Physiotherapy Across the Continuum of Care: Clinical Contributions, Health-System Integration, and Sustainable Rehabilitation - A Review
DOI:
https://doi.org/10.59890/ijnhs.v4i4.13Keywords:
Physiotherapy, Physical Therapy, Rehabilitation, Health Systems, Therapeutic Exercise, Primary Care, Telerehabilitation, Community-Based Rehabilitation, Functional Recovery, Patient-Centred CareAbstract
Physiotherapy has expanded from a predominantly post-injury service into a health-system function spanning prevention, primary care, acute recovery, chronic disease management, community rehabilitation, healthy ageing, and digital care. This qualitative literature review critically synthesises recent evidence on the clinical, organisational, technological, ethical, and contextual dimensions that shape this expanded role. Peer-reviewed literature published primarily between 2020 and 2026 was purposively identified and interpreted through a narrative-integrative approach rather than a systematic review framework. The synthesis indicates that physiotherapy contributes most consistently by improving human functioning, including mobility, activity, independence, participation, self-management, and quality of life. Evidence is particularly strong for exercise-based musculoskeletal care, task-specific neurological rehabilitation, pulmonary rehabilitation, fall prevention, and selected home-based or telerehabilitation pathways. At the health-system level, direct access, first-contact physiotherapy, advanced-practice roles, community rehabilitation, and hybrid digital models may improve accessibility, continuity, and efficiency when supported by appropriate regulation, financing, workforce capability, referral pathways, and interprofessional collaboration. However, benefits are context-dependent and may be limited by inequitable service distribution, workforce shortages, digital exclusion, and fragmented care
References
Anil, K., Freeman, J.A., Buckingham, S., Demain, S., Gunn, H., Jones, R.B., Logan, A., Marsden, J., Playford, D., Sein, K. and Kent, B. (2021) 'Scope, context and quality of telerehabilitation guidelines for physical disabilities: a scoping review', BMJ Open, 11(8), e049603. DOI: 10.1136/bmjopen-2021-049603. Available at: https://doi.org/10.1136/bmjopen-2021-049603
Aras, D., Tang, A. and Ahmad, H. (2022) 'Analysis of the Covid-19 pandemic impact on osteoarthritis patient visits at physiotherapy clinics in Indonesia: A retrospective cohort study', Annals of Medicine and Surgery, 84, 104826. DOI: 10.1016/j.amsu.2022.104826. Available at: https://doi.org/10.1016/j.amsu.2022.104826
Barker, K., Holland, A.E., Skinner, E.H. and Lee, A.L. (2023) 'Clinical outcomes following exercise rehabilitation in people with multimorbidity: a systematic review', Journal of Rehabilitation Medicine, 55, jrm00377. DOI: 10.2340/jrm.v55.2551. Available at: https://doi.org/10.2340/jrm.v55.2551
Barry, E.S., Merkebu, J. and Varpio, L. (2022) 'State-of-the-art literature review methodology: A six-step approach for knowledge synthesis', Perspectives on Medical Education, 11(5), pp. 281-288. DOI: 10.1007/s40037-022-00725-9. Available at: https://doi.org/10.1007/s40037-022-00725-9
Bennell, K.L., Lawford, B.J., Metcalf, B., Mackenzie, D., Russell, T., van den Berg, M., Finnin, K., Crowther, S., Aiken, J., Fleming, J. and Hinman, R.S. (2021) 'Physiotherapists and patients report positive experiences overall with telehealth during the COVID-19 pandemic: a mixed-methods study', Journal of Physiotherapy, 67(3), pp. 201-209. DOI: 10.1016/j.jphys.2021.06.009. Available at: https://doi.org/10.1016/j.jphys.2021.06.009
Bernhardt, J., Urimubenshi, G., Gandhi, D.B.C. and Eng, J.J. (2020) 'Stroke rehabilitation in low-income and middle-income countries: a call to action', The Lancet, 396(10260), pp. 1452-1462. DOI: 10.1016/S0140-6736(20)31313-1. Available at: https://doi.org/10.1016/S0140-6736(20)31313-1
