The Role of Physiotherapy in Primary Health Care in Different Health Systems: A Scoping Review

The Role of Physiotherapy in Primary Health Care in Different Health Systems: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role of Physiotherapy in Primary Health Care in Different Health Systems: A Scoping Review Luiz Henrique Bastos da Silva de Oliveira, Everaldo Pinheiro da Mota Junior, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6917826/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Physiotherapy, historically associated with rehabilitation in hospital and clinical settings, has been expanding its role within Primary Health Care (PHC), reflecting the need for more responsive and accessible health systems capable of addressing population health demands. This study aimed to investigate the physiotherapist’s role in PHC, analyzing how their scope of practice (SoP) adapts to different health system configurations. Specific objectives included understanding the organization of physiotherapy work within PHC, identifying factors influencing the SoP, and describing practice models across diverse contexts. A two-stage methodological approach was employed. The first stage involved a scoping review conducted according to PRISMA-ScR guidelines, covering publications from 2004 to 2024 in Portuguese, English, and Spanish. Studies that explicitly addressed physiotherapy practice in PHC and described the SoP were included, resulting in 28 studies selected for final analysis. The second stage involved a documentary analysis of official documents from national and international organizations, legislation, and institutional websites, focusing on three dimensions for each country: health system characteristics, PHC organization, and physiotherapy regulation. Data were organized into a comparative matrix, enabling identification of practice models and key factors shaping the professional scope. The analysis covered eight countries (Brazil, Canada, Spain, France, Italy, the Netherlands, the United Kingdom, and Sweden), highlighting different configurations tailored to local contexts. Findings indicate that the physiotherapist’s SoP in PHC is shaped by the interaction of four main factors: (I) population and epidemiological characteristics; (II) professional education and training models; (III) regulatory frameworks; and (IV) service organization and funding mechanisms. The study demonstrates that context-specific adaptations influence professional roles, with universal health systems like SUS (Brazil) and NHS (UK) showing greater capacity for innovation and interdisciplinary integration. The results suggest opportunities for cross-country learning, particularly in enhancing service efficiency and care quality. Primary Health Care Physiotherapy Scope of Practice Figures Figure 1 INTRODUCTION Currently, health systems are confronted with the challenge of the triple burden of disease, which comprises the increasing prevalence of non-communicable chronic diseases (NCDs), the persistence of communicable diseases, and external causes such as accidents and violence. Even when non-fatal, these conditions contribute to functional impairments that undermine individual autonomy, place considerable strain on health services, and adversely affect productivity and quality of life. Evidence suggests that, beyond the triple burden of disease, population aging must be a central consideration in public health policy-making ( 1 – 3 ). In this context, the World Health Organization (WHO), in 2017, issued a global call for the strengthening of rehabilitation, emphasizing its integration with other health sectors and the incorporation of rehabilitation services into universal health coverage. This initiative opened the door for discussions regarding the integration of rehabilitation within Primary Health Care (PHC) ( 4 , 5 ). Primary Health Care (PHC) is defined as a set of comprehensive practices aimed at addressing both individual and collective health needs, serving as the foundation of well-developed and sustainable health systems ( 6 ). The Alma-Ata Declaration (1978) defines PHC as the first level of contact between individuals and health systems, emphasizing principles such as universal access, community participation, and a focus on disease prevention and health promotion ( 7 ). In this regard, the principles of PHC were reaffirmed by the Astana Declaration (2018), which emphasized PHC as an essential strategy for ensuring more effective and equitable health systems ( 8 ). The growing concern with population aging and its implications for health systems reinforces the strategic role of PHC, which is recognized as a favorable setting for actions in health promotion, prevention, treatment, and rehabilitation. In this context, physical therapy stands out as a profession with broad potential for action, contributing to mitigating the impacts of NCDs and promoting population functioning. Physical therapy can be defined as an applied science focused on the study of human movement in its various forms and capacities, including the changes caused by pathological conditions and their organic and psychological impacts. Its primary aim is to preserve, maintain, enhance, or restore the integrity of body organs, systems, or functions ( 9 ). The Chartered Society of Physiotherapy defines physical therapy as a health profession based on scientific evidence that works with individuals affected by injuries, diseases, or disabling conditions, contributing to improved quality of life and reduced risk of recurrence ( 10 ). To comprehensively understand the contribution of physical therapy to PHC, it is essential to explore its Scope of Practice (SoP) within this level of care, considering professional competencies, specific responsibilities, and the ethical and legal parameters that guide practice. The term "scope of practice" refers to the set of actions, roles, and responsibilities that a professional is legally and technically qualified to perform safely, based on their education, training, and competencies. This concept defines the boundaries of professional practice, ensuring that interventions align with the practitioner’s skills and qualifications, always prioritizing the safety and well-being of individuals ( 11 ). Scopes of practice can be classified into two types: collective and individual. The collective scope encompasses the full range of possible roles, tasks, functions, and practice settings within the profession. In contrast, the individual scope represents a subset of this broader scope, shaped by the specific education, experience, work environment, and training of each professional ( 12 ). The definition of an individual’s scope of practice is subject to variation depending on the organizations and regulatory agencies to which professionals are accountable. Such variation can affect the safety, access, and overall well-being of health system users ( 13 ). Regarding physical therapy, several official documents establish codes of conduct and regulatory standards for professional practice. Examples include the Code of Ethics and Deontology for Physical Therapy in Brazil ( 14 ) and the Scope of Practice for Physiotherapists and Physiotherapy Technicians in the Emirate of Abu Dhabi ( 15 ). The scope of practice in physical therapy has evolved significantly over the years. Initially, physical therapists operated under medical prescription, with their role limited to executing pre-defined interventions. Over time, the accumulation of scientific evidence and the development of profession-specific clinical reasoning enabled substantial advances, granting greater professional autonomy to physical therapy ( 16 ). Given the central role of PHC as the structural axis of health systems, it is essential to understand the scope of practice of physical therapy within this model of care across different contexts. This article aims to explore the diverse dynamics of physical therapy work organization in PHC settings. Additionally, we seek to identify the key elements driving changes in the composition of the scope of practice of physical therapy in PHC and to describe the characteristics and specificities of various SoP models. METHODS To achieve the proposed objectives, a scoping review was conducted. This type of review is suitable for addressing broad topics, allowing the inclusion of various types of studies. Its main purpose is not to identify the best evidence for a particular intervention or health practice, but rather to gather diverse forms of evidence and analyze how they were produced. Scoping reviews aim to map and synthesize existing knowledge, providing an overview of available studies and identifying potential research gaps ( 17 ). Based on the objective of this study, the following research question was formulated: "How is the Scope of Practice of Physical Therapy configured in Primary Health Care across different Health Systems?" Additionally, two secondary questions were explored: "What elements contribute to changes in the Scope of Practice of Physical Therapy?" and "What are the characteristics and specificities of different Scope of Practice models?" Keywords were identified using terms from the “Descritores de Ciências da Saúde” (DeCS) and Medical Subject Headings (MeSH), including descriptors that allowed for screening of titles and abstracts aligned with the population, concept, and context guiding the review question. The following keywords were used: (“Physical Therapy” OR “Physiotherapy”) AND “Primary Health Care” and “Fisioterapia” AND (“Atenção Primária à Saúde” OR “Atenção Básica”) in Portuguese. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) ( 18 ). The target population was defined as physical therapists working in Primary Health Care. The concept related to the scope of practice, defined as the set of activities, functions, and procedures that a professional is qualified to perform safely, in accordance with legislation, education, training, and competence. The context encompassed the need to strengthen a resolutive PHC system for the entire population, emphasizing the importance of health systems maintaining PHC networks oriented beyond curative and rehabilitative practices, to also include health promotion and disease prevention. The literature search was limited to studies published in English, Portuguese, and Spanish, covering the period from January 2004 to May 2024. Searches were conducted in May 2024 using the following databases: PubMed, BVS, SciELO, and PEDro. The protocol for this scoping review was registered in the Open Science Framework ( https://osf.io/pkuct/ ). The retrieved records were imported into Rayyan (Intelligent Systematic Review; https://www.rayyan.ai ). Duplicate articles were removed, and the remaining abstracts were screened. A flowchart (Fig. 1) outlines all steps from study identification to the inclusion of articles in the review. The selection, eligibility, and inclusion processes are detailed below. The selection and data extraction process took place between June and September 2024 and was conducted in three stages: Stage 1 – Blind screening of titles and abstracts based on the eligibility criteria (Table 1 ), conducted independently by two researchers. Stage 2 – Full-text reading of studies selected in the previous stage. Disagreements were addressed through discussion, and if consensus was not reached, a third reviewer provided the final decision. Stage 3 – Development of a final data extraction table (Table − 2), jointly compiled by the two reviewers to ensure the reliability of the data mapping process. Data analysis was conducted between September and November 2024. It involved a detailed review and re-review of all selected articles, based on the information extracted and organized in the data extraction table. Table 1 Inclusion and Exclusion Criteria of the Review Inclusion Criteria* Exclusion Criteria Literature published in Portuguese, English, or Spanish between January 2004 and May 2024 was considered. Studies were eligible if they described the role of physical therapy in PHC along with the characterization of the SoP of physical therapy. Studies were excluded if they met any of the following criteria: (I) articles that used PHC merely as a testing field for the evaluation of new techniques; (II) experience reports focused on the training of physical therapists for PHC. Note: Specific physical therapy techniques described in isolation were not considered as inclusion criteria, even though they are recognized as part of the physical therapist’s scope of practice. This decision was made to refine the results and enable a better comparison between the SoP of physical therapists in Brazil and other countries. Table 1 - Own elaboration It is worth noting that this study did not require submission to a Research Ethics Committee, as it is based solely on bibliographic data. Table 2 – Characterization of the Studies Selected for Review Year Title Author(s) Country Objective Scope of Practice 2024 Cooperation between physicians and physios fosters trust you know": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care. Kechichian A, Pommier D, Druart L, Lowry V, Pinsault N, Desmeules F. France To explore the experience and perceptions of patients attending a First Contact Physiotherapist (FCP) within a collaborative advanced practice primary care model for acute low back pain. First Contact Physiotherapy (Diagnosis, referral, prescription of medications, medical leave certificates up to 5 days). 