Advances in Clinical and Medical Research

Abstract


Introduction General Introduction
Primary health care is the care for all ages, which includes all the people, who deserve the right care, everywhere, rights in their community. In the health care system of any country, the role of physiotherapists is very important because they ensure that the patients and their families. Physiotherapists are concerned with facilitating diagnosis, treatment, and the management of a variety of chronic and acute conditions, and this is also useful in the promotion of mobility and its function along with physical activities [1]. A large number of people in the whole world are facing the problem of disability in any form, and approximately 15 percent of the people from the world population are facing this problem. The disability prevalence is higher in poor countries in terms of resources in comparison with the high-income countries. At the global level, the estimation of disability has been increasing because of the spread of the population along with chronic disease along with improvement in the methodology that has been used to calculate the disabilities [2].
Health promotion is the most important element in addressing the issues related to public health, and now this time, the global health condition is not good. Health promotion is a political process, and the multi-faceted social have been aimed to improve the capabilities and individual skills [10]. Health promotion is the process of helping the people to have more control as far as the determinants of health, in terms of both individually and collectively are concerned with respect to enhancing the health. The physiotherapist is very important in the promotion of health, and their role is also significant in wellness, disability, and disease [11]. The physiotherapists are taking advantage of the expertise and the chance to assist the population and the individuals in avoiding the overall health and health problems [12].
The problem statement of this research work is that the role of a physiotherapist as the health DOI: https://doi.org/10.52793/ACMR.2022.4(1)-49 promotion practitioner in primary health care is not clear, especially in Riyadh city. This research work will be useful to fill the existing gap in the available literature by providing one city's evidence. Most of the research work has been conducted in the past to examine physiotherapists as health promotion practitioners in different regions of the world. A number of research works have been conducted in Saudi Arabia about the role of the physiotherapist in the primary health care sector in Riyadh City. Most of the research work is based on secondary data, but this research work will contribute significantly by using primary data. So, the statement of the problem is that the physiotherapist as health promotion practitioners in the primary health care in Riyadh City is not clear.

Research Questions
The research question of this research work are as follows; ➢ What is the role of a physiotherapist as a health promotion practitioner in the primary health care sector in Riyadh City?
➢ What is the importance of physiotherapists in primary health care in Riyadh City?
➢ What are the strategies used by the primary health care organizations and physiotherapists to increase the integration and mitigate the barriers?
➢ How can Physiotherapists reduce avoidable admission to residential care and to hospitals

Research Objectives
The main aim of this research work will be to find the role of a physiotherapist as a health promotion practitioner in primary health care of Riyadh city. The objectives to achieve this aim are as follows; ➢ To determine the role of the physiotherapist in Health promotion practitioners in Primary health care ➢ To find the importance of physiotherapists in primary health care in Riyadh City ➢ To suggest the policy on the basis of the findings of the study

Significance of the Study
The significance of this research work is that it will contribute significantly to the available literature on this particular topic. Most of the previous research work has been conducted by the different researchers in the past by taking the single or multiple countries as a shred of evidence. This research work is different from the previous studies because of the single city model. This research work will consist only of Riyadh city, and the results of the study will be applicable to the physiotherapist in Riyadh city. A number of research works are available on this issue, but most of them are conducted on the basis of secondary data, and this research work will contribute significantly towards available literature by using the primary data. So, this research work will help the policymakers in the primary health care sector in Riyadh City, Saudi Arabia, as far as the physiotherapist as health promotion practitioners are concerned.

Managerial Relevance
This research work is clear the picture associated with the role of the physiotherapists in the health care system. The findings of this study help the policymakers and the public to know the importance of physiotherapists as health promotion practitioners in the primary health care system in Riyadh city.
Physiotherapists play a key role in primary health care; the role of physiotherapists in health promotion helps to maximize the quality of life. The physiotherapists help in the rehabilitation and the habilitation programs because they can motivate the patients to recover fast.

Scientific Relevance
Physiotherapists play a key role in the maximization of physical potential and are also concerned with human function. In the primary health care sector, Physiotherapists help to ensure the care for patients and their families across the country. They also play an important role in the management and treatment of a number of acute and chronic conditions and diseases. They also promote physical activities, and they also increase function and mobility. The follow-up program and the regular monitoring from the side of the Physiotherapists help to fight the chronic disease and to maintain physical health.

