
==== Front
Sci Rep
Sci Rep
Scientific Reports
2045-2322
Nature Publishing Group UK London

39237699
71232
10.1038/s41598-024-71232-6
Article
Knowledge, attitudes, and practices of healthcare professionals toward rehabilitation of peripheral nerve injury
Li Guannan 1
Xu Ning 1
Luo Tingting 2
Wang Lingshu wanglingshu2013@163.com

1
1 https://ror.org/059c9vn90 grid.477982.7 0000 0004 7641 2271 Department of Rehabilitation, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, 150060 China
2 grid.412068.9 0000 0004 1759 8782 Department of Rehabilitation, Heilongjiang University of Traditional Chinese Medicine, Harbin, 150040 China
5 9 2024
5 9 2024
2024
14 207253 2 2024
26 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Peripheral nerve injury (PNI) occurs due to damage of peripheral nerves, with healthcare professionals playing significant roles in PNI rehabilitation. This study aimed to explore the knowledge, attitudes, and practices (KAP) towards PNI rehabilitation among healthcare professionals. This cross-sectional study was conducted on June 2023 in China and healthcare professionals were enrolled. A total of 611 valid questionnaires were collected, with 62.52% female respondents. Mean scores for KAP were 14.26 ± 2.044 (possible range: 0–19), 29.77 ± 3.622 (possible range: 7–35), and 41.55 ± 9.523 (possible range: 11–55), respectively. Multivariate logistic regression revealed positive associations of professional titles (OR = 1.743, 95% CI: 1.083–2.804), occupation (OR = 1.833, 95% CI: 1.151–2.919), and involvement in treatment or care of PNI patients (OR = 1.462, 95% CI: 1.024–2.088) with knowledge. Knowledge (OR = 1.155, 95% CI: 1.042–1.280), gender (OR = 2.140, 95% CI: 1.255–3.646), education (OR = 2.258, 95% CI: 1.131–4.507), and involvement in treatment or care of PNI patients (OR = 2.463, 95% CI: 1.460–4.155) were positively associated with attitude. Attitude (OR = 1.214, 95% CI: 1.148–1.283), bachelor's degree education (OR = 0.548, 95% CI: 0.326–0.919), master's degree or higher (OR = 0.545, 95% CI: 0.308–0.964), having rehabilitation training for PNI (OR = 2.485, 95% CI: 1.633–3.781), and involvement in treatment or care of PNI patients (OR = 2.093, 95% CI: 1.395–3.138) were independently associated with practice. Healthcare professionals exhibited moderate knowledge, positive attitudes, and moderate practices towards the PNI rehabilitation. Those involved in the treatment or care of PNI have significantly higher KAP. Targeted interventions were needed to enhance understanding and promote proactive engagement in clinical practice.

Keywords

Knowledge
Attitudes
Practices
Peripheral nerve injury
Rehabilitation
Healthcare professionals
Cross-sectional study
Subject terms

Neuroscience
Medical research
issue-copyright-statement© Springer Nature Limited 2024
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pmcIntroduction

Peripheral nerve injury (PNI) refers to damage incurred by peripheral nerves, and manifests as motor, sensory, or autonomic dysfunction1. These injuries stem from various sources, including trauma, medical conditions, and surgeries1. PNI exacts heavy tolls on patients both physically and mentally, and detrimentally impacts multiple facets of their lives. Physical consequences of PNI include compromised motor function, loss of sensation, and chronic pain, all of which substantially diminish individuals' ability to perform daily activities and lead an independent life2,3. Moreover, the resulting loss of autonomy can lead to frustration, anxiety, and depression, which further exacerbates the burden on patients' mental health4. Globally, PNI has posed substantial public health issues, with an incidence rate of 13 to 23 per 100,000 person-years5. Notably, approximately 20 million individuals are afflicted by PNI in China, with an annual increase of 2 million cases6. This escalating trend underscores the importance of effective rehabilitation strategies to mitigate these consequences.

Healthcare professionals play a critical role in the rehabilitation of PNI by providing comprehensive care and support to patients. Specifically, physicians and specialized neurologists are responsible for accurately diagnosing PNI, which involves thorough physical examination and various diagnostic tests, such as electromyography (EMG) and nerve conduction studies7. Besides, surgeons with expertise in nerve repair and reconstruction may be involved in cases of severe nerve injuries, such as nerve lacerations or avulsions, to restore nerve function8. Moreover, pain management specialists prescribe medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants, to alleviate pain and reduce inflammation associated with PNI9. To ensure the effectiveness of rehabilitation efforts, knowledge of the latest advances in PNI management, coupled with positive attitudes toward patient care and evidence-based practices, are instrumental in the multidisciplinary approach.