2023 The experiences of physiotherapy independent prescribing in primary care: implications for practice. Mullan J, Smithson J, Walsh N. United Kingdom To explore the experiences of independent musculoskeletal physiotherapy prescribing in primary care from the perspectives of physiotherapists and general practitioners, and to identify the implications these have for contemporary physiotherapy practice in primary care. Advanced practice physiotherapy (Independent Prescription of Medications performed by physiotherapists with postgraduate qualifications). 2023 Uso de fisioterapia entre idosos usuários de serviços de atenção primária. Moreira, Rodrigo Canto, Dias Neto, José Maria. Brazil To demonstrate which activities can be performed by physiotherapy professionals with older adults in Primary Health Care to improve their functional capacity, as a way to promote a better quality of life. Individual, group, and home care. 2022 Physiotherapy as part of primary health care, Italy. Da Ros A, Paci M, Buonandi E, Rosiello L, Moretti S, Barchielli C. Italy To describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services into primary health care in Tuscany, Italy. Development of Health Education strategies and counseling for caregivers. Referral to other professionals within Primary Health Care. 2022 Physiotherapy work process in primary health care in a Brazilian municipality: qualitative study. Bim CR, Carvalho BG, Trelha CS, Ribeiro K, Baduy RS, González AD. Brazil Analyze the work process of physiotherapists in primary health care (PHC) and the impacts of work management practices. Home Visits, Group Activities, Individual Consultations, Continuing Education Activities, Health Education Activities. 2022 The introduction of advanced practice physiotherapy within Dutch primary care is a quest for possibilities, added value, and mutual trust: a qualitative study amongst advanced practice physiotherapists and general practitioners. Pellekooren S, Donker M, Reijnders E, Boutalab L, Ostelo R, van Tulder M, Pool-Goudzwaard A. Netherlands To explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) regarding the implementation of Advanced Practice Physiotherapy (APP) in Dutch primary care. Advanced Practice Physiotherapy (defining and communicating diagnoses, screening for surgery or surgical opinions, requesting diagnostic imaging or laboratory tests, and prescribing/injecting medications) 2021 Práticas fisioterapêuticas para a produção do cuidado na atenção primária à saúde Bim, Cíntia Raquel, Carvalho, Brígida Gimenez de, Trelha, Celita Salmaso, Ribeiro, Kátia Suely Queiroz Silva, Baduy, Rossana Staevie, González, Alberto Durán. Brazil To understand the daily routine and tools used by physiotherapists in primary health care and to analyze the determinants influencing care delivery in a municipality where physiotherapists work in all basic health units. Specific individual care, group consultations, and home visits. 2020 Atuação do fisioterapeuta na atenção primária à saúde: revisão de escopo Luana Padilha da Rocha, Ft., M.Sc., Fabiana de Oliveira Silva Sousa, Washington José dos Santos, Ft., M.Sc., Lorena Albuquerque de Melo, Ft., M.Sc., Thatiana Ferreira de Vasconcelos, Ft. Brazil To describe the role of physiotherapists working in Primary Health Care based on the most current evidence available in the scientific literature. Individual care, group care, individual shared care, group shared care, health education. 2020 Atuação do fisioterapeuta na Atenção Primária à Saúde do município de Crateús - CE Camêlo, Hellen Karine da Silva, Arruda, Gisele Maria Melo Soares, de Vasconcelos, Thiago Brasileiro, Bezerra, Maria Iracema Capistrano. Brazil To analyze the performance of physiotherapists in Primary Health Care (PHC) in the municipality of Crateús. Home visits, group activities (School Health Program), (Health Promotion Groups) (Women and Caregivers) (Thematic Groups), individual care, and health promotion activities focused on the health needs of the population. 2020 Atuação do fisioterapeuta nos núcleos de apoio à saúde da família em Teresina, Piauí Silva, Allan Dellon da, Nogueira, Luciana Tolstenko, Silva, Hengrid Graciely Nascimento, Frota, Samanta Cris Monteiro. Brazil To analyze the performance of physiotherapists in the Family Health Support Center ( Núcleo de Apoio à Saúde da Família ) in Teresina, Piauí. Individual consultations, group activities, preventive actions and health education, home follow-ups. 2017 The role of physical therapists in the context of family health support centers Braghini, Cássia Cristina, Ferretti, Fátima, Ferraz, Lucimare. Brazil Analyze the role of the physiotherapist and the obstacles to carrying out their work within the Family Health Support Center ( Núcleo de Apoio à Saúde da Família ).. Group sessions, home visits, health education activities, and disease prevention. 2017 Arthritis management in primary care - A study of physiotherapists' current practice, educational needs and adherence to national guidelines. Andersson SF, Bergman S, Henriksson EW, Bremander A. Sweden Investigate physiotherapy practices related to arthritis and study adherence to evidence-based treatment. Pain education, prescription of home exercises, prescription of physical activities, and counseling on work/leisure activities. 2016 NASF's tools and practices in health of physical therapists Fernandes, Janainny Magalhães, Rios, Talita Abi, Sanches, Vinicius Santos, Santos, Mara Lisiane de Moraes dos. Brazil Analyze the work process of physiotherapists in Family Health Support Center ( Núcleo de Apoio à Saúde da Família ), the use of technological tools, and their training for the job. Individualized treatment, health promotion and prevention activities, group activities, health education, Expanded Clinic, Singular Therapeutic Project, Health Project in the Territory, Matrix Support. 2016 A fisioterapia na atenção primária à saúde: uma revisão integrativa Fonseca, Juliany Marques Abreu da, Rodrigues, Malvina Thais Pacheco, Mascarenhas, Márcio Dênis Medeiros, Lima, Luisa Helena de Oliveira. Brazil Analyze the activities carried out by physiotherapy in primary health care. Educational, preventive, and health promotion activities; group activities; home visits; referrals to specialized services; individual care; home visits with caregiver guidance; prevention and education activities through lectures; care in community spaces; development of therapeutic care; building support networks and educational actions; multiprofessional activities with health group formation; and continuing education activities. 2015 Fisioterapia, cuidado e sua práxis no Núcleo de Apoio à Saúde da Família Souza, Marcio Costa de, Almeida, Camila dos Reis, Bomfim, Aline Santana, Santos, Isabela Fernandes dos, Souza, Jairrose Nascimento. Brazil Understand the health care provided by the physiotherapist in the Family Health Support Center ( Núcleo de Apoio à Saúde da Família ). Home visits, group care, and health education activities. 2015 Atuação fisioterapêutica no núcleo de apoio à saúde da família: uma revisão sistemática Nascimento, Angelo Augusto Paula do, Inácio, Walter da Silva. Brazil Search for findings in the literature that portray the role of physiotherapy in the context of Family Health Support Center ( Núcleo de Apoio à Saúde da Família ) and describe the main actions that physiotherapists perform within it in Brazil. Individual care, home care, operative groups and educational activities within the team, outpatient care, home visits, health education meetings, institutional activities, and continuing education. 2015 Clinical practice in line with evidence? A survey among primary care physiotherapists in western Sweden. Bernhardsson S, Öberg B, Johansson K, Nilsen P, Larsson ME. Sweden To examine the preferred treatment interventions reported by physiotherapists employed in primary care for three common musculoskeletal disorders (low back pain, neck pain, and subacromial pain), the extent to which these interventions are supported by evidence, and associations with demographic variables. Health Education 2014 Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting? Mallett R, Bakker E, Burton M. United Kingdom To determine whether self-referral to physiotherapy is feasible, cost-effective, and beneficial for musculoskeletal outpatient patients in a primary care setting. Telehealth triage 2014 Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners Sinéad Patricia Dufour; Judith Brown; S. Deborah Lucy. Canada To understand the gap in the provision of primary health care from the perspective of specific key members regarding contributions from physiotherapists. Health Education 2014 Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial. Samsson K, Larsson ME. Sweden To evaluate screening by a physiotherapist of patients referred for orthopedic consultation compared to standard practice in primary care. Conducting screening for patients presenting with pain complaints, followed by outcomes that may include referral to an orthopedic surgeon, return referral to the patient’s general practitioner, referral for additional investigations, or referral to physiotherapy or occupational therapy clinics. 2013 Atuação dos fisioterapeutas dos núcleos de apoio à saúde da família entre idosos do município de Arapiraca-Al, Brasil Dibai Filho, Almir Vieira, Aveiro, Mariana Chaves. Brazil To analyze the role of physiotherapists in the Family Health Support Centers ( Núcleo de Apoio à Saúde da Família ) with elderly individuals residing in the municipality of Arapiraca-AL, Brazil. Group care 2011 Atuação do fisioterapeuta na atenção básica à saúde: uma revisão da literatura brasileira Portes, Leonardo Henriques, Caldas, Maria Alice Junqueira, de Paula, Leandro Talma, Freitas, Marcos Souza. Brazil To analyze the role of physiotherapists through a literature review, covering full Brazilian texts published in scientific and online journals. Health education, home care activities, group activities, epidemiological investigation and action planning, interdisciplinary activities, academic roles, individual care at the Basic Health Unit (UBS), care for caregivers, intersectoral actions, and welcoming practices.. 2010 A interface entre o trabalho do agente comunitário de saúde e do fisioterapeuta na atenção básica à saúde Loures, Liliany Fontes, Silva, Maria Cecília de Souza. Brazil To identify the actions of the physiotherapist and the community health agent from the perspective of integrating their roles in primary health care. Home care, individual care focused on rehabilitation, and thematic group care. 2010 Analysis of the activity of mobile rehabilitation-physiotherapy units in primary care López-Liria R, Padilla Góngora D, Catalán Matamoros D, Arrebola López C, Garrido Fernández P, Martínez Cortés Mdel C, Zurita Ortega F. Spain To describe the home care provided by mobile rehabilitation-physiotherapy teams as a response to the needs of the dependent population, the characteristics of its implementation, and the outcomes observed in patients and their functional independence. Home care 2009 Ações de reabilitação de pessoas com deficiência na estratégia da saúde da família da Fundação Zerbini e Secretaria Municipal de Saúde de São Paulo - Região Sudeste – Sapopemba/Vila Prudente - período 2000/2006* Eucenir Fredini Rocha / Márcia Regina Kretzer Brazil To describe the implementation of rehabilitation actions within the Family Health Strategy in the Sapopemba/Vila Prudente Region – Fundação Zerbini/ São Paulo Municipal Health Department, during the period 2000–2006. Therapeutic care, support network building, educational activities, technical meetings, administrative work. 2009 Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. Comer CM, Redmond AC, Bird HA, Conaghan PG. United Kingdom To explore the clinical recognition of Neurogenic Claudication, current patient assessment patterns, and the current treatment of these patients in a large musculoskeletal primary care service. Advanced physiotherapy practices (referring patients to hospital consultants, including pain management specialists, orthopedic surgeons, and neurosurgeons; group exercises; prescription of walking aids). 2008 A fisioterapia na atenção básica: atuação com gestantes em caráter coletivo Brandão, Ana Carolina Schmitz; Gasparetto, Andriele; Pivetta, Hedionéia Maria Foletto Brazil To describe the effects of physiotherapy on the quality of life of pregnant women in primary health care. Health education and group activities. 