Review of Literature
The review of literature is the most important part of any research work because it helps to find the research gap in the available literature. This will help to get a complete insight into the knowledge about the physiotherapist as the health promotion practitioners in the primary health care sector. The major objective associated with the literature review is to get a complete insight into the available debates and the existing literature related to a particular area and the topic of the study. The review of literature has been present the knowledge in the form of the written report, and this also helps to build the knowledge in the respective field.
[8] explained the procedure of occupational and physical preparation by conducting a call for action. The experts in the world are supporting the integration of wellness and promotion as far as the traditional health care services are concerned. The health care service providers should be engaged in providing the services by believing in the physical therapist and the occupational therapists. This research has been conducted with the aim of providing complete guidelines for occupational and physical therapists. Health promotion is most important to attain a higher level of life expectance rate and increase the control over improving the overall health. The results of the study have been suggesting that the role of physiotherapist are key to increasing awareness and the promotion of health not only at the individual level but also at the whole population level.
[3] conducted the research work on the Swedish physical activities on the prescription with the help of conducting the interview study with the management and the primary healthcare staff. The major objective of this research work is to describe the health professional views and the requirements along with barriers for the successful implementation of the Swedish physical activity on prescription in primary healthcare. The primary data have been collected with the help of eighteen semi-structured interviews, and among the respondents, the ten people are working in the local and central management, and further eight people are working as professionals in the health care system in the health care organization at the regional level with the help of analyzing and using the qualitative content analysis. The findings of the study have been suggesting the importance of forming the guidelines and the policies to establish the organizational structure and also ensuring that these are well known and are also approved in all the parts of the organization related to healthcare [13] explored capitationbased financing with the help of the provision of preventive services in primary health care. The online survey has been conducted to collect the primary data from the respondents of the survey, and the sample of 4320 adults has been used to collect the data. The data of 4320 respondents have been collected through the online survey on the basis of gender and the age of the respondents. The empirical findings of the research work have been suggesting that there is no correlation between the unit price of examination and the use of services. Under this research work, the model has been created that has been concerned with the consultation, engagement, and collaborative work at each level. It was also useful to channel the huge number of people into preventive health services that have been shown the facts more than 80% of the population are lies in the intervention area.
[4] carried out the research work on physical therapy and the health promotion of women with the help of defining abnormal function. This study expresses the case of women with various pelvic-related problems and presents the evidence for the use of physical therapy. Pelvic floor physical therapy is low risk, minimally invasive, and evidence-based. The empirical findings of the study have been suggesting that physical therapy and women's health promotion play a key role in primary health care [15] investigate the perceptions of health and the illness that are directly associated with physiotherapy and the frequent use in the primary health care system.
The major aim of this research work is to express the association between the non-regular and the regular use of the services related to physiotherapy, the perception of the illness, and the impact of illness. The primary data have been used, and the data for the cross-sectional survey have been including patients between 18 to 70 years of age. The empirical results of the research work have been suggesting that 507 patients are taking part in the survey, and 46 is the mean age of the participant. The significant variables in the final equation are associated with the regular use of physiotherapy [6] conducted qualitative research work for the purpose of understanding the promotion of the physiotherapy practice. The main public health issue is physical inactivity, and the professionals in health care are encouraged and promote physical activities in the routine patient contacts for the purpose of reducing the non-communicable disease, and it also enhances the quality of life of the individuals. The main objective of this research work is to understand the experience related to physiotherapists and their experience in clinical practice. The online interview was conducted through telephone, and the quota sampling techniques were used to collect the data. The findings of the study have been suggesting that four themes have been identified, which include the general wellbeing and the functional restoration, and the exercise, along with current physiotherapy as well as the barriers to physical activities promotion.
Health is an important element in a person's life because, without this aspect, life would be meaningless. The researchers have explained that health is greatly contributed to the functioning of the people. The role of physiotherapists is most crucial when it comes to the health of the people as these personnel director guide the people about how to manage their health issues [14]. These days, health issues have remained the major concern for the people while physiotherapists usually help the people about maintaining their health by proper and suitable kind of exercise as well as other aspects that are needed for a person to maintain health to the highest level [9]. The physiotherapists spend their lives to keep interacting with the people and listening to their health issues, and then directing them to buy medicines that are more likely to resolve their health issues. In this way, the role of the physiotherapists is positively correlated with the healthcare of the people and keeps them away from suffering from any major disorder or disease [10].
Over time, the researchers have understood that the physiotherapist's role is significant in maintaining the health of the people and contributing to their mental wellbeing as well. The study was conducted in the Netherlands in order to correlate with the primary health of the people. The main objective of physiotherapists is to educate people to understand what really matters for them to increase the chances of keeping away any kind of disorder or disease [17]. With exercise, people can maintain their health, but it is important to understand how much exercise will be required for the body. In developed nations, the role of the physiotherapists is much more important who understand healthcare values. Primary healthcare is greatly linked with the role of physiotherapists [13].
The changing mindset of the people is needed in order to maintain their better health, and physiotherapists are the personnel who keep in touch with the people. They also improve the lifestyles of people by making them ready to face serious issues in life [21]. A healthy diet with proper exercise could be critical to maintaining individual health, but this is not the case as in some areas, there is no focus on the diet pattern. However, the presence of physiotherapists is helpful in creating better methods to ensure the health of the people [14].
Continued care is related to the health of the public, whereas physiotherapists are useful in providing guidelines to manage healthcare affairs. Moreover, diseases can destroy people and can change their lives altogether, but periodic checkups of physiotherapists contribute to reducing the risks of diseases as well as disorders in public [17]. A recent study investigated that physiotherapist are the helping hand of the people who contribute to the healthcare system. The information of physiotherapists was collected who viewed that large numbers of the patients they treated and now they are well and spending their lives in a better way. Therefore, primary healthcare is related to the reduction in the rates of diseases or disorders. Cardiovascular diseases are increasing with the period of time, which are the leading cause of death on this planet [18].
