Knowledge–practice gap in cardiovascular vital sign assessment and its influence on clinical decision-making among outpatient physical therapists in Saudi Arabia: A national cross-sectional study

Cardiovascular screening through blood pressure (BP) and heart rate (HR) assessment is a fundamental component of safe outpatient physical therapy practice. However, the extent to which such assessments influence clinical decision-making remains unclear. To evaluate the association between cardiovascular vital sign knowledge, routine assessment practice, and clinical decision-making among outpatient physical therapists in Saudi Arabia, and to identify perceived barriers to routine monitoring. A national cross-sectional survey was conducted among 404 licensed outpatient physical therapists. The questionnaire assessed demographics, knowledge of BP/HR, routine monitoring practices, responses to standardized clinical vignettes, and perceived barriers. Associations were examined using chi-square tests, and findings were interpreted with consideration of effect direction and magnitude. Most participants were aged 20 to 39 years (88.8%), with 57.7% practicing musculoskeletal physical therapy. Knowledge of normal BP and exercise-related thresholds was significantly associated with more conservative clinical decisions in scenarios involving elevated BP ( P < .05). In contrast, routine measurement of BP and HR was not significantly associated with treatment decisions across scenarios. The most commonly reported barriers were lack of equipment (66.8%), time constraints (49.2%), and insufficient training (49.0%). A gap exists between knowledge and routine practice in cardiovascular vital sign assessment among outpatient physical therapists. While knowledge appears to inform clinical judgment, routine measurement alone does not necessarily translate into altered decision-making. These findings highlight the need for integrated, system-level interventions that combine education, standardized protocols, and workflow support to enhance the effective use of cardiovascular assessment in clinical practice.