2007 O fisioterapeuta no Programa de Saúde da Família em Londrina (PR) Trelha, Celita Salmaso, Silva, Daniela Wosiack da, Lida, Lígia Megumi, Fortes, Mariana Hernandes, Mendes, Thaissa de Souza. Brazil To understand the main characteristics of physiotherapy care in the municipality of Londrina (PR) and the challenges related to professional practice. Home care, individual or group sessions, and lectures for thematic groups. Table 2 - Own elaboration RESULTS The search process identified 1,610 articles, of which 109 were duplicates, leaving a total of 1,501 articles for title and abstract screening. After this stage, 1,308 articles were excluded for not meeting the inclusion criteria. In the end, 193 articles were read in full, and only 28 were deemed eligible for this study (Fig. 1). The studies analyzed in this review cover the period from 2004 to 2024; however, no articles published before 2007 were included. Among the 28 studies included in this scoping review, 11 (39.2%) were published in the last five years. Regarding the origin of the articles, studies were conducted in eight countries: Brazil, Canada, Spain, France, the Netherlands, Italy, the United Kingdom, and Sweden. Among these, the highest concentration was from Brazil, with 17 articles (60.7%). Concerning the SoP of physiotherapists in PHC, individual and/or group care was reported in 64.0% of the studies, home visits/care in 53.5%, and health education activities in 42.8%. Table presents the objectives and scope of practice identified in each of the 28 studies included in this scoping review. DISCUSSION This scoping review enabled the mapping of the various roles of physiotherapists in PHC across different countries, revealing a wide diversity in SoP influenced by contextual, structural, and political-health factors. The main findings indicate that, although there have been advances in the integration and recognition of physiotherapists within PHC—particularly in health promotion and prevention activities—individualized care practices still predominate. Brazilian studies on physiotherapy practice in PHC reveal a diversified approach that goes beyond rehabilitation, encompassing functional aspects as well as social, economic, cultural, and psychological determinants of health. Practice is centered on individual and group care and home visits, with a strong emphasis on health promotion and disease prevention actions ( 19 – 22 ). Several studies highlight home care as a relevant aspect of physiotherapy SoP. In the province of Almería, Spain, a mobile service known as “equipos móviles de rehabilitación y fisioterapia” was implemented to assist individuals with disabilities. Between 2004 and 2007, a total of 1,097 patients were served, primarily presenting motor weakness, pain, and muscle atrophy. The most frequent interventions included kinesiotherapy, electrotherapy, and caregiver guidance, with a focus on promoting autonomy and primary care ( 3 , 23 ). In Italy, the Family and Community Physiotherapist model has been developed based on the experience of the Family and Community Nurse. In this model, home visits are limited and focused on prevention, health promotion, and caregiver guidance for individuals with reduced mobility or who are bedridden. The service aims to strengthen longitudinal care and the comprehensiveness of health care, especially in community settings ( 24 ). An important innovation in physiotherapy practice concerns the Extended Scope of Practice models, notably the First-Contact Physiotherapists (FCP) and Advanced Practitioner Physiotherapists (APP), implemented in countries such as France, the United Kingdom, the Netherlands, and Sweden ( 25 – 28 ). These models emerged in response to the shortage of General Practitioners (GPs) in PHC and seek to delegate functions traditionally restricted to GPs to other professionals. Designed to foster collaborative work, they aim to move beyond professional individualism and promote teamwork ( 29 , 30 ). APPs are physiotherapists with advanced competencies who perform activities traditionally restricted to physicians, such as diagnosis, ordering diagnostic tests, prescribing medications, and surgical triage ( 31 ). FCPs act as the first point of contact for specific complaints—particularly musculoskeletal—helping to reduce GP workload and promoting early resolution of cases ( 32 , 33 ). In France, Kechichian et al. (2024) report the use of structured protocols by APPs in the management of low back pain, including diagnosis, therapeutic education, exercise, and anti-inflammatory prescriptions ( 25 ). In the Netherlands, Pellekooren et al . (2022) highlight that although APPs have demonstrated effectiveness, their implementation faces cultural and structural barriers within the health system, especially resistance from GPs to share roles ( 27 ). Studies from the United Kingdom reinforce the feasibility of direct access to physiotherapy without the need for referrals from other professionals, reporting benefits in cost-effectiveness and user experience, along with GP support for independent prescribing by physiotherapists—despite legislative barriers ( 26 , 34 ). In Sweden, Andersson et al. observed strong physiotherapist adherence to clinical guidelines for osteoarthritis management, although they identified gaps in the treatment of rheumatoid arthritis ( 35 ). Other Swedish studies emphasize the importance of clinical guidelines in supporting decision-making and standardizing care, contributing to improved effectiveness and more appropriate patient referrals ( 36 , 37 ). Table 3 presents, based on the reviewed literature, the physiotherapy SoP elements identified in each country. It is important to note that the absence of a given SoP element in a country does not necessarily imply it is not part of physiotherapy practice there, but rather that no studies were found documenting that specific scope in that country. Table 3 – Scope of Practice by Country BRAZIL CANADA SPAIN FRANCE ITALY NETHERLANDS UNITED KINGDOM SWEDEN Consultations Shared group consultations x Shared individual consultations x Home visits x x x Group consultations x x Individual consultations x x Prescriptions Home exercise prescription x x Physical activity prescription x Assistive device prescription x Education Health education x x x x Pain education x Multiprofessional Activities Continuing education activities x Extended clinical x Territorial Health Project x Individual Therapeutic Project x Support Network Building x Matrix Support x Referrals Referral to other health professionals x x Referral to specialized care x Advanced practice physiotherapist Administer medications x Prescribe medications x x Order lab and imaging tests x Define and communicate diagnoses x Pain triage x Administrative tasks x Table 3 - Own elaboration A report by World Physiotherapy states that physiotherapy SoP goes beyond direct patient care and includes public health actions, supervision, leadership, management, teaching, research, and health policy development at local, regional, and national levels ( 38 ). Beyond international guidelines that outline a professional profile for physiotherapists, demographic and systemic factors may also influence physiotherapy SoP. This is demonstrated in the work of Kersten et al. (2007), which aimed to explore the drivers and perspectives surrounding extended roles in physiotherapy. The study concluded that health policies, population aging, epidemiological transitions, and efforts to improve the efficiency and accessibility of health care are all factors that shape physiotherapy SoP ( 39 ). Supporting this finding, Wiggins et al. (2022) identified eight factors potentially responsible for changes in SoP: Education; Competence; Professional identity; Role mixing; Legislation and regulatory policies; Organizational structures; Financial factors; and Professional and personal factors ( 40 ). Thus, this discussion seeks to reflect on these findings in light of the factors that challenge and shape the physiotherapy SoP, such as population profiles, institutional arrangements, educational guidelines, and health policies. EXPANDED SCOPE OF PRACTICE The expansion of the SoP has been one of the main international strategies to address the challenges imposed by demographic and epidemiological transitions. In the field of physiotherapy, two models have gained prominence: APP and FCP. Both were primarily designed to meet the high demand for musculoskeletal care in PHC. This evolution has enabled physiotherapists to independently perform physiotherapeutic diagnoses, prescribe and execute treatments, leading to legislative and legal changes that consolidated physiotherapists as direct-access and advanced-practice professionals ( 16 ). In countries where these models are implemented—such as Canada, the United Kingdom, France, and the Netherlands—physiotherapists are authorized to carry out functions traditionally restricted to physicians, including pain triage, ordering laboratory and imaging tests, defining and communicating diagnoses, administering medications, and, in some cases, prescribing drugs ( 26 , 47 , 48 ). Studies show that these models improve access to services, reduce waiting times, and expand non-surgical treatment options, with positive impacts on the efficiency and quality of care ( 25 , 49 ). Patients seen by FCPs report satisfaction with the timeliness of care, clarity of explanations, and a sense of greater autonomy in managing their own health ( 27 ). Comparisons between traditional models (GP), FCP, and FCP with additional training indicate better clinical outcomes—such as earlier recovery, reduced need for complementary tests, and faster return to work—in models involving an expanded role for physiotherapists ( 50 ). Moreover, advanced practice promotes longer, more personalized consultations with a patient-centered approach, while improving systemic efficiency by reducing the burden on physicians ( 34 , 51 ). Despite these benefits, the expansion of SOP faces barriers, such as the lack of adequate funding structures, resistance from other professional groups, and the need for specific training ( 27 ). Nevertheless, available evidence indicates that the APP/FCP model can contribute significantly to the sustainability of health systems by redistributing tasks and optimizing human resources—particularly in regions facing physician shortages ( 52 ). In Brazil, although there are no models equivalent to APP and FCP in terms of technical and biological scope, care models have been introduced that expand the scope of physical therapy in PHC, such as Multidisciplinary Teams (eMulti). With a focus on comprehensiveness and matrix support, the work of physical therapy in PHC now includes clinical and educational activities, as well as the use of innovative tools, such as the Singular Therapeutic Project (PTS), the Territory Health Project, and Integrative and Complementary Practices (PICS) ( 53 – 55 ). The PTS is a set of therapeutic proposals jointly developed by professionals and service users, structured into four stages: comprehensive assessment, definition of goals and interventions, distribution of responsibilities within the team, and continuous reassessment ( 54 , 56 ). The Territorial Health Project, in turn, aims to foster democratic spaces for dialogue with the community, promoting co-management in health and the implementation of prevention and health promotion actions within the territorial context. Another area of physiotherapy practice in PHC involves PICS, which draw on traditional and popular knowledge focused on health prevention and recovery. These practices are recognized both in Brazil and internationally under various designations, such as Traditional Medicine, Complementary and Alternative Medicine, or Integrative Medicine ( 57 – 59 ). Unlike international models, which are often centered on the individual and clinical pain management, the Brazilian model prioritizes a collective, territorial, and interdisciplinary approach. This distinction highlights the importance of recognizing and valuing diverse forms of SoP expansion, adapted to specific sociopolitical contexts and aligned with the principles of the Brazilian Health System. EDUCATION AND COMPETENCE Professional education is one of the central pillars for the development and consolidation of the SoP in PHC. In the field of physiotherapy, competency building requires the integration of technical knowledge, interpersonal skills, and reflective capacities—key elements for addressing the daily challenges of healthcare services. In Brazil, despite the recommendation for a generalist, critical, and humanistic education, studies have identified gaps in preparing professionals for PHC practice, particularly regarding the mastery of tools such as matricial support , the PTS, and co-management of care ( 21 ). This disconnect between formal curricula and real-world practice undermines the effectiveness of physiotherapy performance in primary care. World Physiotherapy (2023) emphasizes that both initial and continuing education must be adaptable to changes in health systems and the sociocultural particularities of each country. Higher Education Institutions (HEIs), therefore, should align their curricula with the realities of health services and the competencies required in PHC, preparing professionals to act with autonomy, responsibility, and social commitment ( 38 ). Competency development requires the mobilization of knowledge in real and challenging situations, going beyond the mere acquisition of theoretical content. Accordingly, active pedagogical strategies, supervised internships in communities, and engagement with local populations are essential to consolidating technical, cognitive, and relational skills ( 60 , 61 ) A landmark in this evolution in Brazil was COFFITO Resolution No. 363/2009, which formally recognized Physiotherapy in Collective Health, expanding its SoP beyond hospital and outpatient settings. The resolution legitimized the physiotherapist's role in PHC, health promotion, health education, and the development of public policies aimed at collective well-being ( 62 , 63 ). To guide such training, Moccelin et al. (2020) proposed a framework of specific competencies for PHC, distributed across six dimensions: teamwork organization; health actions in the territory; health education; physiotherapeutic care; intersectoral collaboration; and community engagement. This framework highlights the importance of collaborative practices, cultural competence, and knowledge of public health policies ( 64 ). Thus, aligning professional education with the needs of health systems is a decisive factor in expanding the physiotherapist's