The reduction in the ratio of these diseases is vital to improving the health of the people. Therefore, the role of physiotherapists is determining factor for the health of the people and great leads to creating a better way of life for them [19]. The number of primary healthcare issues is handled by physiotherapists who significantly help the public to keep a check on the health issues. The physiotherapists examined the abnormalities in the body and took effect as well as tame steps to reduce the attack of diseases. In this way, there is a positive influence of physiotherapists in primary healthcare and greatly contributes to making life quite easy for the public [20]. Primary healthcare is associated with reducing big healthrelated issues, and it plays a role in improving the way of life. This particular study was conducted in India, and the general public was selected for the interview, where the objectives of the research were focused [16]. It was concluded that the physiotherapists engage the public of an area and take of their health and try to keep them healthy. It is also stated that the people who used to visit physiotherapists are always fit enough to do different tasks at a time [21].
On the other hand, people who do not take care of their health and do not go to physiotherapists to make sure they check up and look after their body then leads to sudden issues or any problematic disorder that is too difficult to handle [17]. On the other hand, the physiotherapists also guide the people about how to manage their issues and what they should need to do in order to improve their health. They often provide a sheet to them to follow in order to make sure they are healthy internally as well as externally [18]. Working-class involves multiple difficult tasks while the physiotherapists always loom after the working class and take care of them after they suffer from the injury. Injury management is critically important as injury leads to destroying the career of the people while physiotherapists help the people to manage their injury in the right way that there will be no big issues arise [20]. On the other hand, maintaining health is a key factor that greatly contributes to the livelihood of the people. When people are safe and healthy, then there is a fair amount of chances that the people will lead a comfortable life. Moreover, change in the mindset of the people is really important as they need to understand that they should take care of their body and should visit physiotherapists to ensure that they are in good space as far mental health and body health is concerned [22].
In this way, there is a positive relationship between the physiotherapists in maintaining better chances to live a healthy life. This study is evident that physiotherapists are a major part of every society, which helps the public to keep efforts for their health [19]. Primary healthcare is needed for people to check on the increased risks of the diseases. There are various aspects that are associated with primary healthcare, majorly based on non-surgical action [23]. In other words, it is best described as the eliminator of the health-related disorder by improving the way of life by increased exercises and other factors that are needed to keep health in control. The role of the physiotherapist is crucial in maintaining the health of the public as well as decreasing the risks of suffering from major diseases or disorders [21]. Lots of studies have shown that physiotherapists are the main component of society as they often guide the public about maintaining their health as well as taking care of time right away after injury [24]. On the other side, they also sometimes remove the mental scars to make them ready to face any kind of issue quite easily and effectively. In this way, the role of the physiotherapists is crucial for the primary healthcare system in order to promote all those activities which have a positive role in health promotion [25].
Another study indicated that physiotherapists are the main part of every society who keep the people's health in proper order. These days, the issues of climate change are the main concern for the people, and there are lots of diseases that are contributed by the climatic issues [26]. Now, there is the need to take care of health in order to keep disease away from the public quite effectively. In this study, the data was gathered from 200 people in order to assess how physiotherapists help the public to keep their health in the proper order [27]. They indicated that there is a positive correlation between the physiotherapists and primary healthcare and significantly improve the way of living of the people and contribute to managing all the health-related issues [28]. The data have shown that there is a great value of physiotherapists in every society and contribute to the betterment of the people by ensuring their health. This work is evidence that public health is linked with the role of physiotherapists, and they are the main indicator of public health [29].
Disease prevention greatly improves the health of the public and is a part of the primary healthcare system. The physiotherapists are the personnel who take care of people's health when they are keen to visit them to ensure their health [30]. In other words, physiotherapists assist people to prevent any disease or disorder in the future and to maintain health in proper order. For this, they often prescribe various kinds of exercise or even medicine if required, and they try their best to keep people away from the disease attack [31]. On the other hand, the management of the injury and various other disorders are also handled by the physiotherapists who make errors to remove any kind of issues in the body internally as well as externally. Therefore, it is always valuable to assess the role of physiotherapists when it comes to primary healthcare [22]. Primary healthcare is not effective without the role of physiotherapists, as they are the determinants of the effectiveness of the primary healthcare system. Now, people have started understanding the role of physiotherapists in managing health issues of the public and removing the issues that could possibly lead to any kind of disorder or disease [32].
New research in recent times has indicated that the primary healthcare system is the determinant of the health issue of society. When the primary healthcare system is good enough for society, then there are fair chances that people will not suffer from diseases or disorders in the future. Therefore, the effectiveness of primary healthcare leads to the healthy lifestyle of the people, while if this is not the case, then there are more risks of people suffering from any dangerous disease [33]. In this way, it is the physiotherapists who usually keep the public aware of the disease attacks and advise the public to take the further step to make their body immune to various diseases. The education and advice of the physiotherapists are also critical and greatly contribute to people's health by preventing and even managing the diseases [9].
Therefore, physiotherapists are a vital part of the primary healthcare system, and the role of physiotherapists in developed nations is clear and more significant due to the educated public and other striking factors. It is declared that the physiotherapists are the health promoter of the public, which leads to public health [10]. Overall, it is important to understand the physiotherapist's role in the lives of the general public and in primary healthcare. In other words, they are a vital part of every society that educates the general public in a variety of ways. Hence, they give clear directions to the public to manage their health issue in time in order to keep a check on various diseases that would be fatal [13]. However, there is still a need for advancement, more specifically in the case of developing nations where people do not have enough money to spend on the physiotherapist and the role of this personnel are minimized under the circumstances, but still, big cities' people love to visit the physiotherapist to ensure that their body is working well and there are no signs of the diseases or any disorders [15].
Therefore, people should need to explore the role of the physiotherapist in preventing dangerous diseases as well as managing health-related issues that are too hard to handle. Numbers of studies have indicated that the physiotherapist's role can never be negated no matter what are the norms of society, but the role of the physiotherapist is always vital and worthwhile in the case of primary healthcare [14].
On the other hand, they determine the health-related issues that exist in society, and they try their levels best to beat the arising health issues and try to maintain the health of the people in the proper order [16].