In the above context, the knowledge, attitudes, and practices (KAP) study provides a comprehensive approach to examining healthcare professionals' understanding, attitudes, and actions concerning PNI rehabilitation10. By assessing their knowledge, attitudes toward PNI prevention and treatment, and adherence to prescribed measures, this study offers valuable insights for targeted interventions and educational initiatives towards healthcare professionals. For example, a study conducted in Ethiopia revealed that while nearly all emergency medicine and orthopedic physicians held favorable attitudes toward peripheral nerve blocks, the majority did not consistently administer these blocks and lacked the necessary skills11. To date, no KAP studies of PNI rehabilitation are available among healthcare professionals in China. The study gap not only hinders our understanding of the current state of PNI rehabilitation practices, but also has implications for the quality of care provided to PNI patients and their overall prognosis.

This study aimed to fill this gap by conducting KAP study towards the PNI rehabilitation among healthcare professionals in China. Besides, the influential factors of KAP were explored to identify potential targeted population. It was hypothesized that healthcare professionals' knowledge could positively influence their attitudes and practices, and that attitudes could positively impact their practices. Our findings would have implications for healthcare policies and professional training, and ultimately contribute to enhancing outcomes and the overall quality of life for individuals suffered from PNI.

Methods

Study design and participants

The cross-sectional study was conducted among healthcare professionals in China from June 2 to June 30, 2023. Inclusion criteria included the following: (1) Participants aged 18 years or older. (2) Participants possessing the Chinese medical practitioner qualification certificate, irrespective of their direct involvement in PNI-related clinical practice. Exclusion criteria included the following: (1) Participants who declined to participate in the study. Ethical exemption for this study was secured from the Medical Ethics Committee of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, and informed consent was obtained from all participants.

Questionnaire design

The questionnaire design adhered to published guidelines and relevant literature12–16. Subsequently, it underwent an iterative series of refinement with input from two senior rehabilitation physicians and several group discussions. A small-scale pilot test consisting of 28 individuals was conducted to assess its reliability. Cronbach’s α of 0.915 was further yielded, indicating strong consistency of questionnaire.

The finalized questionnaire was presented in Chinese and encompassed four main sections. Demographic information included 11 items, including age, gender, marital status, education, hospital degree, professional title, occupation, years of work experience, participation in rehabilitation training related to PNI, treatment or nursing of patients with PNI, and sources of acquiring knowledge about PNI rehabilitation. Knowledge dimension included 11 questions. Questions 3–4 and 6–11 were scored 1 point for correct answers, with no points awarded for incorrect responses. Questions 1 and 5 used a 2-point scoring system, assigning 2 points for "Proficient," 1 point for "Familiar," and 0 points for "Unaware." Question 2 had a maximum score of 6, with points allocated based on the number of correct answers. Scores in the knowledge dimension ranged from 0 to 19. Attitude dimension included 7 questions, employing a 5-point Likert scale ranging from "Strongly Agree" (5 points) to "Strongly Disagree" (1 point). Scores in the attitude dimension ranged from 7 to 35. Practice dimension included 11 questions, also utilizing a 5-point Likert scale from "Always" (5 points) to "Never" (1 point). Scores in the attitude dimension ranged from 11 to 55.

Adequate knowledge, positive attitude, and proactive practice are defined as a total score exceeding 70% for each dimension17.

Quality control and distribution process

An electronic survey was created via the online platform Sojump, and participants were provided with a QR code for questionnaire access. Respondents could either scan the QR code using WeChat or utilize the provided link to access and complete the survey. To maintain data integrity and comprehensiveness, each IP address was limited to a single submission, and all survey items were mandatory. Participants were guaranteed anonymity throughout the survey process. The research team, comprising three doctors trained as research assistants tasked with questionnaire distribution and promotion, conducted a thorough review of all submissions to ensure completeness, internal consistency, and logical coherence. Additionally, questionnaires completed in under 60 s, those containing logical errors, or those with uniform responses across all items were categorized as invalid.

Sample size calculation

The calculation of sample size was as follows18: n=Z1-a2δ2×p×1-p

where n denoted the sample size, and p was assumed to be 0.5 to ensure the maximum sample size. α, also known as the type I error, was set to 0.05. Assuming an effective questionnaire recovery rate of 80%, the final target is to collect at least 480 completed questionnaires. This study successfully enrolled a total of 611 participants.