scope of practice and ensuring care that is more effective, ethical, and responsive to local realities. REGULATORY POLICIES Regulatory policies have a direct impact on the SoP of health professions. By establishing criteria for education, conduct, competencies, and professional ethics, these policies define the boundaries and possibilities of professional practice, affecting the quality of care, the distribution of the workforce, and the organization of services. An ideal regulatory model combines four key structural elements: (I) professional registration; (II) standards of competence and proficiency; (III) educational standards; and (IV) ethical and conduct guidelines ( 65 ). The integration of these components ensures user safety and legitimizes professional practice. Dubois, Dixon, and McKee (2005) identify two primary regulatory models: the professional autonomy model , in which professional councils regulate education and practice; and the state intervention model , in which the government assumes a central role in the regulation and oversight of professions. These models have increasingly been combined into hybrid arrangements that seek to balance public interest protection with professional autonomy ( 66 ). Portugal and France exemplify countries with mixed regulatory systems. In Portugal, the “Orders” — public entities with self-regulatory functions — coexist with the Health Regulatory Authority, which supervises healthcare services ( 67 ). In France, the Public Health Code establishes ethical and educational guidelines for seven health professions, supplemented by the work of trade unions that negotiate working conditions and uphold functional autonomy ( 68 ). Canada adopts an even more innovative approach with “umbrella frameworks,” legislative structures that allow for overlapping SoP across different professions. In this model, physiotherapists may share functions with physicians and nurses — such as diagnosis and prescribing — provided they have the appropriate training and competencies. While this flexibility promotes interprofessional collaboration and increases access to care, it still faces resistance from traditionally dominant professional groups, such as physicians ( 69 ). In Brazil, the regulatory framework for health is fragmented and distributed across various sectors: the Ministry of Health, the Ministry of Education, professional councils, and state and municipal authorities. This division leads to overlapping regulations and poor coordination between education, professional practice, and labor relations ( 70 ). Girardi et al. (2017), in a study on the SoP of physicians and nurses in Brazilian PHC, point to the need for regulatory reform to overcome corporatist conflicts and adopt a more integrated and flexible model—one that considers local contexts, professional competence levels, and actual user needs. Such changes are crucial to strengthening PHC, expanding professionals' SoP, and improving service effectiveness ( 71 ). In this light, regulation should not be seen merely as a set of restrictive rules but as a tool to enhance care quality, align professional practices with scientific evidence, and respond to the social, epidemiological, and technological transformations affecting contemporary health systems. SERVICE ORGANIZATION The way health services are organized directly influences the SoP of professionals, including physiotherapists working in PHC. The structuring of work processes, financing mechanisms, institutional culture, and team coordination are key determinants for both the effectiveness of practices and the possibilities for their expansion or restriction. In Brazil, the reorganization of PHC—particularly through the creation of a model now known as eMulti —has redefined the role of physiotherapists within this level of care. The inclusion of physiotherapists in this new arrangement required a rethinking of professional practice, incorporating approaches focused on the territory, the collective, and interdisciplinarity ( 20 , 21 ). Studies indicate that physiotherapists working in eMulti teams employ tools such as relational technologies, shared consultations, home visits, therapeutic groups, and family planning interventions—actions that go beyond the traditional logic of individual rehabilitation and integrate the professional into a model of comprehensive and territory-based care ( 72 , 73 ). Despite progress, structural barriers remain to the consolidation of this model. In municipalities such as Crateús (CE), limitations such as lack of resources, shortages of professionals, and a prevailing culture that demands individual appointments hinder the implementation of more collective and interdisciplinary practices ( 74 ). Interprofessional collaboration is another critical aspect. The development of integrated care networks to avoid fragmented actions requires spaces for dialogue, joint planning, and shared responsibility among health professionals. Tools such as Singular Therapeutic Projects (PTS), team meetings, and integrated care appointments are important strategies to ensure continuity of care ( 54 ). In Italy, for instance, fragmentation across levels of care and poor communication between services have hindered the implementation of rehabilitation models within PHC. Overcoming these challenges involves strengthening care coordination and intersectoral integration ( 3 ). In Australia, studies highlight that administrative barriers, restricted hours, insufficient funding, and hierarchical service cultures can limit the full participation of physiotherapists, even within advanced practice models ( 52 , 75 ). Financial feasibility and institutional support are considered decisive factors for the success of initiatives such as APP. The same applies to the experience in the Netherlands, where resistance from general practitioners (GPs) to delegate responsibilities to physiotherapists and the lack of adequate funding were identified as the main obstacles to consolidating advanced practice models ( 27 ). Thus, the SoP of physiotherapists is closely linked to how services are designed, financed, and managed. Expanding the SoP depends on work environments that promote interprofessional collaboration, innovation in practice, and alignment with the principles of PHC—comprehensiveness, equity, and resolvability. CONCLUSIONS Physiotherapy has emerged as a strategic profession in the face of current health challenges, such as population aging and the rise of non-communicable chronic diseases. In this context, several countries have invested in expanding the SoP as a way to improve care quality and address persistent issues such as waiting lists. The analysis of international experiences highlights this trend. In the Netherlands, there is shared practice between physiotherapists, physicians, and nurses; in the United Kingdom, the NHS has developed models such as FCP and APP to respond to musculoskeletal demands with greater speed and quality. In Brazil, the development of the model now known as eMulti represented a collective expansion of the SoP within PHC, requiring changes in professional practices, education, service organization, and even the population’s adaptation to a new model of care. These examples illustrate how public policies, professional education, regulation, and service organization both influence and are influenced by the expansion of SoP. The Brazilian case shows how responding to population needs can trigger transformations across multiple dimensions of the health system. For this reason, policymakers should consider these interconnected aspects to ensure effective progress. Future research that explores the SoP of physiotherapy in PHC across different contexts may reveal new forms of care—not to promote standardization, but to serve as reference points for building more equitable and integrated health systems. As limitations of this study, it is important to note that the choice to use broad search descriptors aimed to capture the widest range of relevant information concerning the physiotherapy SoP in PHC across different countries. Additionally, the study did not aim to exhaustively define the SoP of physiotherapists in the countries analyzed. The absence of specific practices in the results does not necessarily mean they are not part of the physiotherapist’s routine in those contexts. Declarations Ethics approval and consent to participate It is worth noting that this study did not require submission to a Research Ethics Committee, as it is based solely on bibliographic data. Consent for publication Not applicable. Availability of data and materials The protocol for this scoping review was registered in the Open Science Framework (https://osf.io/pkuct/). Competing interests The authors declare that they have no competing interests. Funding This study was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), grant number 001. Authors' contributions Study conception and design: LH and PH Data collection: LH and EP Data analysis and interpretation: LH Manuscript writing: LH and PH Critical revision of the content: LH and PH Final approval of the version to be published: All authors Acknowledgements We would like to thank the Graduate Program in Public Health at the University of São Paulo (USP) for the academic support. We also express our gratitude to Prof. Dr. Paulo Henrique dos Santos Mota for his valuable methodological guidance and to our research group colleagues for their contributions during the discussions that enriched this work. References Peixoto SV. 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Fisioterapia, cuidado e sua práxis no núcleo de apoio à saúde da família. Espaç saúde (Online). 2015;67–76. Camêlo HK, da Arruda S, de Vasconcelos GMMS, Bezerra TB. MIC. Atuação do fisioterapeuta na Atenção Primária à Saúde do município de Crateús - CE. Rev APS. 2021;750–64. Young G, Hulcombe J, Hurwood A, Nancarrow S. The Queensland Health Ministerial Taskforce on health practitioners’ expanded scope of practice: consultation findings. Aust Health Rev. 2015;39(3):249–54. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6917826","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485670829,"identity":"d7ea5f68-3943-46ad-af66-735a193639ac","order_by":0,"name":"Luiz Henrique Bastos da Silva de Oliveira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsElEQVRIiWNgGAWjYBACPgbGBmbGBgYGfhAPxCAI2GBaJBuI18LAANZicIBoLRLJzZ8Ld9TJGd9If/aAccc9YrQkNhjPPHPY2OxGjrkB45li4rQk87YdSNx2I4dNgrEtgTgth3nb6hI3z0h/RrSWxmbeNubEDRIJZkRq4XnYzMwL9IvEmTfmBolniNDCz57++DMvMMT424Eh9nEHEVpQbGQgUQMkWkfBKBgFo2AUYAIA4lE2rHA6Sh4AAAAASUVORK5CYII=","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":true,"prefix":"","firstName":"Luiz","middleName":"Henrique Bastos da Silva","lastName":"de Oliveira","suffix":""},{"id":485670830,"identity":"c0c35997-27da-488d-a853-d7edd2d529ae","order_by":1,"name":"Everaldo Pinheiro da Mota Junior","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Everaldo","middleName":"Pinheiro da Mota","lastName":"Junior","suffix":""},{"id":485670831,"identity":"8c8d770b-86b7-4040-a219-024933472d37","order_by":2,"name":"Paulo Henrique dos Santos Mota","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Paulo","middleName":"Henrique dos Santos","lastName":"Mota","suffix":""}],"badges":[],"createdAt":"2025-06-18 00:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6917826/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6917826/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86938074,"identity":"5aca7069-5b75-447c-9fff-c2bb1f8213b5","added_by":"auto","created_at":"2025-07-17 11:16:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48521,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the evidence source selection process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6917826/v1/07f810e1fc1ecebe0774d88c.png"},{"id":86939664,"identity":"d5b015fa-b620-41ae-8afb-f3734cf0dab5","added_by":"auto","created_at":"2025-07-17 11:32:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":975603,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6917826/v1/43db395d-5a37-4059-846b-1828a7954908.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Role of Physiotherapy in Primary Health Care in Different Health Systems: A Scoping Review\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCurrently, health systems are confronted with the challenge of the triple burden of disease, which comprises the increasing prevalence of non-communicable chronic diseases (NCDs), the persistence of communicable diseases, and external causes such as accidents and violence. Even when non-fatal, these conditions contribute to functional impairments that undermine individual autonomy, place considerable strain on health services, and adversely affect productivity and quality of life. Evidence suggests that, beyond the triple burden of disease, population aging must be a central consideration in public health policy-making (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this context, the World Health Organization (WHO), in 2017, issued a global call for the strengthening of rehabilitation, emphasizing its integration with other health sectors and the incorporation of rehabilitation services into universal health coverage. This initiative opened the door for discussions regarding the integration of rehabilitation within Primary Health Care (PHC) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrimary Health Care (PHC) is defined as a set of comprehensive practices aimed at addressing both individual and collective health needs, serving as the foundation of well-developed and sustainable health systems (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The Alma-Ata Declaration (1978) defines PHC as the first level of contact between individuals and health systems, emphasizing principles such as universal access, community participation, and a focus on disease prevention and health promotion (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In this regard, the principles of PHC were reaffirmed by the Astana Declaration (2018), which emphasized PHC as an essential strategy for ensuring more effective and equitable health systems (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe growing concern with population aging and its implications for health systems reinforces the strategic role of PHC, which is recognized as a favorable setting for actions in health promotion, prevention, treatment, and rehabilitation. In this context, physical therapy stands out as a profession with broad potential for action, contributing to mitigating the impacts of NCDs and promoting population functioning.