Hypothesis
Hypothesis -1 H1a: The role of physiotherapist is significant in Health promotion in primary health care in Riyadh.

The Methodology
This research work is consisting of a mixed research approach which includes both qualitative research approach and quantitative research. The primary data are used in this research work to extract the empirical results, and the primary data will be collected with the help of an online questionnaire. The questionnaire, with the help of Google form, will be used to collect the data, and the questionnaire will consist of two types of questions which include the binary and the Like rt scale questions [34]. The collection of the data through Google form is the best method of data collection, especially in the time of the Global pandemic, because it is very difficult to conduct and arrange the physical meeting and that the main reason behind using the online survey method of data collection [35].
The online survey helps to avoid the biasness in the research work because the respondent, through the online method, will give their response without any influence from the side of the researchers. Simple random sampling will be the best method for the collection of the data because it helps to avoid the biasness of the data, and under this approach, the data have been collected randomly [36]. After the collection of the data, the next step is concerned with the analysis of the data. The data will be in the form of opinion when it is collected through Google form, and different techniques in the form of Data cleaning and data mining will be sued to transform the qualitative data into quantitative data. The data cleaning and data mining will be used to transform the qualitative form of data into the quantitative form of data [32]. After the transformation of the data from the qualitative form to quantitative form with the help of data coding and data cleaning will be used to eliminate the messy data and the outlier from the data set. After the use of Microsoft Excel for data coding and data cleaning, the next stage will be concerned with the use of statistical software in the form of SPSS [30]. In the first stage, while using the SPSS, the principal components analysis will be used under the multivariate analysis techniques. The principal component's analysis technique will be used to transform a large number of observed variables into a small number of latent variables. The primary data have been used for the analysis and the extraction of the results because the data have been collected with the help of a questionnaire, and the first-hand data have been collected with the help of binary and the Likert Scale questions [37].

Research Approach
The mixed research approach, with the help of combining the qualitative and the quantitative research approaches, will be used to extract the findings of this study. The data will be collected by using the qualitative research approach because the questionnaire method will be used for the collection of the data. After the collection of the primary data by using the qualitative research approach, the next step will be concerned with the processing of the data by using the quantitative research approach because the different econometrics techniques will be used with the help of SPSS (Statistical Packages for the Social Science). In this research work, the data have been collected through an online survey with the help of Google form, and primary data have been used further for the analysis by using the Quantitative research approach [29]. The mixed research approach is the most suitable research approach for this research work because the data collection process of this study area lies in the category of qualitative research approach, and the data collection proves are lies in the category of the quantitative research approach. The different econometrics techniques are used for the analysis of the data because the collected data are in the qualitative form, and for the purpose of converting the qualitative data into a quantitative form, the data coding and the data cleaning are used for the analysis of the data [27].

Mixed Research Approach
The mixed research approach is the research approach under which the analysis has been conducted on both qualitative and qualitative data. The mixed research approach has been used more commonly in nursing and the health care sector. The mixed research approach is the combination of both qualitative and qualitative research because in this research work, in the first stage, the questionnaire has been developed with the help of a qualitative approach. The data have been collected in the form of opinions, and after that, different statistical tools are applied to convert the qualitative data into quantitative data [38].
The number of benefits is associated with the mixed research approach and the method flexibility, and the mixed research approach helps to provide flexibility in the designing of the research. The mixed research approach has been for the purpose of collecting and the analysis of the data, and it is used to collect and analyze both types of data. The synergy is the best advantage associated with the mixed research approach, and this is also useful to create a solid foundation for extracting the evaluation and the conclusion. The development and the expansions are also the major advantages associated with the mixed research approach [26].