Statistical analysis

Descriptive analysis was performed on the demographic information and KAP scores of the participants. Continuous data were expressed as means and standard deviations (SDs), while count data were presented as n (%). For continuous variables with normal distribution, Student's t-tests were applied for comparisons between two groups. In cases where the data did not adhere to a normal distribution, Wilcoxon-Mann–Whitney tests were utilized for two-group comparisons. For continuous variables with three or more groups with normal distribution and equal variance, ANOVA was employed for comparisons. Conversely, the Kruskal–Wallis analysis of variance was implemented when the data from three or more groups deviated from normal distribution. KAP scores were dichotomized using a threshold of 70%17. Univariate and multivariate logistic regression analysis were employed to explore the associations between demographic characteristics and KAP scores. Variables with P < 0.05 in univariate analysis were considered for inclusion in the multivariate regression model. In this analysis, P values were reported to three decimal places, with statistical significance defined as P < 0.05. The statistical software used for analysis was SPSS 26.0 (IBM Corporation, America).

Results

Demographic characteristics of participants

A total of 611 responses were collected for this study. The majority of participants were aged 31 years and above (36.82%), held bachelor's degrees (43.54%), and had junior professional titles (36.66%). Most participants were female (62.52%), unmarried (60.39%), affiliated with tertiary hospitals (65.30%), employed as physicians (79.05%), and possessed 1–3 years of work experience (53.68%). Notably, more than half of healthcare professionals did not engage in rehabilitation training related to PNI (58.10%). However, they had experience in treating or caring for patients with PNI (58.76%). Toward sources of knowledge acquisition in PNI rehabilitation, most participants favored professional journal reading (62.19%), followed by attending knowledge lectures (61.37%), and conducting independent literature searches (57.61%) (Table 1).Table 1 Demographic characteristics and KAP Scores of participants (N = 611).

Variables	N (%)	Knowledge (mean ± SD)	P	Attitude (mean ± SD)	P	Practice (mean ± SD)	P	
Total score	611	14.26 ± 2.044		29.77 ± 3.622		41.55 ± 9.523		
Age			0.049		0.575		0.196	
18–25 years	196 (32.08)	14.12 ± 2.11		29.57 ± 3.84		42.31 ± 9.42		
26–30 years	190 (31.10)	14.09 ± 2.15		29.79 ± 3.40		41.78 ± 9.01		
31 years and above	225 (36.82)	14.52 ± 1.87		29.94 ± 3.61		40.68 ± 10.00		
Gender			0.457		0.002		0.001	
Male	229 (37.48)	14.18 ± 1.99		30.37 ± 3.47		43.13 ± 8.96		
Female	382 (62.52)	14.31 ± 2.08		29.42 ± 3.67		40.60 ± 9.73		
Marital Status			0.234		0.680		0.056	
Unmarried	369 (60.39)	14.18 ± 2.06		29.72 ± 3.60		42.14 ± 8.96		
Married	242 (39.61)	14.38 ± 2.02		29.85 ± 3.66		40.64 ± 10.27		
Education			0.001		0.007		0.063	
Associate degree or below	124 (20.29)	13.65 ± 2.28		29.60 ± 3.80		43.31 ± 10.15		
Bachelor's degree	266 (43.54)	14.47 ± 1.91		29.35 ± 3.62		40.92 ± 9.87		
Master's degree or above	221 (36.17)	14.35 ± 2.01		30.37 ± 3.46		41.30 ± 8.62		
Hospital degree			0.409		0.062		0.272	
Tertiary hospital	399 (65.30)	14.24 ± 2.05		30.02 ± 3.51		41.98 ± 9.34		
Secondary hospital	99 (16.20)	14.48 ± 1.97		29.17 ± 3.65		41.07 ± 10.01		
Primary hospital and others	113 (18.49)	14.12 ± 2.08		29.43 ± 3.91		40.43 ± 9.72		
Professional Title			0.005		0.484		0.336	
No professional title	221 (36.17)	13.90 ± 2.19		29.62 ± 3.48		40.02 ± 9.37		
Junior professional title	224 (36.66)	14.47 ± 2.00		29.71 ± 3.70		41.75 ± 9.60		
Intermediate professional title and above	166 (27.17)	14.45 ± 1.85		30.05 ± 3.70		40.63 ± 9.61		
Occupation			0.032		 < 0.001		 < 0.001	
Physician	483 (79.05)	14.35 ± 1.96		30.10 ± 3.53		42.30 ± 9.08		
Nurse	128 (20.95)	13.91 ± 2.30		28.55 ± 3.72		38.71 ± 10.60		
Years of Work Experience			0.308		0.713		0.089	
1–3 years	328 (53.68)	14.16 ± 2.04		29.84 ± 3.53		42.23 ± 8.88		
4–6 years	77 (12.60)	14.16 ± 2.36		29.32 ± 3.86		42.06 ± 10.00		
7–10 years	74 (12.11)	14.30 ± 2.33		29.89 ± 3.56		39.45 ± 10.83		
 > 10 years	132 (21.60)	14.55 ± 1.65		29.81 ± 3.76		40.72 ± 9.87		
Participation in Rehabilitation Training Related to Peripheral Nerve Injuries			0.580		0.001		 < 0.001	
Yes	256 (41.90)	14.31 ± 1.90		30.34 ± 3.66		45.27 ± 8.61		
No	355 (58.10)	14.22 ± 2.15		29.36 ± 3.54		38.86 ± 9.25		
Treatment or Nursing of Patients with Peripheral Nerve Injuries			0.076		 < 0.001		 < 0.001	
Yes	359 (58.76)	14.38 ± 1.86		30.35 ± 3.46		44.48 ± 8.51		
No	252 (41.24)	14.08 ± 2.28		28.95 ± 3.69		37.36 ± 9.34		
Sources of Acquiring Knowledge About Peripheral Nerve Injury Rehabilitation (Multiple Choices)								
Reading professional journals	380 (62.19)							
Knowledge lectures	375 (61.37)							
Continuing education courses	333 (54.50)							
Participation in professional workshops	232 (37.97)							
Self-searching literature and materials	352 (57.61)							
Other	203 (33.22)							