\u003c/p\u003e\u003cp\u003ePhysical therapy can be defined as an applied science focused on the study of human movement in its various forms and capacities, including the changes caused by pathological conditions and their organic and psychological impacts. Its primary aim is to preserve, maintain, enhance, or restore the integrity of body organs, systems, or functions (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The Chartered Society of Physiotherapy defines physical therapy as a health profession based on scientific evidence that works with individuals affected by injuries, diseases, or disabling conditions, contributing to improved quality of life and reduced risk of recurrence (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo comprehensively understand the contribution of physical therapy to PHC, it is essential to explore its Scope of Practice (SoP) within this level of care, considering professional competencies, specific responsibilities, and the ethical and legal parameters that guide practice.\u003c/p\u003e\u003cp\u003eThe term \"scope of practice\" refers to the set of actions, roles, and responsibilities that a professional is legally and technically qualified to perform safely, based on their education, training, and competencies. This concept defines the boundaries of professional practice, ensuring that interventions align with the practitioner\u0026rsquo;s skills and qualifications, always prioritizing the safety and well-being of individuals (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eScopes of practice can be classified into two types: collective and individual. The collective scope encompasses the full range of possible roles, tasks, functions, and practice settings within the profession. In contrast, the individual scope represents a subset of this broader scope, shaped by the specific education, experience, work environment, and training of each professional (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe definition of an individual\u0026rsquo;s scope of practice is subject to variation depending on the organizations and regulatory agencies to which professionals are accountable. Such variation can affect the safety, access, and overall well-being of health system users (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding physical therapy, several official documents establish codes of conduct and regulatory standards for professional practice. Examples include the \u003cem\u003eCode of Ethics and Deontology for Physical Therapy\u003c/em\u003e in Brazil (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and the \u003cem\u003eScope of Practice for Physiotherapists and Physiotherapy Technicians\u003c/em\u003e in the Emirate of Abu Dhabi (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe scope of practice in physical therapy has evolved significantly over the years. Initially, physical therapists operated under medical prescription, with their role limited to executing pre-defined interventions. Over time, the accumulation of scientific evidence and the development of profession-specific clinical reasoning enabled substantial advances, granting greater professional autonomy to physical therapy (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the central role of PHC as the structural axis of health systems, it is essential to understand the scope of practice of physical therapy within this model of care across different contexts. This article aims to explore the diverse dynamics of physical therapy work organization in PHC settings. Additionally, we seek to identify the key elements driving changes in the composition of the scope of practice of physical therapy in PHC and to describe the characteristics and specificities of various SoP models.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eTo achieve the proposed objectives, a scoping review was conducted. This type of review is suitable for addressing broad topics, allowing the inclusion of various types of studies. Its main purpose is not to identify the best evidence for a particular intervention or health practice, but rather to gather diverse forms of evidence and analyze how they were produced. Scoping reviews aim to map and synthesize existing knowledge, providing an overview of available studies and identifying potential research gaps (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBased on the objective of this study, the following research question was formulated: \u003cem\u003e\"How is the Scope of Practice of Physical Therapy configured in Primary Health Care across different Health Systems?\"\u003c/em\u003e Additionally, two secondary questions were explored: \u003cem\u003e\"What elements contribute to changes in the Scope of Practice of Physical Therapy?\"\u003c/em\u003e and \u003cem\u003e\"What are the characteristics and specificities of different Scope of Practice models?\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eKeywords were identified using terms from the \u003cem\u003e\u0026ldquo;Descritores de Ci\u0026ecirc;ncias da Sa\u0026uacute;de\u0026rdquo; (DeCS)\u003c/em\u003e and Medical Subject Headings (MeSH), including descriptors that allowed for screening of titles and abstracts aligned with the population, concept, and context guiding the review question. The following keywords were used: (\u0026ldquo;Physical Therapy\u0026rdquo; OR \u0026ldquo;Physiotherapy\u0026rdquo;) AND \u0026ldquo;Primary Health Care\u0026rdquo; and \u0026ldquo;Fisioterapia\u0026rdquo; AND (\u0026ldquo;Aten\u0026ccedil;\u0026atilde;o Prim\u0026aacute;ria \u0026agrave; Sa\u0026uacute;de\u0026rdquo; OR \u0026ldquo;Aten\u0026ccedil;\u0026atilde;o B\u0026aacute;sica\u0026rdquo;) in Portuguese.\u003c/p\u003e\u003cp\u003eThe review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The target population was defined as physical therapists working in Primary Health Care. The concept related to the scope of practice, defined as the set of activities, functions, and procedures that a professional is qualified to perform safely, in accordance with legislation, education, training, and competence. The context encompassed the need to strengthen a resolutive PHC system for the entire population, emphasizing the importance of health systems maintaining PHC networks oriented beyond curative and rehabilitative practices, to also include health promotion and disease prevention.\u003c/p\u003e\u003cp\u003eThe literature search was limited to studies published in English, Portuguese, and Spanish, covering the period from January 2004 to May 2024. Searches were conducted in May 2024 using the following databases: PubMed, BVS, SciELO, and PEDro. The protocol for this scoping review was registered in the Open Science Framework (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/pkuct/\u003c/span\u003e\u003cspan address=\"https://osf.io/pkuct/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The retrieved records were imported into Rayyan (Intelligent Systematic Review; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rayyan.ai\u003c/span\u003e\u003cspan address=\"https://www.rayyan.ai\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDuplicate articles were removed, and the remaining abstracts were screened. A flowchart (Fig.\u0026nbsp;1) outlines all steps from study identification to the inclusion of articles in the review. The selection, eligibility, and inclusion processes are detailed below.\u003c/p\u003e\u003cp\u003eThe selection and data extraction process took place between June and September 2024 and was conducted in three stages:\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 1\u003c/b\u003e \u0026ndash; Blind screening of titles and abstracts based on the eligibility criteria (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), conducted independently by two researchers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 2\u003c/b\u003e \u0026ndash; Full-text reading of studies selected in the previous stage. Disagreements were addressed through discussion, and if consensus was not reached, a third reviewer provided the final decision.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 3\u003c/b\u003e \u0026ndash; Development of a final data extraction table (Table \u0026minus;\u0026thinsp;2), jointly compiled by the two reviewers to ensure the reliability of the data mapping process.\u003c/p\u003e\u003cp\u003eData analysis was conducted between September and November 2024. It involved a detailed review and re-review of all selected articles, based on the information extracted and organized in the data extraction table.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInclusion and Exclusion Criteria of the Review\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion Criteria*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExclusion Criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiterature published in Portuguese, English, or Spanish between January 2004 and May 2024 was considered. Studies were eligible if they described the role of physical therapy in PHC along with the characterization of the SoP of physical therapy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudies were excluded if they met any of the following criteria: (I) articles that used PHC merely as a testing field for the evaluation of new techniques; (II) experience reports focused on the training of physical therapists for PHC.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNote: Specific physical therapy techniques described in isolation were not considered as inclusion criteria, even though they are recognized as part of the physical therapist\u0026rsquo;s scope of practice. This decision was made to refine the results and enable a better comparison between the SoP of physical therapists in Brazil and other countries.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e - Own elaboration\u003c/p\u003e\u003cp\u003eIt is worth noting that this study did not require submission to a Research Ethics Committee, as it is based solely on bibliographic data.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e \u0026ndash; Characterization of the Studies Selected for Review\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAuthor(s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObjective\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eScope of Practice\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCooperation between physicians and physios fosters trust you know\": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKechichian A, Pommier D, Druart L, Lowry V, Pinsault N, Desmeules F.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore the experience and perceptions of patients attending a First Contact Physiotherapist (FCP) within a collaborative advanced practice primary care model for acute low back pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFirst Contact Physiotherapy (Diagnosis, referral, prescription of medications, medical leave certificates up to 5 days).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe experiences of physiotherapy independent prescribing in primary care: implications for practice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMullan J, Smithson J, Walsh N.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnited Kingdom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore the experiences of independent musculoskeletal physiotherapy prescribing in primary care from the perspectives of physiotherapists and general practitioners, and to identify the implications these have for contemporary physiotherapy practice in primary care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAdvanced practice physiotherapy (Independent Prescription of Medications performed by physiotherapists with postgraduate qualifications).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUso de fisioterapia entre idosos usu\u0026aacute;rios de servi\u0026ccedil;os de aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMoreira, Rodrigo Canto, Dias Neto, Jos\u0026eacute; Maria.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo demonstrate which activities can be performed by physiotherapy professionals with older adults in Primary Health Care to improve their functional capacity, as a way to promote a better quality of life.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndividual, group, and home care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysiotherapy as part of primary health care, Italy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDa Ros A, Paci M, Buonandi E, Rosiello L, Moretti S, Barchielli C.