Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

Shabnam ShahAli; Saeed Shahabi; Manal Etemadi; Maryam Hedayati; Barth Cornelia Anne; Parviz Mojgani; Masoud Behzadifar; Kamran Bagheri Lankarani

doi:10.1016/j.heliyon.2023.e20736

Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

Heliyon. 2023 Oct 6;9(10):e20736. doi: 10.1016/j.heliyon.2023.e20736. eCollection 2023 Oct.

Authors

Shabnam ShahAli¹, Saeed Shahabi², Manal Etemadi^{3

4}, Maryam Hedayati⁵, Barth Cornelia Anne^{6

7}, Parviz Mojgani^{8

9}, Masoud Behzadifar¹⁰, Kamran Bagheri Lankarani²

Affiliations

¹ Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
² Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
³ The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, UK.
⁴ Population Health Sciences, Bristol Medical School, University of Bristol, UK.
⁵ Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
⁶ School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland.
⁷ Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
⁸ Iran-Helal Institute of Applied Science and Technology, Tehran, Iran.
⁹ Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran.
¹⁰ Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.

Abstract

Purpose: This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC).

Materials and methods: PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis.

Results: Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC.

Conclusion: Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists' time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.

Keywords: Physiotherapy; Primary care; Primary health care; Qualitative evidence; Rehabilitation; Scoping review.