Research Design
This research work is used the mixed research approach because this study is based on primary data. The primary data have been used for the analysis and the extraction of the results. The questionnaire consists of different types of questions which include binary questions, Likert scale questions, and openended questions to find the physiotherapist as health promotion practitioners in the primary health care in Riyadh city [39]. The questionnaire is more reliable, and validate because all the ethical aspects are considered while making the questionnaire of the study. The primary data have been collected with the help of questioner that further consists of several types of questions. After the collection of the data, the objectives of the study have been achieved [40].

Data Collection Approach
The Google form method is used for the collection of the data on the basis of the online questionnaire.
The online survey will be used for the collection of the data, and the questionnaire will consist of binary and Likert scale questions. This study is based on the survey because this will be the best suitable method of data collection in this research work. The online approach of data collection will be the best method of data collection because, at the time of the Global pandemic of Covid-19, it is very difficult to conduct a physical meeting with the respondents. The online survey is consisting of three major types of questions which further include the Likert Scale questions, binary questions, and open-ended questions [41]. The main reason behind using the online survey is the ongoing Global pandemic of Covid-19 because it is very difficult to conduct a physical meeting with the respondents. The online survey is also useful to save money and time because it reduces the time required to deal with the respondents, such as transportation costs.

Sample Size and Population
The sample size of this research work consists of the data of 500 physiotherapists, and the targeted population is all the physiotherapists who operate in the Kingdom of Saudi Arabia. The simple random sampling technique has been used for the collection of the data among the physiotherapists because it helps to avoid the biasness in the data collection procedure, and further, it also helps to save time. The selection of the physiotherapist is the most important factor associated with the collection of the data, and the main reason behind using simple random sampling is that it helps to save the time spent on selecting the respondents. The biasness and the influence of the researcher on the respondents are not part of the simple random sampling [23].

Data Analysis
Microsoft Excel and the SPSS software are used for the data analysis that will be collected by using the Google form method for collection of the data. The data coding and the data cleaning will be used to transform the data from qualitative form to quantitative form. The data coding will be used to transform the data from qualitative to quantitative form because it helps to transform the data from opinionbased to number-based. The Data cleaning and data mining will be used to eliminate the unnecessary data from the data set, and it helps to eliminate the outliers from the data set. After applying, data cleaning and data mining will be used to make the data set suitable for the SPSS software [43]. The multivariate analysis techniques are used in the form of principal components analysis, and the factor analysis will be used to transform a large number of observed variables into a small number of latent variables. Transforming a large number of observed variables into a small number of latent variables will help make the analysis easier. The Cronbach's Alpha will be used to measure the internal consistency of the data because it is very important to apply Cronbach's alpha on the data to measure the internal consistency. The correlation matrix will be used to measure the direction and the strength of the association between two variables. The multiple linear regression analysis will be used to find the association between the dependent and independent variables [33].

Cronbach's Alpha
The Cronbach's alpha is the econometrics technique that helps to find the internal consistency of the data and the reliability of the data. The value of Cronbach's alpha is lies between 0 to 1, and the higher value of the alpha coefficient indicates that the variable is highly reliable and moves in the same direction. The internal consistency of the data has been measured with the help of the alpha coefficient because the value higher than 0.5 indicates that the observed variables are moving in the same direction, and they are internally consistent with each other. The higher value means that the observed variables are highly associated or correlated to each other to produce more productive results [22].

Principal Components Analysis
The principal components analysis is used to reduce the size of the data, and it also reduces the dimension of the data. The multivariate analysis techniques are the best technique used to reduce the dimension of the data. It helps to reduce a large number of observed variables sin to the small number of the latent variable. The collected data are consisting of a large number of variables that very difficult to proceed with for the purpose of extracting valuable results. The PCA is used to reduce the number of variables, and it is also helpful to transform the higher correlated variable into a lower number of uncorrelated variables [31]. The KMO test has been used to measure whether the data are suitable or not for the principal components analysis. The value of the KMO test greater than 0.5 indicates that the principal components analysis is useful for the analysis of the data. It reduces the dimension of the data by reducing a large number of observed variables into a small number of variables. The factor analysis and the principal components analysis are used to reduce the number of variables, and it also converts a large number of highly correlated variables to the small number of uncorrelated variables [28].

Correlation Matrix
After extracting the latent factors or variables with the help of principal components analysis, the next stage is concerned with finding the association between the latent variables. The correlation between the latent factors helps to determine the degree and the strength of the association between the variables in both negative and positive ways. The value of the correlation coefficient is lies between -1 to +1. The Zero value of the correlation coefficient indicates that there is no association between the two variables, and they are totally uncorrelated to each other [25]. The negative value of the correlation coefficient indicates that the two variables are moving in the opposite direction, which means that the increase in the value of one variable led to reduce the value of the other variable. The higher negative value of the correlation matrix indicates that two variables are highly negatively associated with each other, while the higher positive value indicates that the two variables are moving in the same direction. If the correlation value between the two variables, is one indicates that the two variables are perfectly correlated to each other. It helps to find how two variables are related to each other and how the change in one variable affects the other variable [24].