Bickenbach, J. (2021) 'Human Functioning: Developments and Grand Challenges', Frontiers in Rehabilitation Sciences, 1, 617782. DOI: 10.3389/fresc.2020.617782. Available at: https://doi.org/10.3389/fresc.2020.617782
Cattrysse, E., Van den Broeck, J., Petroons, R., Teugels, A., Scafoglieri, A. and van Trijffel, E. (2024) 'Impact of direct access on the quality of primary care musculoskeletal physiotherapy: a scoping review from a patient, provider, and societal perspective', Archives of Physiotherapy, 14, pp. 20-28. DOI: 10.33393/aop.2024.3023. Available at: https://doi.org/10.33393/aop.2024.3023
Cieza, A., Causey, K., Kamenov, K., Hanson, S.W., Chatterji, S. and Vos, T. (2020) 'Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019', The Lancet, 396(10267), pp. 2006-2017. DOI: 10.1016/S0140-6736(20)32340-0. Available at: https://doi.org/10.1016/S0140-6736(20)32340-0
Davis, M.E. and McGrane, N. (2021) 'Exercise as a treatment for clinical depression in adults and progressing the physiotherapists role: a systematic review and meta-analysis', Physiotherapy Practice and Research, 42(2), pp. 105-118. DOI: 10.3233/PPR-210512. Available at: https://doi.org/10.3233/PPR-210512
Demont, A., Bourmaud, A., Kechichian, A. and Desmeules, F. (2021) 'The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature', Disability and Rehabilitation, 43(12), pp. 1637-1648. DOI: 10.1080/09638288.2019.1674388. Available at: https://doi.org/10.1080/09638288.2019.1674388
Dorsch, S., Carling, C., Cao, Z., Fanayan, E., Graham, P.L., McCluskey, A., Schurr, K., Scrivener, K. and Tyson, S. (2023) 'Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review', Journal of Physiotherapy, 69(1), pp. 15-22. DOI: 10.1016/j.jphys.2022.11.008. Available at: https://doi.org/10.1016/j.jphys.2022.11.008
Elsbach, K.D. and van Knippenberg, D. (2020) 'Creating High-Impact Literature Reviews: An Argument for Integrative Reviews', Journal of Management Studies, 57(6), pp. 1277-1289. DOI: 10.1111/joms.12581. Available at: https://doi.org/10.1111/joms.12581
Fischer, M., Bui, E., Besombes, L., Pinsault, N. and Francois, M. (2026) 'Effect of direct access to physiotherapy on prescribing and imaging in primary care for musculoskeletal disorders: a systematic review and meta-analysis', Family Practice, 43(4), cmag046. DOI: 10.1093/fampra/cmag046. Available at: https://doi.org/10.1093/fampra/cmag046
Fryer, C., Sturm, A., Roth, R. and Edwards, I. (2021) 'Scarcity of resources and inequity in access are frequently reported ethical issues for physiotherapists internationally: an observational study', BMC Medical Ethics, 22, 97. DOI: 10.1186/s12910-021-00663-x. Available at: https://doi.org/10.1186/s12910-021-00663-x
Goodwin, R., Moffatt, F., Hendrick, P., Stynes, S., Bishop, A. and Logan, P. (2021) 'Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight', Physiotherapy, 113, pp. 209-216. DOI: 10.1016/j.physio.2021.08.003. Available at: https://doi.org/10.1016/j.physio.2021.08.003
Hayden, J.A., Ellis, J., Ogilvie, R., Malmivaara, A. and van Tulder, M.W. (2021) 'Exercise therapy for chronic low back pain', Cochrane Database of Systematic Reviews, 9, CD009790. DOI: 10.1002/14651858.CD009790.pub2. Available at: https://doi.org/10.1002/14651858.CD009790.pub2
Ho-Henriksson, C.-M., Svensson, M., Thorstensson, C.A. and Nordeman, L. (2022) 'Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care: a cost-effectiveness analysis of a pragmatic trial', BMC Musculoskeletal Disorders, 23, 260. DOI: 10.1186/s12891-022-05201-3. Available at: https://doi.org/10.1186/s12891-022-05201-3
Hoffmann, T.C., Lewis, J. and Maher, C.G. (2020) 'Shared decision making should be an integral part of physiotherapy practice', Physiotherapy, 107, pp. 43-49. DOI: 10.1016/j.physio.2019.08.012. Available at: https://doi.org/10.1016/j.physio.2019.08.012
