Perceived barriers and required knowledge for physical therapists in renal rehabilitation: a nationwide cross-sectional questionnaire-based study

Abstract Background Chronic kidney disease (CKD) contributes to functional decline and poor outcomes. Renal rehabilitation (RR), centered on exercise therapy, improves prognosis but remains underutilized. This study investigated physical therapists’ (PTs) perceived barriers and knowledge needs for RR, with a focus on text-mining analysis. Methods A nationwide cross-sectional online survey was conducted among members of the Japanese Physical Therapy Association (January 2025). The questionnaire assessed demographics, perceptions of RR, barriers, and knowledge requirements. Respondents were categorized into RR implementation and non-RR implementation groups. Free-text responses were analyzed using text-mining and cooccurrence network analysis. Results Of 85,775 invited PTs, 5059 responded (5.9%), and 5019 were analyzed (RR group: 3528; non-RR group: 1491). Text-mining identified eight barrier categories: (1) implementation of exercise therapy; (2) intervention time during dialysis; (3) information on kidney disease; (4) lack of knowledge; (5) recognition of challenges in RR; (6) interprofessional collaboration; (7) reimbursement; and (8) risk management. Text-mining identified seven required-knowledge categories: (1) up-to-date knowledge; (2) basic knowledge; (3) understanding of RR; (4) risk management; (5) understanding of pathology; (6) exercise load setting; and (7) implementation in clinical facilities. Overall, RR groups reported concrete operational issues, whereas non-RR groups reported knowledge and system gaps. Conclusions Tailored education and strengthened interprofessional collaboration are required to expand RR practice and improve CKD care.