Descriptive Statistics
The summary statistics are the consist of summarizing the data in the form of central tendency and the dispersion of the data. It is used in the case of observed variables and the latent variables by summarizing the data in the form of mean, median, and mode. The central tendency has been measured with the help of mean, median, and mode, while the standard deviation and the variance are used to measure the dispersion of the data from the mean of the data. The value of standard deviation indicates that the individual value is diverse from the mean of the data [19].

Regression Analysis
The regression analysis is used to determine the association between the dependent and the independent variables. At the end of the analysis, the multiple linear regression analysis helps to find the final results by examining the relationship between the dependent and the independent variables. The p-value of the multiple linear regression analysis is used to examine the association between the dependent and the independent variables; if the p-value is less than 0.05 indicates the two variables are significantly associated with each other, or the increase in the value of one variable leads to increase in the value of the other variable. It is one of the most commonly used techniques in the research, which helps to understand the association dependent and the independent variables, and it also examined the change in the dependent variable as the result of the change in the independent variables [20].

Analysis and Result
The SPSS and the Microsoft Excel have been used for the analysis of the data and the different statistical tool have been applied on the data. The data of 362 participant have been used for the analysis and the results of the survey have been pasted in the Appendix-C. The questionnaire has been used for the collection of the date and the questionnaire of this research work is also pasted in the Appendix-A as the evidence. The summary statistics have been used to summarized the variables which includes the demographic variables along with the variables that used to the diffusion of the information. The correlation test has been used to check the relationship between the variables by measuring the degree and the magnitude of the relationship between the variables. The multivariate analysis techniques are also used to extract the latent variable of the physiotherapist as the health promotion practitioners with the help of 24 items that have been observed through the questionnaire. The primary health care has been measured with the help of the binary variable because it is very important measure that how the physiotherapist as the health promotion plays a key role in the growth of the primary health care in Riyadh City.

Results of Descriptive Statistics
The results of the summary statistics have been presented in the below mentions tables and the different tables have been used to express the characteristics of the data because all the characteristics is very difficult to summarized in just one  The above mention table are consisting on the summary of the first ten variables that have been used for the diffusion of the variables. The number of participants has been changed with the change in the questions, the mean value of the variables is indicating that the most of the participant are agree on the asked statement in the form of questions. The value of the standard error is indicating that the sample size is not fully represent the population. The variance and the standard deviation are indicating that the mean and the individual are different from each other.
The above mention table are indicating that the most of the participant are agree on the statement and the Skewness value indicates that the data is spread from the mean value which means that it is skewed in the both sides. On the other hand, the value of the standard error is indicating that sample are fully represent the whole population. The different statement has different participants because some people are not like to answers all the questions.  The values of the kurtosis are indicating that the data are positively skewed which means that that most of the data are lies at the right side of the bell curve. The mean value of the most of the variables are indicates that the participant is agree and strongly agree on most of the statement because the mean in most of the causes are les between the one and two. The values of the standard deviation are indicating the data are diverse from the mean values of the most of the variables. The above mention   *. Correlation is significant at the 0.05 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed). The above mention tables, 6, 7, 8, and 9 are shows the degree and the strength of the relationship between the observed variables. The first six variables have been used to extract the association between these variables because the all-variables summary about the correlation are not possible to mention in just one table. The negative association between the two variables means that they are moves in the different direction and increase in the value of one variable are leads to increase the value of the other variables. The Pearson correlation test are also examining the significance of the relationship between the variables. The value of Pearson test is indicating that the if it is less than 0.05 which means that there is significant relationship between the variables while if it is greater than 0.05 which means that there is no association between the variables. The higher value of correlation between two variables means that these two variables are highly and directly associated with each other and it also indicates that the increase in the value of one variable are leads to increase in the value of the other variable.    The above mention tables that contain the results of the Alpha test are indicates that the 24 observed variables have been used to extract the one latent competent in the form of Physiotherapist as Health Promotion Practitioners because it required to check the association with the primary health care and the growth of the primary health care sector have been measured by using the binary variable in the form of dummy variable. The value of the alpha is indicated that the variables are internally reliable and they are moving in the same direction. The 24 items have been used to extract the latent factor and the value of the alpha greater than 0.7 which is the minimum acceptance level and it shows that the variables are internally reliable and they are moves in the same direction. Sig. 0      The results of the regression analysis are indicating that there is direct relationship between the Physiotherapist as Health Promotion Practitioners and the growth of Primary Health Care because the null hypothesis have been rejected on the basis of the p-value and the alternative hypothesis have been accepted because the p-value is greater than 0.05. The growth of primary health care has been measured with the help of dummy variable and the Physiotherapist as Health Promotion Practitioners have been extracted with the help of 24 items that asked from the participant in the form of questions.

Model
So, at the end we can say that the role of Physiotherapist as Health Promotion Practitioners in primary health care is significant.  Physiotherapists have no role to play in the health promotion in Riyadh City.