KAP dimension

Participants attained an average knowledge score of 14.26 ± 2.044. Significantly higher knowledge scores were observed among participants aged 31 years and older (14.52 ± 1.87; P = 0.049), those with bachelor's degrees (14.47 ± 1.91; P = 0.001), individuals holding junior professional titles (14.47 ± 2.00; P = 0.005), and those working as physicians (14.35 ± 1.96; P = 0.032) (Table 1). Majority demonstrated familiarity in understanding the definition (98.22%) and common complications (81.67%) of PNI. However, a lower percentage were aware that firearm injuries (61.05%) and electric and radiation burns (62.19%) could also lead to PNI (Table 2).Table 2 The distribution of responses in the knowledge dimension.

	N (%)	
	Unaware	Familiar	Proficient	
1. Peripheral nerves consist of nerve ganglia, trunks, and endings, categorizing into cranial, spinal, and autonomic nerves. They extend throughout the skin, mucous membranes, muscles, joints, blood vessels, and internal organs within the body	72 (11.78)	478 (78.22)	61 (9.98)	
2. Common complications caused by peripheral nerve injuries include carpal tunnel syndrome, joint contracture, pseudo-neuroma, and disuse syndrome	112 (18.33)	459 (75.12)	40 (6.55)	
	Correct	Incorrect		
3. Peripheral nerve injuries may lead to decreased or absent sensation, muscle weakness or paralysis, and progressive muscle atrophy	600 (98.20)	11 (1.80)		
4. The use of orthoses can effectively prevent complications after peripheral nerve injuries	564 (92.31)	47 (7.69)		
5. The fundamental principle of clinical rehabilitation treatment is to initiate rehabilitation therapy at the earliest opportunity	594 (97.22)	17 (2.78)		
6. Early rehabilitation objectives encompass pain management, swelling reduction, complication prevention, and mitigation of muscle and joint contractures in the affected limb	604 (98.85)	7 (1.15)		
7. Electromyography is an important diagnostic and prognostic method for peripheral nerve injuries	595 (97.38)	16 (2.62)		
8. During the recovery phase, rehabilitation focuses on preventing muscle atrophy, promoting nerve regeneration, enhancing muscle strength, and restoring normal nerve function	602 (98.53)	9 (1.47)		
9. In the initial 24–48 h following peripheral nerve injuries, therapeutic interventions such as neuromuscular electrical stimulation, infrared therapy, administration of nerve-nutrient medications, limb mobilization exercises to prevent joint contractures, as well as acupuncture and massage, can be employed to alleviate nerve shock, mitigate nerve adhesions, and promote joint relaxation	577 (94.44)	34 (5.56)		
10. Do you know the causes of peripheral nerve injuries? (Multiple Choices)				
 a. Traction injuries (such as brachial plexus injuries caused by childbirth, etc.)	550 (90.02)			
 b. Cutting injuries (such as knife wounds, electric saw injuries, glass cuts)	494 (80.85)			
 c. Compression injuries (nerve compression caused by fractures or dislocations)	544 (89.03)			
 d. Firearm injuries (such as gunshot wounds and shrapnel injuries)	373 (61.05)			
 e. Electric and radiation burns	380 (62.19)			
 f. Medication injections and other iatrogenic injuries	424 (69.39)			
11. Do you know the rehabilitation components during the recovery phase?				
 a. Physical therapy, occupational therapy	42 (6.87)			
 b. Traditional Chinese rehabilitation methods, including acupuncture and traditional Chinese medicine	59 (9.66)			
 c. Nutrient nerve medication therapy	4 (0.65)			
 e. All of the above	506 (82.82)			

Participants exhibited an average attitude score of 29.77 ± 3.622. Higher attitude scores were observed among male participants (30.37 ± 3.47; P = 0.002), individuals holding master's degrees or higher qualifications (30.37 ± 3.46; P = 0.007), physicians (30.10 ± 3.53; P < 0.001), those engaged in rehabilitation training related to PNI (30.34 ± 3.66; P = 0.001), and those involved in the treatment or care of patients with PNI (30.35 ± 3.46; P < 0.001) (Table 1). Majority (96.40%) exhibited a positive attitude toward prioritizing the implementation of rehabilitation treatment for patients with PNI (A1). In contrast, the limited proportion (60.89%) expressed confidence that their current knowledge about PNI rehabilitation aligned with clinical requirements (A2) (Table 3).Table 3 The distribution of responses in the attitude dimension.