Hon, S., Ritter, R. and Allen, D.D. (2021) 'Cost-effectiveness and outcomes of direct access to physical therapy for musculoskeletal disorders compared to physician-first access in the United States: systematic review and meta-analysis', Physical Therapy, 101(1), pzaa201. DOI: 10.1093/ptj/pzaa201. Available at: https://doi.org/10.1093/ptj/pzaa201
Huang, J., Ji, J.-R., Liang, C., Zhang, Y.-Z., Sun, H.-C., Yan, Y.-H. and Xing, X.-B. (2022) 'Effects of physical therapy-based rehabilitation on recovery of upper limb motor function after stroke in adults: a systematic review and meta-analysis of randomized controlled trials', Annals of Palliative Medicine, 11(2), pp. 521-531. DOI: 10.21037/apm-21-3710. Available at: https://doi.org/10.21037/apm-21-3710
Hutting, N., Caneiro, J.P., Ong'wen, O.M., Miciak, M. and Roberts, L. (2022) 'Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person', Musculoskeletal Science and Practice, 57, 102434. DOI: 10.1016/j.msksp.2021.102434. Available at: https://doi.org/10.1016/j.msksp.2021.102434
Igwesi-Chidobe, C.N., Bishop, A., Humphreys, K., Hughes, E., Protheroe, J., Maddison, J. and Bartlam, B. (2021) 'Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England', Physiotherapy, 111, pp. 31-39. DOI: 10.1016/j.physio.2020.07.002. Available at: https://doi.org/10.1016/j.physio.2020.07.002
Jesus, T.S., Landry, M.D., Hoenig, H. and Dussault, G. (2021) 'Global need: including rehabilitation in health system strengthening', The Lancet, 397(10275), pp. 665-666. DOI: 10.1016/S0140-6736(21)00207-5. Available at: https://doi.org/10.1016/S0140-6736(21)00207-5
Kulju, K., Suhonen, R., Puukka, P. and Leino-Kilpi, H. (2020) 'Self-evaluated ethical competence of a practicing physiotherapist: a national study in Finland', BMC Medical Ethics, 21, 43. DOI: 10.1186/s12910-020-00469-3. Available at: https://doi.org/10.1186/s12910-020-00469-3
Lafrance, S., Demont, A., Thavorn, K., Fernandes, J., Santaguida, C. and Desmeules, F. (2021) 'Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses', BMC Health Services Research, 21, 1214. DOI: 10.1186/s12913-021-07221-6. Available at: https://doi.org/10.1186/s12913-021-07221-6
Lee, K.E., Choi, M. and Jeoung, B. (2022) 'Effectiveness of rehabilitation exercise in improving physical function of stroke patients: a systematic review', International Journal of Environmental Research and Public Health, 19(19), 12739. DOI: 10.3390/ijerph191912739. Available at: https://doi.org/10.3390/ijerph191912739
Leemans, G., Taeymans, J., Van Royen, P. and Vissers, D. (2021) 'Respiratory physiotherapy interventions focused on exercise training and enhancing physical activity levels in people with chronic obstructive pulmonary disease are likely to be cost-effective: a systematic review', Journal of Physiotherapy, 67(4), pp. 271-283. DOI: 10.1016/j.jphys.2021.08.018. Available at: https://doi.org/10.1016/j.jphys.2021.08.018
Levin, M.F. and Demers, M. (2021) 'Motor learning in neurological rehabilitation', Disability and Rehabilitation, 43(24), pp. 3445-3453. DOI: 10.1080/09638288.2020.1752317. Available at: https://doi.org/10.1080/09638288.2020.1752317
Liang, X., Tan, Z., Yun, G., Cao, J., Wang, J., Liu, Q. and Chen, T. (2021) 'Effectiveness of exercise interventions for children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials', Journal of Rehabilitation Medicine, 53(4), jrm00176. DOI: 10.2340/16501977-2772. Available at: https://doi.org/10.2340/16501977-2772
Lubbe, W., ten Ham-Baloyi, W. and Smit, K. (2020) 'The integrative literature review as a research method: A demonstration review of research on neurodevelopmental supportive care in preterm infants', Journal of Neonatal Nursing, 26(6), pp. 308-315. DOI: 10.1016/j.jnn.2020.04.006. Available at: https://doi.org/10.1016/j.jnn.2020.04.006