Frequency Analysis
Physiotherapists working within district health system should include health promotion in their services in Riyadh City. The physiotherapists is responsible for the planning of a health promotion polices in Riyadh City.
Physiotherapists as health promotion practitioners are responsible for evaluation and implementation of health promotion in Riyadh City.
Would physiotherapists educate people on ergonomics in community where you practice in Riyadh City.
Would Physiotherapists play a part in arrive alive campaign of the government in Riyadh City.  Would Physiotherapists educate all the clients on healthy diet and need for exercise in Riyadh City. Would physiotherapists participate in an advocacy activity to electrify households to reduce burns caused by the use of coal and paraffin in Riyadh City. Would physiotherapists get involved in the efforts to improve the physical exercise for schoolchildren to reduce the prevalence of obesity and related diseases in Riyadh City. The physiotherapists advice others to make use of seatbelt to prevent serious injuries in Riyadh City.

Discussion and Conclusion
This research work is concerned with the physiotherapist as the health promotion practitioners in the primary healthcare of Saudi Arabia by taking the evidence of the Riyadh city. The role of physiotherapist is very important in the healthcare system of any country because the focus on the healthcare improvements is the main concern from the last few years. The primary healthcare is one of the most important sectors in any country and it also important for the individuals. This work is based on the primary data analysis and the primary data have been collected from the participants through the Google form method. The questionnaire has been used to collect the data from the participants that related to physiotherapists and the total 362 respondents are participates in the survey. The participation rate of the participants in the survey have been changed with the changed in the questions that have been asked from the participants.
The number of questions has been asked from the participants of the study and the questionnaire are Physiotherapists can reduce wait times for medical specialists for patient who assessed and screened access have been already in orthopaedics, rheumatology and neurosurgery in Riyadh City.
Physiotherapists can reduce avoidable admissions to hospital and residential care in Riyadh City.
Physiotherapists can optimize and maintain functioning of independence in those beginning to fail in Riyadh City.
Physiotherapists can facilitate early discharge in Riyadh City.
the data with the help of number of techniques which includes the descriptive statistics and the correlation matrix along with the dimension reduction techniques as well as the reliability test. The frequency and the percentage analysis are also including in the study to determine the frequency of appearing each option as the answer of the asked question.

Discussion
The major finding of the study is suggested that the physiotherapist have a key role in the primary healthcare sector in the Saudi Arabia. The participation rate of the participants has been changed with the change in the questions because the participants are not answer all the question and the number of responses has been fluctuate with the change in the questions. The first questions asked from the participants about the age of the respondents and the answer of the participants are indicates that the large share of the participants in the survey have an age group of 18 years to 25 years. The participation rate is indicating that the 33.8 participants have an age of 26-35 years as far as the participation in the survey with respect to age is concerned. The other age group have a very limited share in the survey because their participation is decreasing with the increase in the participants in the survey.
On the other hand, the female physiotherapist share in the study is greater than the share of the male participants in the survey. The composition of the gender participation is indicating that the female share in the survey is 54.3 percent while the share of the male in the survey is 45.7 percent. It means that the share of the male participants is lower as compared to share of the females' participants and it indicates that the female are participants in the survey with more encouraged level. In the survey the share of the married individuals is greater than the other option because the data are suggested that the share of married physiotherapist is 32% and it is greater until the divorced data is not appeared in the survey. The 42% share of the survey are consisting on the single individuals and the 20.7% is divorced.
It shows that the single participants are greater than the all-other categories because they have a higher rate as compared to other categories such as the divorced and the singles. On the other hand, when we come to the education level of the participants in the survey find that the participants with the education level of bachelor is greater than the all-other education level because the data are indicating that the bachelor have a share of 68% in the survey while the share of masters in the survey is 30.7%. The share of the other education level in the survey is lower as compared to all other categories of the education. The data of other occupation are indicating that the private sector have a lower share in the survey as compared to the Government sector because the participation rate of the physiotherapist in the survey are indicates that the physiotherapist from government sector is contributing in the survey is 79.8 percent while the share of the private is 20.2%.
The data of the nationality are indicating that the 100 percent participants are contribute in the survey are belong to Saudi Arabia and it means that not a single individual are including in the survey from the other countries. The data of the provinces are indicated that the large share of the participants is coming from Riyadh and the hundred percent participants are belongs to Riyadh city. All the participants of the study are belonging to the Riyadh as the province and it is used as the research area of the study. The composition of the participation rate has been changed of the questions that used to determine the role of the physiotherapist in the health promotion in the Riyadh city of Saudi Arabia. The first questions asked from the participants about the physiotherapist have no role in the health promotion and the answer of the respondents are indicates that most of the participants are comes with the question of the strongly disagree which means that the role of physiotherapist have significant contribution in the health promotion in Riyadh city.
The second question have been asked from the participants about the physiotherapist working within the district health system. The second question asked from the participants about the inclusion of the physiotherapist in the promotion of the healthcare services in the Riyadh city Saudi Arabia. 36.2 percent participation rate are indicating the physiotherapist must be include as the health promotion in the services that provides in the Riyadh city. The 56.4 percent participants are agreeing on the statement that concerned with the district health system that includes the health promotion in the Riyadh city. The share of neutral and the disagree option is very lower which means that the most of the participants are agree and strongly agree about the statement of the question two.
The third questions have been asked from physiotherapist and most of the participants are agree and the strongly agree about the statement that have been from the participants. The share of the neutral is lower as compared to the strongly agree and agree which means that the physiotherapist is responsible for the development of the health promotion policies in the Riyadh city. The most of the participants are agree and strongly agree on the statement the physiotherapist are shift from the biomedical approach to a model ensuring health promotion in Riyadh city. The 55 percent participants are strongly agreeing and the 40 percent are agreed on the statement which means that the physiotherapist in the Riyadh Saudi Arabia are shift from the biomedical approach to the model ensuring health promotion.
The question fifth have been asked from the participants that indicates physiotherapist are responsible for the planning of the health promotion policies in Riyadh City. The 72% participants are strongly agreeing on the statement and the 26 are agree about that which means that the most of the physiotherapists are more responsible for the planning of the health promotion policies in Riyadh City. The physiotherapist as the health practitioners is responsible for the evaluation of the implementation of the health promotion in the city of Riyadh. The 46.6 participants are agreeing and the strongly agree each about the statement that examined that the physiotherapist is responsible for the implementation and the evaluation of the health promotion in Riyadh City.
The physiotherapist is educated people about the ergonomics in the community that have been practices in the Riyadh city. The 70.1 percent participants are strongly agreeing and the 26.6 are agree on the statement that the physiotherapist are educate people about the ergonomics in the community. The statement of the question eight are indicates that the physiotherapist is play an important role in the arrive of the alive campaign of the Government and the most of the participants are agree and the strongly agree about the statement that most of the participants are agree on that physiotherapist play an important role in the campaign that have been launched by the Government. The physiotherapist has been educating all the clients about the exercise in the Riyadh city of Saudi Arabia and it shows that the large share of the participants is strongly agree and the agree on the statement that concerned with the role of physiotherapist about the educating the people about the health diet in Saudi Arabia. The result of the study has been also suggesting that the physiotherapist have been reduced if the burns that arises because of the use of the coal and the paraffin in the Riyadh city in Saudi Arabia. The findings are also suggested that the role of physiotherapist is also important in the efforts that required to improve the physical exercise for school children for the purpose to reducing the prevalence of the obesity and the other related disease.