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eItaly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services into primary health care in Tuscany, Italy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDevelopment of Health Education strategies and counseling for caregivers. Referral to other professionals within Primary Health Care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysiotherapy work process in primary health care in a Brazilian municipality: qualitative study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBim CR, Carvalho BG, Trelha CS, Ribeiro K, Baduy RS, Gonz\u0026aacute;lez AD.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnalyze the work process of physiotherapists in primary health care (PHC) and the impacts of work management practices.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHome Visits, Group Activities, Individual Consultations, Continuing Education Activities, Health Education Activities.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe introduction of advanced practice physiotherapy within Dutch primary care is a quest for possibilities, added value, and mutual trust: a qualitative study amongst advanced practice physiotherapists and general practitioners.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePellekooren S, Donker M, Reijnders E, Boutalab L, Ostelo R, van Tulder M, Pool-Goudzwaard A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNetherlands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) regarding the implementation of Advanced Practice Physiotherapy (APP) in Dutch primary care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAdvanced Practice Physiotherapy (defining and communicating diagnoses, screening for surgery or surgical opinions, requesting diagnostic imaging or laboratory tests, and prescribing/injecting medications)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePr\u0026aacute;ticas fisioterap\u0026ecirc;uticas para a produ\u0026ccedil;\u0026atilde;o do cuidado na aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria \u0026agrave; sa\u0026uacute;de\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBim, C\u0026iacute;ntia Raquel, Carvalho, Br\u0026iacute;gida Gimenez de, Trelha, Celita Salmaso, Ribeiro, K\u0026aacute;tia Suely Queiroz Silva, Baduy, Rossana Staevie, Gonz\u0026aacute;lez, Alberto Dur\u0026aacute;n.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo understand the daily routine and tools used by physiotherapists in primary health care and to analyze the determinants influencing care delivery in a municipality where physiotherapists work in all basic health units.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSpecific individual care, group consultations, and home visits.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtua\u0026ccedil;\u0026atilde;o do fisioterapeuta na aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria \u0026agrave; sa\u0026uacute;de: revis\u0026atilde;o de escopo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLuana Padilha da Rocha, Ft., M.Sc., Fabiana de Oliveira Silva Sousa, Washington Jos\u0026eacute; dos Santos, Ft., M.Sc., Lorena Albuquerque de Melo, Ft., M.Sc., Thatiana Ferreira de Vasconcelos, Ft.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo describe the role of physiotherapists working in Primary Health Care based on the most current evidence available in the scientific literature.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndividual care, group care, individual shared care, group shared care, health education.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtua\u0026ccedil;\u0026atilde;o do fisioterapeuta na Aten\u0026ccedil;\u0026atilde;o Prim\u0026aacute;ria \u0026agrave; Sa\u0026uacute;de do munic\u0026iacute;pio de Crate\u0026uacute;s - CE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCam\u0026ecirc;lo, Hellen Karine da Silva, Arruda, Gisele Maria Melo Soares, de Vasconcelos, Thiago Brasileiro, Bezerra, Maria Iracema Capistrano.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo analyze the performance of physiotherapists in Primary Health Care (PHC) in the municipality of Crate\u0026uacute;s.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHome visits, group activities (School Health Program), (Health Promotion Groups) (Women and Caregivers) (Thematic Groups), individual care, and health promotion activities focused on the health needs of the population.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtua\u0026ccedil;\u0026atilde;o do fisioterapeuta nos n\u0026uacute;cleos de apoio \u0026agrave; sa\u0026uacute;de da fam\u0026iacute;lia em Teresina, Piau\u0026iacute;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSilva, Allan Dellon da, Nogueira, Luciana Tolstenko, Silva, Hengrid Graciely Nascimento, Frota, Samanta Cris Monteiro.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo analyze the performance of physiotherapists in the Family Health Support Center (\u003cem\u003eN\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/em\u003e) in Teresina, Piau\u0026iacute;.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndividual consultations, group activities, preventive actions and health education, home follow-ups.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe role of physical therapists in the context of family health support centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBraghini, C\u0026aacute;ssia Cristina, Ferretti, F\u0026aacute;tima, Ferraz, Lucimare.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnalyze the role of the physiotherapist and the obstacles to carrying out their work within the Family Health Support Center (\u003cem\u003eN\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/em\u003e)..\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup sessions, home visits, health education activities, and disease prevention.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArthritis management in primary care - A study of physiotherapists' current practice, educational needs and adherence to national guidelines.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAndersson SF, Bergman S, Henriksson EW, Bremander A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSweden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInvestigate physiotherapy practices related to arthritis and study adherence to evidence-based treatment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePain education, prescription of home exercises, prescription of physical activities, and counseling on work/leisure activities.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNASF's tools and practices in health of physical therapists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFernandes, Janainny Magalh\u0026atilde;es, Rios, Talita Abi, Sanches, Vinicius Santos, Santos, Mara Lisiane de Moraes dos.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnalyze the work process of physiotherapists in Family Health Support Center (\u003cem\u003eN\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/em\u003e), the use of technological tools, and their training for the job.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndividualized treatment, health promotion and prevention activities, group activities, health education, Expanded Clinic, Singular Therapeutic Project, Health Project in the Territory, Matrix Support.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA fisioterapia na aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria \u0026agrave; sa\u0026uacute;de: uma revis\u0026atilde;o integrativa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFonseca, Juliany Marques Abreu da, Rodrigues, Malvina Thais Pacheco, Mascarenhas, M\u0026aacute;rcio D\u0026ecirc;nis Medeiros, Lima, Luisa Helena de Oliveira.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnalyze the activities carried out by physiotherapy in primary health care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEducational, preventive, and health promotion activities; group activities; home visits; referrals to specialized services; individual care; home visits with caregiver guidance; prevention and education activities through lectures; care in community spaces; development of therapeutic care; building support networks and educational actions; multiprofessional activities with health group formation; and continuing education activities.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFisioterapia, cuidado e sua pr\u0026aacute;xis no N\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSouza, Marcio Costa de, Almeida, Camila dos Reis, Bomfim, Aline Santana, Santos, Isabela Fernandes dos, Souza, Jairrose Nascimento.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUnderstand the health care provided by the physiotherapist in the Family Health Support Center (\u003cem\u003eN\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/em\u003e).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHome visits, group care, and health education activities.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtua\u0026ccedil;\u0026atilde;o fisioterap\u0026ecirc;utica no n\u0026uacute;cleo de apoio \u0026agrave; sa\u0026uacute;de da fam\u0026iacute;lia: uma revis\u0026atilde;o sistem\u0026aacute;tica\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNascimento, Angelo Augusto Paula do, In\u0026aacute;cio, Walter da Silva.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSearch for findings in the literature that portray the role of physiotherapy in the context of Family Health Support Center (\u003cem\u003eN\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/em\u003e) and describe the main actions that physiotherapists perform within it in Brazil.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndividual care, home care, operative groups and educational activities within the team, outpatient care, home visits, health education meetings, institutional activities, and continuing education.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical practice in line with evidence? A survey among primary care physiotherapists in western Sweden.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBernhardsson S, \u0026Ouml;berg B, Johansson K, Nilsen P, Larsson ME.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSweden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo examine the preferred treatment interventions reported by physiotherapists employed in primary care for three common musculoskeletal disorders (low back pain, neck pain, and subacromial pain), the extent to which these interventions are supported by evidence, and associations with demographic variables.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHealth Education\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIs physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMallett R, Bakker E, Burton M.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnited Kingdom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo determine whether self-referral to physiotherapy is feasible, cost-effective, and beneficial for musculoskeletal outpatient patients in a primary care setting.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTelehealth triage\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntegrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSin\u0026eacute;ad Patricia Dufour; Judith Brown; S. Deborah Lucy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCanada\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo understand the gap in the provision of primary health care from the perspective of specific key members regarding contributions from physiotherapists.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHealth Education\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSamsson K, Larsson ME.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSweden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo evaluate screening by a physiotherapist of patients referred for orthopedic consultation compared to standard practice in primary care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eConducting screening for patients presenting with pain complaints, followed by outcomes that may include referral to an orthopedic surgeon, return referral to the patient\u0026rsquo;s general practitioner, referral for additional investigations, or referral to physiotherapy or occupational therapy clinics.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtua\u0026ccedil;\u0026atilde;o dos fisioterapeutas dos n\u0026uacute;cleos de apoio \u0026agrave; sa\u0026uacute;de da fam\u0026iacute;lia entre idosos do munic\u0026iacute;pio de Arapiraca-Al, Brasil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDibai Filho, Almir Vieira, Aveiro, Mariana Chaves.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo analyze the role of physiotherapists in the Family Health Support Centers (\u003cem\u003eN\u0026uacute;cleo de Apoio \u0026agrave; Sa\u0026uacute;de da Fam\u0026iacute;lia\u003c/em\u003e) with elderly individuals residing in the municipality of Arapiraca-AL, Brazil.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtua\u0026ccedil;\u0026atilde;o do fisioterapeuta na aten\u0026ccedil;\u0026atilde;o b\u0026aacute;sica \u0026agrave; sa\u0026uacute;de: uma revis\u0026atilde;o da literatura brasileira\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePortes, Leonardo Henriques, Caldas, Maria Alice Junqueira, de Paula, Leandro Talma, Freitas, Marcos Souza.