	N (%)	
	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	
1. You prioritize the implementation of rehabilitation treatment for patients with peripheral nerve injuries	373 (61.05)	216 (35.35)	19 (3.11)	1 (0.16)	2 (0.33)	
2. You are confident that your current knowledge about peripheral nerve injury rehabilitation aligns with clinical requirements	166 (27.17)	206 (33.72)	152 (24.88)	79 (12.93)	8 (1.31)	
3. Patient attitudes toward peripheral nerve injury rehabilitation influence your treatment and nursing decisions	217 (35.52)	283 (46.32)	86 (14.08)	21 (3.44)	4 (0.65)	
4. You place great importance on applying the knowledge of peripheral nerve injury rehabilitation you've acquired in patient care	247 (40.43)	309 (50.57)	50 (8.18)	5 (0.82)	/	
5. You are committed to monitoring and assessing the rehabilitation of patients with peripheral nerve injuries	214 (35.02)	293 (47.95)	96 (15.71)	8 (1.31)	/	
6. You are inclined to pursue formal training in peripheral nerve injury rehabilitation?	290 (47.46)	298 (48.77)	20 (3.27)	3 (0.49)	/	
7. Patient trust serves as a motivating factor for your engagement in peripheral nerve injury rehabilitation treatment	306 (50.08)	278 (45.5)	24 (3.93)	2 (0.33)	1 (0.16)	

Participants demonstrated an average practice score of 41.55 ± 9.523. Higher practice scores were achieved by male participants (43.13 ± 8.96; P = 0.001), physicians (42.30 ± 9.08; P < 0.001), individuals who had participated in rehabilitation training related to PNI (45.27 ± 8.61; P < 0.001), and those engaged in the treatment or care of patients with PNI (44.48 ± 8.51; P < 0.001) (Table 1). A substantial majority (79.54%) promptly responded to unusual patient conditions (P10). In contrast, the least proportion (36.83%) expressed a commitment to enrolling in training courses focused on PNI rehabilitation (P3) (Table 4).Table 4 The distribution of responses in the practice dimension.

	N (%)	
	Always	Often	Sometimes	Occasionally	Never	
1. Actively seek information on peripheral nerve injury rehabilitation from diverse sources such as books, the internet, and literature	117 (19.15)	175 (28.64)	166 (27.17)	137 (22.42)	16 (2.62)	
2. Share experiences in managing patients with peripheral nerve injuries with fellow healthcare professionals	115 (18.82)	179 (29.3)	168 (27.5)	119 (19.48)	30 (4.91)	
3. Enroll in training courses focused on peripheral nerve injury rehabilitation	103 (16.86)	122 (19.97)	162 (26.51)	180 (29.46)	44 (7.2)	
4. Perform comprehensive patient assessments	177 (28.97)	202 (33.06)	113 (18.49)	94 (15.38)	25 (4.09)	
5. Proactively assist identified patients in need of rehabilitation treatment or care	237 (38.79)	240 (39.28)	76 (12.44)	52 (8.51)	6 (0.98)	
6. Offer detailed information to patients toward their need for peripheral nerve injury rehabilitation and available treatment plans	204 (33.39)	212 (34.7)	106 (17.35)	76 (12.44)	13 (2.13)	
7. Provide emotional support and psychological intervention to patients	227 (37.15)	216 (35.35)	103 (16.86)	57 (9.33)	8 (1.31)	
8. Deliver health education to inform patients about the advantages of peripheral nerve injury rehabilitation treatment	228 (37.32)	224 (36.66)	82 (13.42)	68 (11.13)	9 (1.47)	
9. Continuously monitor patients' latest developments in health status and physical condition	228 (37.32)	234 (38.3)	79 (12.93)	59 (9.66)	11 (1.8)	
10. Swiftly intervene when patients encounter unusual conditions	254 (41.57)	232 (37.97)	72 (11.78)	44 (7.2)	9 (1.47)	
11. Regularly adapt the rehabilitation plan in accordance with the patient's current status	236 (38.63)	240 (39.28)	67 (10.97)	57 (9.33)	11 (1.8)	