Maart, S. and Sykes, C. (2022) 'Expanding on the use of The International Classification of Functioning, Disability and Health: Examples and resources', South African Journal of Physiotherapy, 78(1), 1614. DOI: 10.4102/sajp.v78i1.1614. Available at: https://doi.org/10.4102/sajp.v78i1.1614
McEvoy, M., Luker, J., Fryer, C. and Lewis, L.K. (2020) 'Changes in physiotherapists' perceptions of evidence-based practice after a year in the workforce: A mixed-methods study', PLOS ONE, 15(12), e0244190. DOI: 10.1371/journal.pone.0244190. Available at: https://doi.org/10.1371/journal.pone.0244190
Meiring, R.M., Tanimukai, K. and Bradnam, L. (2020) 'The effect of exercise-based cardiac rehabilitation on objectively measured physical activity and sedentary behavior: a systematic review and meta-analysis', Journal of Primary Care & Community Health, 11, 2150132720935290. DOI: 10.1177/2150132720935290. Available at: https://doi.org/10.1177/2150132720935290
Montero-Odasso, M., Kamkar, N., Pieruccini-Faria, F. et al. (2021) 'Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review', JAMA Network Open, 4(12), e2138911. DOI: 10.1001/jamanetworkopen.2021.38911. Available at: https://doi.org/10.1001/jamanetworkopen.2021.38911
Nascimento, L.R., Gaviorno, L.F., Brunelli, M.S., Goncalves, J.V. and Areas, F.Z.S. (2022) 'Home-based is as effective as centre-based rehabilitation for improving upper limb motor recovery and activity limitations after stroke: a systematic review with meta-analysis', Clinical Rehabilitation, 36(12), pp. 1565-1577. DOI: 10.1177/02692155221121015. Available at: https://doi.org/10.1177/02692155221121015
Naylor, J., Killingback, C. and Green, A. (2023) 'What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies', Disability and Rehabilitation, 45(6), pp. 950-961. DOI: 10.1080/09638288.2022.2055165. Available at: https://doi.org/10.1080/09638288.2022.2055165
Novak, I., te Velde, A., Hines, A., Stanton, E., Mc Namara, M., Paton, M.C.B., Finch-Edmondson, M. and Morgan, C. (2021) 'Rehabilitation Evidence-Based Decision-Making: The READ Model', Frontiers in Rehabilitation Sciences, 2, 726410. DOI: 10.3389/fresc.2021.726410. Available at: https://doi.org/10.3389/fresc.2021.726410
Nugraha, B., Ruslina Defi, I., Prima Yolanda, R., Warliani, M., Biben, V., Jennie, J., Mubarak, H., Mayasari, N. and Gutenbrunner, C. (2021) 'Describing community-based rehabilitation services in Indonesia by using the International Classification of Service Organization in Rehabilitation 2.0', Journal of Rehabilitation Medicine, 53(3), jrm00166. DOI: 10.2340/16501977-2804. Available at: https://doi.org/10.2340/16501977-2804
Romm, M.J., Ahn, S., Fiebert, I. and Cahalin, L.P. (2021) 'A meta-analysis of therapeutic pain neuroscience education, using dosage and treatment format as moderator variables', Pain Practice, 21(3), pp. 366-380. DOI: 10.1111/papr.12962. Available at: https://doi.org/10.1111/papr.12962
Seron, P., Oliveros, M.-J., Gutierrez-Arias, R. et al. (2021) 'Effectiveness of telerehabilitation in physical therapy: a rapid overview', Physical Therapy, 101(6), pzab053. DOI: 10.1093/ptj/pzab053. Available at: https://doi.org/10.1093/ptj/pzab053
Sharififar, S., Ghasemi, H., Geis, C., Azari, H., Adkins, L., Speight, B. and Vincent, H.K. (2023) 'Telerehabilitation service impact on physical function and adherence compared to face-to-face rehabilitation in patients with stroke: a systematic review and meta-analysis', PM&R, 15(12), pp. 1654-1672. DOI: 10.1002/pmrj.12988. Available at: https://doi.org/10.1002/pmrj.12988
Stafinski, T., Nagase, F.I., Avdagovska, M., Stickland, M.K. and Menon, D. (2022) 'Effectiveness of home-based pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease (COPD): systematic review', BMC Health Services Research, 22, 557. DOI: 10.1186/s12913-022-07779-9. Available at: https://doi.org/10.1186/s12913-022-07779-9