Conclusion
The primary data analysis has been conducted to find the relationship between the physiotherapist and the primary healthcare sector. The 24 questions have been asked form the participants about the relationship between the primary healthcare and the role of primary healthcare in Saudi Arabia. The different techniques in the form, of correlation matrix, reliability test and the dimension reduction techniques have been used for the analysis of the data. The frequency analysis along with the bar charts are also conduct to find the frequency and the percentage of the participants as far as the answer of the questions is concerned. The results of the study have been indicating that the physiotherapist have been play an important role in the reduction of the obesity because they play a key role in the improvement of the physical activities.
The empirical findings of the study that have been extracted by using the survey data of the study indicates that the physiotherapist is given the education to the public about the use of precautionary to avoid from the injuries that may occur such as the use of the seatbelt in the Riyadh City. The physiotherapist is involved in proving the good environment as far as the working environment is concerned are providing the good working environment is concerned. The data analysis is also indicating that the physiotherapist is educating the client on the correct posture and the method to lifting the heavy objects in the Riyadh city. The most of the participants are strongly agree and agree on the statement that the physiotherapist are providing the sweetened beverage for the purpose prevent the diabetes in the Riyadh city. The physiotherapist is playing a key role in the evaluation of the promotion of the health activities because of the respondents are agree and strongly agree on the statement that the physiotherapist helps in the evaluation of the health promotion activities in the Riyadh city of Saudi Arabia.
This work is also found that the physiotherapist are helps the patients about the early discharge from the hospital in Saudi Arabia. More than half participants are agreeing on that the physiotherapist are play significant role in the early discharge of the patients from the Hospitals. They also provide the optimization and maintaining the functioning of the independence to fall in the Riyadh and the results are also suggest that the physiotherapist is also reduced the rate of admission in the residential care in the city of Riyadh KSA. The reduction in the time associated with the getting the services of the medical experts as far as the specialty is concerned are also depends on the physiotherapist.

Managerial Relevance
The managerial relevance of this research work is that it helps the managers in the primary health care sector to increase the appearance of the physiotherapist and give important to the opinion of the physiotherapist in the decision making. The role of manager is very important in any sector and the situation is not different in the primary healthcare sector. This research work is also helping the managers to make the policy on the basis of the findings and it helps to build the competitive advantages of the primary healthcare sector by using the significant role of physiotherapist.

Scientific Implications
The scientific implication of the study is that it based on the primary data analysis and this work is contribute in the available literature in a significant way. This research work is providing the future research direction in the primary healthcare sector. The findings are help to develop the effective polices in primary healthcare sector as far as the role of physiotherapist as the health promotion is concerned.

Limitations and Scope for Future Research
The limitations of this work are that only applicable in the primary healthcare sector and it only limited to one city of the Riyadh city in KSA. The future research direction is that the research work must be conducted in other cities and overall impact of the physiotherapist on the life expectancy rate.