Logistic regression analysis of KAP scores

KAP scores were categorized into low and high levels using a threshold of 70% in each dimension. Logistic regression analysis was further conducted to identify the influential factors of KAP. In the multivariate logistic regression analysis, participants holding junior professional titles demonstrated significantly higher knowledge scores compared to those without professional titles (OR = 1.743, 95% CI: 1.083–2.804, P = 0.022). Furthermore, physicians attained higher knowledge scores when compared to nurses (OR = 1.833, 95% CI: 1.151–2.919, P = 0.011). Additionally, healthcare professionals involved in the treatment or care of patients with peripheral nerve injuries exhibited higher knowledge scores in comparison to their counterparts without such training (OR = 1.462, 95% CI: 1.024–2.088, P = 0.037) (Table 5).Table 5 Univariate and multivariate logistic regression analysis of knowledge.

Knowledge dimension	Univariate	Multivariate	
OR (95%CI)	P	OR (95%CI)	P	
Age	
18–25 years	0.572 (0.377–0.868)	0.009	0.888 (0.409–1.927)	0.763	
26–30 years	0.569 (0.374–0.866)	0.008	0.594 (0.307–1.150)	0.122	
31 years and	ref		ref		
Gender	
Male	1.043 (0.736–1.479)	0.812			
Female	ref				
Marital status	
Unmarried	0.693 (0.488–0.986)	0.041	0.983 (0.563–1.717)	0.953	
Married	ref		ref		
Education	
Associate degree or below	ref		ref		
Bachelor's degree	1.592 (1.024–2.475)	0.039	1.425 (0.873–2.326)	0.157	
Master's degree or above	1.696 (1.072–2.683)	0.024	1.448 (0.814–2.577)	0.208	
Hospital degree	
Tertiary hospital	1.091 (0.702–1.695)	0.700			
Secondary hospital	1.103 (0.622–1.956)	0.736			
Primary hospital and others	ref				
Professional title	
No professional title	ref		ref		
Junior professional title	1.712 (1.155–2.538)	0.007	1.743 (1.083–2.804)	0.022	
Intermediate professional title and above	1.882 (1.219–2.907)	0.004	1.168 (0.604–2.256)	0.644	
Occupation	
Physician	1.739 (1.165–2.595)	0.007	1.833 (1.151–2.919)	0.011	
Nurse	ref		ref		
Years of work experience	
1–3 years	0.532 (0.336–0.844)	0.007	0.669 (0.289–1.545)	0.346	
4–6 years	0.602 (0.324–1.120)	0.109	0.712 (0.315–1.610)	0.414	
7–10 years	0.639 (0.340–1.202)	0.165	0.663 (0.331–1.327)	0.246	
 > 10 years	ref		ref		
Participation in rehabilitation training related to peripheral nerve injuries	
Yes	1.328 (0.939–1.877)	0.108			
No	ref				
Treatment or nursing of patients with peripheral nerve injuries	
Yes	1.582 (1.124–2.225)	0.008	1.462 (1.024–2.088)	0.037	
No	ref		ref		

In the multivariate logistic regression analysis, there was a positive association between knowledge scores and attitude scores (OR = 1.155, 95% CI: 1.042–1.280, P = 0.006). Male participants achieved significantly higher attitude scores compared to their female counterparts (OR = 2.140, 95% CI: 1.255–3.646, P = 0.005). Additionally, individuals with master's degrees or higher qualifications had higher attitude scores in comparison to those with associate degrees or below (OR = 2.258, 95% CI: 1.131–4.507, P = 0.021). Furthermore, healthcare professionals involved in the treatment or care of patients with peripheral nerve injuries exhibited higher attitude scores than their counterparts without such training (OR = 2.463, 95% CI: 1.460–4.155, P = 0.001) (Table 6).Table 6 Univariate and multivariate logistic regression analysis of attitude.