Stynes, S., Jordan, K.P., Hill, J.C., Wynne-Jones, G., Cottrell, E., Foster, N.E., Goodwin, R. and Bishop, A. (2021) 'Evaluation of the First Contact Physiotherapy (FCP) model of primary care: patient characteristics and outcomes', Physiotherapy, 113, pp. 199-208. DOI: 10.1016/j.physio.2021.08.002. Available at: https://doi.org/10.1016/j.physio.2021.08.002
Sukhera, J. (2022) 'Narrative Reviews in Medical Education: Key Steps for Researchers', Journal of Graduate Medical Education, 14(4), pp. 418-419. DOI: 10.4300/JGME-D-22-00481.1. Available at: https://doi.org/10.4300/JGME-D-22-00481.1
Suso-Marti, L., La Touche, R., Herranz-Gomez, A., Angulo-Diaz-Parreno, S., Paris-Alemany, A. and Cuenca-Martinez, F. (2021) 'Effectiveness of telerehabilitation in physical therapist practice: an umbrella and mapping review with meta-meta-analysis', Physical Therapy, 101(5), pzab075. DOI: 10.1093/ptj/pzab075. Available at: https://doi.org/10.1093/ptj/pzab075
Tawiah, A.K., Desmeules, F., Finucane, L., Lewis, J., Wieler, M., Stokes, E. and Woodhouse, L.J. (2021) 'Advanced practice in physiotherapy: a global survey', Physiotherapy, 113, pp. 168-176. DOI: 10.1016/j.physio.2021.01.001. Available at: https://doi.org/10.1016/j.physio.2021.01.001
Tsokanos, A., Livieratou, E., Billis, E., Tsekoura, M., Tatsios, P., Tsepis, E. and Fousekis, K. (2021) 'The efficacy of manual therapy in patients with knee osteoarthritis: a systematic review', Medicina, 57(7), 696. DOI: 10.3390/medicina57070696. Available at: https://doi.org/10.3390/medicina57070696
Unsgaard-Tondel, M. and Soderstrom, S. (2022) 'Building therapeutic alliances with patients in treatment for low back pain: a focus group study', Physiotherapy Research International, 27(1), e1932. DOI: 10.1002/pri.1932. Available at: https://doi.org/10.1002/pri.1932
van Dijk, H., Koke, A.J.A., Elbers, S., Mollema, J., Smeets, R.J.E.M. and Wittink, H. (2023) 'Physiotherapists using the biopsychosocial model for chronic pain: barriers and facilitators-a scoping review', International Journal of Environmental Research and Public Health, 20(2), 1634. DOI: 10.3390/ijerph20021634. Available at: https://doi.org/10.3390/ijerph20021634
Vieira, A.G.S., Pinto, A.C.P.N., Garcia, B.M.S.P., Eid, R.A.C., Mol, C.G. and Nawa, R.K. (2022) 'Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review', Journal of Physiotherapy, 68(2), pp. 90-98. DOI: 10.1016/j.jphys.2022.03.011. Available at: https://doi.org/10.1016/j.jphys.2022.03.011
Watson, J.A., Ryan, C.G., Atkinson, G., Williamson, P., Ellington, D., Whittle, R., Dixon, J. and Martin, D.J. (2021) 'Inter-individual differences in the responses to pain neuroscience education in adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomized controlled trials', Journal of Pain, 22(1), pp. 9-20. DOI: 10.1016/j.jpain.2020.03.006. Available at: https://doi.org/10.1016/j.jpain.2020.03.006
Yang, M., Bishop, A., Sussex, J., Roland, M., Jowett, S. and Wilson, E.C.F. (2021) 'Economic evaluation of patient direct access to NHS physiotherapy services', Physiotherapy, 111, pp. 40-47. DOI: 10.1016/j.physio.2020.12.005. Available at: https://doi.org/10.1016/j.physio.2020.12.005
Zadro, J.R., O'Keeffe, M., Allison, J.L., Lembke, K.A., Forbes, J.L. and Maher, C.G. (2020) 'Effectiveness of implementation strategies to improve adherence of physical therapist treatment choices to clinical practice guidelines for musculoskeletal conditions: systematic review', Physical Therapy, 100(9), pp. 1516-1541. DOI: 10.1093/ptj/pzaa101. Available at: https://doi.org/10.1093/ptj/pzaa101
Zhang, H., Hu, D., Xu, Y., Wu, L. and Lou, L. (2022) 'Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials', Annals of Medicine, 54(1), pp. 262-273. DOI: 10.1080/07853890.2021.1999494. Available at: https://doi.org/10.1080/07853890.2021.1999494