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo analyze the role of physiotherapists through a literature review, covering full Brazilian texts published in scientific and online journals.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHealth education, home care activities, group activities, epidemiological investigation and action planning, interdisciplinary activities, academic roles, individual care at the Basic Health Unit (UBS), care for caregivers, intersectoral actions, and welcoming practices..\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA interface entre o trabalho do agente comunit\u0026aacute;rio de sa\u0026uacute;de e do fisioterapeuta na aten\u0026ccedil;\u0026atilde;o b\u0026aacute;sica \u0026agrave; sa\u0026uacute;de\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLoures, Liliany Fontes, Silva, Maria Cec\u0026iacute;lia de Souza.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo identify the actions of the physiotherapist and the community health agent from the perspective of integrating their roles in primary health care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHome care, individual care focused on rehabilitation, and thematic group care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnalysis of the activity of mobile rehabilitation-physiotherapy units in primary care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL\u0026oacute;pez-Liria R, Padilla G\u0026oacute;ngora D, Catal\u0026aacute;n Matamoros D, Arrebola L\u0026oacute;pez C, Garrido Fern\u0026aacute;ndez P, Mart\u0026iacute;nez Cort\u0026eacute;s Mdel C, Zurita Ortega F.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSpain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo describe the home care provided by mobile rehabilitation-physiotherapy teams as a response to the needs of the dependent population, the characteristics of its implementation, and the outcomes observed in patients and their functional independence.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHome care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u0026ccedil;\u0026otilde;es de reabilita\u0026ccedil;\u0026atilde;o de pessoas com defici\u0026ecirc;ncia na estrat\u0026eacute;gia da sa\u0026uacute;de da fam\u0026iacute;lia da Funda\u0026ccedil;\u0026atilde;o Zerbini e Secretaria Municipal de Sa\u0026uacute;de de S\u0026atilde;o Paulo - Regi\u0026atilde;o Sudeste \u0026ndash; Sapopemba/Vila Prudente - per\u0026iacute;odo 2000/2006*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEucenir Fredini Rocha / M\u0026aacute;rcia Regina Kretzer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo describe the implementation of rehabilitation actions within the Family Health Strategy in the Sapopemba/Vila Prudente Region \u0026ndash; Funda\u0026ccedil;\u0026atilde;o Zerbini/ S\u0026atilde;o Paulo Municipal Health Department, during the period 2000\u0026ndash;2006.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTherapeutic care, support network building, educational activities, technical meetings, administrative work.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComer CM, Redmond AC, Bird HA, Conaghan PG.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnited Kingdom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore the clinical recognition of Neurogenic Claudication, current patient assessment patterns, and the current treatment of these patients in a large musculoskeletal primary care service.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAdvanced physiotherapy practices (referring patients to hospital consultants, including pain management specialists, orthopedic surgeons, and neurosurgeons; group exercises; prescription of walking aids).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA fisioterapia na aten\u0026ccedil;\u0026atilde;o b\u0026aacute;sica: atua\u0026ccedil;\u0026atilde;o com gestantes em car\u0026aacute;ter coletivo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBrand\u0026atilde;o, Ana Carolina Schmitz; Gasparetto, Andriele; Pivetta, Hedion\u0026eacute;ia Maria Foletto\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo describe the effects of physiotherapy on the quality of life of pregnant women in primary health care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHealth education and group activities.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eO fisioterapeuta no Programa de Sa\u0026uacute;de da Fam\u0026iacute;lia em Londrina (PR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrelha, Celita Salmaso, Silva, Daniela Wosiack da, Lida, L\u0026iacute;gia Megumi, Fortes, Mariana Hernandes, Mendes, Thaissa de Souza.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo understand the main characteristics of physiotherapy care in the municipality of Londrina (PR) and the challenges related to professional practice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHome care, individual or group sessions, and lectures for thematic groups.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e - Own elaboration\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe search process identified 1,610 articles, of which 109 were duplicates, leaving a total of 1,501 articles for title and abstract screening. After this stage, 1,308 articles were excluded for not meeting the inclusion criteria. In the end, 193 articles were read in full, and only 28 were deemed eligible for this study (Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eThe studies analyzed in this review cover the period from 2004 to 2024; however, no articles published before 2007 were included. Among the 28 studies included in this scoping review, 11 (39.2%) were published in the last five years. Regarding the origin of the articles, studies were conducted in eight countries: Brazil, Canada, Spain, France, the Netherlands, Italy, the United Kingdom, and Sweden. Among these, the highest concentration was from Brazil, with 17 articles (60.7%).\u003c/p\u003e\u003cp\u003eConcerning the SoP of physiotherapists in PHC, individual and/or group care was reported in 64.0% of the studies, home visits/care in 53.5%, and health education activities in 42.8%. Table presents the objectives and scope of practice identified in each of the 28 studies included in this scoping review.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis scoping review enabled the mapping of the various roles of physiotherapists in PHC across different countries, revealing a wide diversity in SoP influenced by contextual, structural, and political-health factors. The main findings indicate that, although there have been advances in the integration and recognition of physiotherapists within PHC\u0026mdash;particularly in health promotion and prevention activities\u0026mdash;individualized care practices still predominate.\u003c/p\u003e\u003cp\u003eBrazilian studies on physiotherapy practice in PHC reveal a diversified approach that goes beyond rehabilitation, encompassing functional aspects as well as social, economic, cultural, and psychological determinants of health. Practice is centered on individual and group care and home visits, with a strong emphasis on health promotion and disease prevention actions (\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral studies highlight home care as a relevant aspect of physiotherapy SoP. In the province of Almer\u0026iacute;a, Spain, a mobile service known as \u0026ldquo;equipos m\u0026oacute;viles de rehabilitaci\u0026oacute;n y fisioterapia\u0026rdquo; was implemented to assist individuals with disabilities. Between 2004 and 2007, a total of 1,097 patients were served, primarily presenting motor weakness, pain, and muscle atrophy. The most frequent interventions included kinesiotherapy, electrotherapy, and caregiver guidance, with a focus on promoting autonomy and primary care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Italy, the Family and Community Physiotherapist model has been developed based on the experience of the Family and Community Nurse. In this model, home visits are limited and focused on prevention, health promotion, and caregiver guidance for individuals with reduced mobility or who are bedridden. The service aims to strengthen longitudinal care and the comprehensiveness of health care, especially in community settings (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAn important innovation in physiotherapy practice concerns the Extended Scope of Practice models, notably the First-Contact Physiotherapists (FCP) and Advanced Practitioner Physiotherapists (APP), implemented in countries such as France, the United Kingdom, the Netherlands, and Sweden (\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These models emerged in response to the shortage of General Practitioners (GPs) in PHC and seek to delegate functions traditionally restricted to GPs to other professionals. Designed to foster collaborative work, they aim to move beyond professional individualism and promote teamwork (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAPPs are physiotherapists with advanced competencies who perform activities traditionally restricted to physicians, such as diagnosis, ordering diagnostic tests, prescribing medications, and surgical triage (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). FCPs act as the first point of contact for specific complaints\u0026mdash;particularly musculoskeletal\u0026mdash;helping to reduce GP workload and promoting early resolution of cases (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn France, Kechichian \u003cem\u003eet al.\u003c/em\u003e (2024) report the use of structured protocols by APPs in the management of low back pain, including diagnosis, therapeutic education, exercise, and anti-inflammatory prescriptions (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In the Netherlands, Pellekooren \u003cem\u003eet al\u003c/em\u003e. (2022) highlight that although APPs have demonstrated effectiveness, their implementation faces cultural and structural barriers within the health system, especially resistance from GPs to share roles (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies from the United Kingdom reinforce the feasibility of direct access to physiotherapy without the need for referrals from other professionals, reporting benefits in cost-effectiveness and user experience, along with GP support for independent prescribing by physiotherapists\u0026mdash;despite legislative barriers (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Sweden, Andersson et al. observed strong physiotherapist adherence to clinical guidelines for osteoarthritis management, although they identified gaps in the treatment of rheumatoid arthritis (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Other Swedish studies emphasize the importance of clinical guidelines in supporting decision-making and standardizing care, contributing to improved effectiveness and more appropriate patient referrals (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents, based on the reviewed literature, the physiotherapy SoP elements identified in each country. It is important to note that the absence of a given SoP element in a country does not necessarily imply it is not part of physiotherapy practice there, but rather that no studies were found documenting that specific scope in that country.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Scope of Practice by Country\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBRAZIL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCANADA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSPAIN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFRANCE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eITALY\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNETHERLANDS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eUNITED KINGDOM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eSWEDEN\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eConsultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShared group consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShared individual consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndividual consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePrescriptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome exercise prescription\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical activity prescription\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssistive device prescription\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePain education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eMultiprofessional Activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuing education activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtended clinical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTerritorial Health Project\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndividual Therapeutic Project\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupport Network Building\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMatrix Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eReferrals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferral to other health professionals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferral to specialized care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAdvanced practice physiotherapist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdminister medications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrescribe medications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrder lab and imaging tests\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDefine and communicate diagnoses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePain triage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdministrative tasks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e- Own elaboration\u003c/p\u003e\u003cp\u003eA report by World Physiotherapy states that physiotherapy SoP goes beyond direct patient care and includes public health actions, supervision, leadership, management, teaching, research, and health policy development at local, regional, and national levels (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBeyond international guidelines that outline a professional profile for physiotherapists, demographic and systemic factors may also influence physiotherapy SoP. This is demonstrated in the work of Kersten et al. (2007), which aimed to explore the drivers and perspectives surrounding extended roles in physiotherapy. The study concluded that health policies, population aging, epidemiological transitions, and efforts to improve the efficiency and accessibility of health care are all factors that shape physiotherapy SoP (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSupporting this finding, Wiggins et al. (2022) identified eight factors potentially responsible for changes in SoP: Education; Competence; Professional identity; Role mixing; Legislation and regulatory policies; Organizational structures; Financial factors; and Professional and personal factors (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus, this discussion seeks to reflect on these findings in light of the factors that challenge and shape the physiotherapy SoP, such as population profiles, institutional arrangements, educational guidelines, and health policies.