Attitude dimension	Univariate	Multivariate	
OR (95%CI)	P	OR (95%CI)	P	
Knowledge dimension	1.170 (1.060–1.292)	0.002	1.155 (1.042–1.280)	0.006	
Age	
18–25 years	0.653 (0.396–1.076)	0.094			
26–30 years	1.075 (0.622–1.857)	0.796			
31 years and	ref				
Gender	
Male	2.227 (1.364–3.635)	0.001	2.140 (1.255–3.646)	0.005	
Female	ref		ref		
Marital status	
Unmarried	0.829 (0.534–1.286)	0.402			
Married	ref				
Education	
Associate degree or below	ref		ref		
Bachelor's degree	1.039 (0.610–1.771)	0.887	1.077 (0.602–1.924)	0.803	
Master's degree or above	1.894 (1.039–3.451)	0.037	2.258 (1.131–4.507)	0.021	
Hospital degree	
Tertiary hospital	1.473 (0.863–2.514)	0.156			
Secondary hospital	0.949 (0.488–1.845)	0.878			
Primary hospital and others	ref				
Professional title	
No professional title	ref				
Junior professional title	0.986 (0.606–1.603)	0.954			
Intermediate professional title and above	1.268 (0.729–2.206)	0.401			
Occupation	
Physician	1.719 (1.065–2.775)	0.027	0.965 (0.549–1.697)	0.902	
Nurse	ref		ref		
Years of work experience	
1–3 years	1.047 (0.613–1.788)	0.865			
4–6 years	0.804 (0.395–1.638)	0.549			
7–10 years	1.524 (0.665–3.493)	0.320			
 > 10 years	ref				
Participation in rehabilitation training related to peripheral nerve injuries	
Yes	2.061 (1.297–3.277)	0.002	1.404 (0.801–2.459)	0.236	
No	ref		ref		
Treatment or nursing of patients with peripheral nerve injuries	
Yes	2.936 (1.893–4.554)	 < 0.001	2.463 (1.460–4.155)	0.001	
No	ref		ref		

In the multivariate logistic regression analysis, there was a positive association between attitude scores and practice scores (OR = 1.214, 95% CI: 1.148–1.283, P < 0.001). Participants with bachelor’s degrees (OR = 0.548, 95% CI: 0.326–0.919, P = 0.023) and those with master’s degrees or higher (OR = 0.545, 95% CI: 0.308–0.964, P = 0.037) had lower practice scores compared to participants with associate degrees or below. Additionally, participants who had engaged in rehabilitation training related to peripheral nerve injuries scored higher in the practice dimension compared to those without such training (OR = 2.485, 95% CI: 1.633–3.781, P < 0.001). Furthermore, healthcare professionals involved in the treatment or care of patients with peripheral nerve injuries exhibited higher practice scores compared to counterparts without such training (OR = 2.093, 95% CI: 1.395–3.138, P < 0.001) (Table 7).Table 7 Univariate and multivariate logistic regression analysis of practice.

Practice dimension	Univariate	Multivariate	
OR (95%CI)	P	OR (95%CI)	P	
Knowledge dimension	1.004 (0.929–1.086)	0.917	0.936 (0.854–1.025)	0.154	
Attitude dimension	1.224 (1.164–1.287)	 < 0.001	1.214 (1.148–1.283)	 < 0.001	
Age	
18–25 years	1.279 (0.870–1.881)	0.211			
26–30 years	1.161 (0.788–1.710)	0.451			
31 years and	ref				
Gender	
Male	1.359 (0.976–1.893)	0.070			
Female	ref				
Marital status	
Unmarried	1.223 (0.883–1.693)	0.226			
Married	ref				
Education	
Associate degree or below	ref		ref		
Bachelor's degree	0.575 (0.371–0.893)	0.014	0.548 (0.326–0.919)	0.023	
Master's degree or above	0.630 (0.401–0.991)	0.046	0.545 (0.308–0.964)	0.037	
Hospital degree	
Tertiary hospital	1.457 (0.958–2.215)	0.078			
Secondary hospital	1.209 (0.704–2.075)	0.491			
Primary hospital and others	ref				
Professional title	
No professional title	ref				
Junior professional title	1.024 (0.704–1.490)	0.901			
Intermediate professional title and above	0.782 (0.522–1.172)	0.233			
Occupation	
Physician	1.486 (1.005–2.197)	0.047	1.508 (0.923–2.464)	0.101	
Nurse	ref		ref		
Years of work experience	
1–3 years	1.319 (0.879–1.979)	0.181			
4–6 years	1.364 (0.774–2.406)	0.283			
7–10 years	0.781 (0.441–1.383)	0.396			
 > 10 years	ref				
Participation in rehabilitation training related to peripheral nerve injuries	
Yes	3.716 (2.628–5.255)	 < 0.001	2.485 (1.633–3.781)	 < 0.001	
No	ref		ref		
Treatment or nursing of patients with peripheral nerve injuries	
Yes	3.597 (2.565–5.045)	 < 0.001	2.093 (1.395–3.138)	 < 0.001	
No	ref				

Discussion

Healthcare professionals exhibited moderate knowledge, positive attitudes, and moderate practices towards the PNI rehabilitation. Positive associations were determined between knowledge and attitude, as well as between attitude and practice. Furthermore, influential factors were identified, including gender, educational, professional title and occupation. These findings may offer insights for healthcare interventions to promote the KAP of PNI rehabilitation among healthcare professionals.

