' performance. • Quality assurance committee assigned to solicit feedback from the department regarding the course and ensure that quality is maintained. • Quality assurance committee to find solutions and make proper plans to overcome any difficulties found in the annual report. • Advisory Committee to hold regular timescale meetings with staff in the department to discuss the issues which occurred throughout semester.
• Problems identified are discussed and suitable solutions are suggested. • A follow-up is conducted to check the execution of the suggested solutions.

Project Management Group
This group is responsible for the management of the project on a daily basis and will monitor the progression of the course from inception to termination. Initially, the group meets twice a month and then once a month.

Steering Group
This group consists of individuals from other institutions, including a European university, with experience in implementing exercise therapy content in their students' curriculum. The group contributes by providing advice, including guidance in the preparation phase of the project, with no managerial function. Meetings with the project management team will be arranged three times in the preparation phase (Year 1) and followed by documented reports.
• Staff XO -Academic Director of Physiotherapy courses at the University of X*. • Staff XXO -Director of Applied Undergraduate Clinical Skills at the University of X*. • Staff XXXO -Academic Coordinator of Physiotherapy courses at the University of X*. • Staff XXXXO -Course Coordinator at the University of X*.
*The name of the university depends on the selection of a recognised European University by KAU.