Similarly, almost all physicians in Ethiopia held positive attitudes toward peripheral nerve blocks11. However, most did not consistently perform these blocks and lacked necessary skills, possibly due to limited knowledge dissemination and inadequate medical training. These findings collectively emphasize the importance of enhancing educational efforts and promoting practical measures in PNI rehabilitation among healthcare professionals.

The low awareness toward firearm injuries (61.05%) and electric and radiation burns (62.19%) as potential causes of PNI warrants careful consideration. Considering the facilitating roles of crush, compression and trauma in PNI19, lack of awareness of specific causes can cause delays in diagnosis and treatment. In order to promote complete functional recovery, healthcare professionals should be equipped with comprehensive knowledge to address diverse PNI cases20. Besides, only 60.89% expressed confidence that their current knowledge about PNI rehabilitation aligned with clinical requirements. This result raised questions about the adequacy of the training programs provided to healthcare professionals. Confidence in one's knowledge and skills is crucial for delivering high-quality care to patients with PNI, as it directly influences clinical decision-making and treatment outcomes21. Moreover, the low adherence rate (36.83%) of enrolling in training courses on PNI reflected potential gaps in the availability, accessibility, or awareness of educational opportunities related to PNI rehabilitation. Stephenson, Bonnes22 found that higher levels of education engagement were associated with greater clinical knowledge and better patient outcomes. Limited availability of training courses and competing demands on time may deter enrollment in training courses, highlighting the multidisciplinary cooperation to reverse the trend.

The positive association between knowledge and attitude scores could be explained by the fact that healthcare providers who were well-informed about the benefits of rehabilitation were likely to approach patient care positively. Furthermore, in consistency with the theory of planned behavior, healthcare professionals with more positive attitude were inclined to translate their beliefs into clinical practice23. However, no significant association between knowledge and practice scores was observed. It was possible that practical constraints, institutional policies, patient preferences, or time limitations might influence the extent to which healthcare providers could implement their knowledge into practice. Additionally, factors such as motivation and the availability of resources might also contribute to the disconnect between knowledge and practice.

Several influential factors of KAP were subsequently determined. First, the difference in knowledge scores between physicians and nurses might stem from discrepancy in their education training. In Chian, physicians usually undergo comprehensive medical training, while nurses might not receive the same depth of training in specific areas like PNI. Second, healthcare professionals involved in the treatment or care of patients with PNI exhibited higher KAP scores. Consistently, Tegegne, Yimam24 investigated the effects of training on nurses' knowledge and practices in wound care management, and found that those who received specialized training had significantly higher scores compared to those who did not. Providing targeted training and continuing education for healthcare professionals involved in PNI care can help bridge knowledge gaps, improve clinical skills, and ultimately enhance patient outcomes. Third, participants holding junior professional titles demonstrated significantly higher knowledge scores compared to those without professional titles. Reportedly, higher professional titles can reflect enhanced technical experience and academic achievements25. Fourth, male participants achieved significantly higher attitude scores compared to their female counterparts. Differences in training, education, and professional experiences between male and female healthcare professionals may play a role in shaping their attitudes towards PNI rehabilitation. For example, male healthcare professionals may have more exposure to certain aspects of PNI care during their training or professional development, leading to positive attitudes towards managing these conditions26. However, these findings should be interpreted with caution, and potential confounding variables may influence the association between gender and attitude scores.

Several strengths should be acknowledged. First, this study represented the first investigation into the KAP toward PNI rehabilitation among healthcare professionals in China. Second, comparative analysis and logistic regression analysis were combined to assess the interrelationships and influential factors of KAP. The two-step analytical approach can enhance the robustness and reasonability of the findings. This study had several limitations. First, the cross-sectional design and small sampling hindered the establishment of causality among variables and limited the generalizability of findings. Second, the potential presence of social desirability bias in KAP scores could lead to score overestimation, as participants might tend to provide responses aligning with social norms rather than accurately reflecting their actual ideas27.

In summary, Chinese healthcare professionals exhibited moderate knowledge, positive attitudes, and moderate practices towards the rehabilitation of PNI. Participants involved in the treatment or care of PNI have significantly higher KAP. Moreover, educational interventions and behavior modification strategies was recommended, particularly those with limited involvement in the treatment or care of PNI patients.

Author contributions

LS W and GN L proposed the research topic and designed the research. GN L and N X carried out the studies, participated in collecting data, research and collation of literature. LS W and TT L involved in the collection, analysis or interpretation of data. LS W and GN L drafted the paper, revised the paper, and gave guidance support to the final review of the paper. All authors read and approved the final manuscript.

Data Availability

All data generated or analysed during this study are included in this published article.

Competing interests

The authors declare no competing interests.

Ethical approval

All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Ethical exemption for this study was secured from the Medical Ethics Committee of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, and informed consent was obtained from all participants. The study was carried out in accordance with the applicable guidelines and regulations.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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