\u003c/p\u003e\n\u003ch3\u003eEXPANDED SCOPE OF PRACTICE\u003c/h3\u003e\n\u003cp\u003eThe expansion of the SoP has been one of the main international strategies to address the challenges imposed by demographic and epidemiological transitions. In the field of physiotherapy, two models have gained prominence: APP and FCP. Both were primarily designed to meet the high demand for musculoskeletal care in PHC. This evolution has enabled physiotherapists to independently perform physiotherapeutic diagnoses, prescribe and execute treatments, leading to legislative and legal changes that consolidated physiotherapists as direct-access and advanced-practice professionals (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn countries where these models are implemented\u0026mdash;such as Canada, the United Kingdom, France, and the Netherlands\u0026mdash;physiotherapists are authorized to carry out functions traditionally restricted to physicians, including pain triage, ordering laboratory and imaging tests, defining and communicating diagnoses, administering medications, and, in some cases, prescribing drugs (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies show that these models improve access to services, reduce waiting times, and expand non-surgical treatment options, with positive impacts on the efficiency and quality of care (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Patients seen by FCPs report satisfaction with the timeliness of care, clarity of explanations, and a sense of greater autonomy in managing their own health (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eComparisons between traditional models (GP), FCP, and FCP with additional training indicate better clinical outcomes\u0026mdash;such as earlier recovery, reduced need for complementary tests, and faster return to work\u0026mdash;in models involving an expanded role for physiotherapists (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). Moreover, advanced practice promotes longer, more personalized consultations with a patient-centered approach, while improving systemic efficiency by reducing the burden on physicians (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite these benefits, the expansion of SOP faces barriers, such as the lack of adequate funding structures, resistance from other professional groups, and the need for specific training (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Nevertheless, available evidence indicates that the APP/FCP model can contribute significantly to the sustainability of health systems by redistributing tasks and optimizing human resources\u0026mdash;particularly in regions facing physician shortages (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Brazil, although there are no models equivalent to APP and FCP in terms of technical and biological scope, care models have been introduced that expand the scope of physical therapy in PHC, such as Multidisciplinary Teams (eMulti). With a focus on comprehensiveness and matrix support, the work of physical therapy in PHC now includes clinical and educational activities, as well as the use of innovative tools, such as the Singular Therapeutic Project (PTS), the Territory Health Project, and Integrative and Complementary Practices (PICS) (\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe PTS is a set of therapeutic proposals jointly developed by professionals and service users, structured into four stages: comprehensive assessment, definition of goals and interventions, distribution of responsibilities within the team, and continuous reassessment (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). The Territorial Health Project, in turn, aims to foster democratic spaces for dialogue with the community, promoting co-management in health and the implementation of prevention and health promotion actions within the territorial context. Another area of physiotherapy practice in PHC involves PICS, which draw on traditional and popular knowledge focused on health prevention and recovery. These practices are recognized both in Brazil and internationally under various designations, such as Traditional Medicine, Complementary and Alternative Medicine, or Integrative Medicine (\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnlike international models, which are often centered on the individual and clinical pain management, the Brazilian model prioritizes a collective, territorial, and interdisciplinary approach. This distinction highlights the importance of recognizing and valuing diverse forms of SoP expansion, adapted to specific sociopolitical contexts and aligned with the principles of the Brazilian Health System.\u003c/p\u003e\n\u003ch3\u003eEDUCATION AND COMPETENCE\u003c/h3\u003e\n\u003cp\u003eProfessional education is one of the central pillars for the development and consolidation of the SoP in PHC. In the field of physiotherapy, competency building requires the integration of technical knowledge, interpersonal skills, and reflective capacities\u0026mdash;key elements for addressing the daily challenges of healthcare services.\u003c/p\u003e\u003cp\u003eIn Brazil, despite the recommendation for a generalist, critical, and humanistic education, studies have identified gaps in preparing professionals for PHC practice, particularly regarding the mastery of tools such as \u003cem\u003ematricial support\u003c/em\u003e, the PTS, and co-management of care (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This disconnect between formal curricula and real-world practice undermines the effectiveness of physiotherapy performance in primary care.\u003c/p\u003e\u003cp\u003eWorld Physiotherapy (2023) emphasizes that both initial and continuing education must be adaptable to changes in health systems and the sociocultural particularities of each country. Higher Education Institutions (HEIs), therefore, should align their curricula with the realities of health services and the competencies required in PHC, preparing professionals to act with autonomy, responsibility, and social commitment (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCompetency development requires the mobilization of knowledge in real and challenging situations, going beyond the mere acquisition of theoretical content. Accordingly, active pedagogical strategies, supervised internships in communities, and engagement with local populations are essential to consolidating technical, cognitive, and relational skills (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eA landmark in this evolution in Brazil was COFFITO Resolution No. 363/2009, which formally recognized Physiotherapy in Collective Health, expanding its SoP beyond hospital and outpatient settings. The resolution legitimized the physiotherapist's role in PHC, health promotion, health education, and the development of public policies aimed at collective well-being (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo guide such training, Moccelin et al. (2020) proposed a framework of specific competencies for PHC, distributed across six dimensions: teamwork organization; health actions in the territory; health education; physiotherapeutic care; intersectoral collaboration; and community engagement. This framework highlights the importance of collaborative practices, cultural competence, and knowledge of public health policies (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus, aligning professional education with the needs of health systems is a decisive factor in expanding the physiotherapist's scope of practice and ensuring care that is more effective, ethical, and responsive to local realities.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eREGULATORY POLICIES\u003c/h2\u003e\u003cp\u003eRegulatory policies have a direct impact on the SoP of health professions. By establishing criteria for education, conduct, competencies, and professional ethics, these policies define the boundaries and possibilities of professional practice, affecting the quality of care, the distribution of the workforce, and the organization of services.\u003c/p\u003e\u003cp\u003eAn ideal regulatory model combines four key structural elements: (I) professional registration; (II) standards of competence and proficiency; (III) educational standards; and (IV) ethical and conduct guidelines (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e). The integration of these components ensures user safety and legitimizes professional practice.\u003c/p\u003e\u003cp\u003eDubois, Dixon, and McKee (2005) identify two primary regulatory models: the \u003cem\u003eprofessional autonomy model\u003c/em\u003e, in which professional councils regulate education and practice; and the \u003cem\u003estate intervention model\u003c/em\u003e, in which the government assumes a central role in the regulation and oversight of professions. These models have increasingly been combined into hybrid arrangements that seek to balance public interest protection with professional autonomy (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePortugal and France exemplify countries with mixed regulatory systems. In Portugal, the \u0026ldquo;Orders\u0026rdquo; \u0026mdash; public entities with self-regulatory functions \u0026mdash; coexist with the Health Regulatory Authority, which supervises healthcare services (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). In France, the Public Health Code establishes ethical and educational guidelines for seven health professions, supplemented by the work of trade unions that negotiate working conditions and uphold functional autonomy (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCanada adopts an even more innovative approach with \u0026ldquo;umbrella frameworks,\u0026rdquo; legislative structures that allow for overlapping SoP across different professions. In this model, physiotherapists may share functions with physicians and nurses \u0026mdash; such as diagnosis and prescribing \u0026mdash; provided they have the appropriate training and competencies. While this flexibility promotes interprofessional collaboration and increases access to care, it still faces resistance from traditionally dominant professional groups, such as physicians (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Brazil, the regulatory framework for health is fragmented and distributed across various sectors: the Ministry of Health, the Ministry of Education, professional councils, and state and municipal authorities. This division leads to overlapping regulations and poor coordination between education, professional practice, and labor relations (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGirardi et al. (2017), in a study on the SoP of physicians and nurses in Brazilian PHC, point to the need for regulatory reform to overcome corporatist conflicts and adopt a more integrated and flexible model\u0026mdash;one that considers local contexts, professional competence levels, and actual user needs. Such changes are crucial to strengthening PHC, expanding professionals' SoP, and improving service effectiveness (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this light, regulation should not be seen merely as a set of restrictive rules but as a tool to enhance care quality, align professional practices with scientific evidence, and respond to the social, epidemiological, and technological transformations affecting contemporary health systems.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSERVICE ORGANIZATION\u003c/h3\u003e\n\u003cp\u003eThe way health services are organized directly influences the SoP of professionals, including physiotherapists working in PHC. The structuring of work processes, financing mechanisms, institutional culture, and team coordination are key determinants for both the effectiveness of practices and the possibilities for their expansion or restriction.\u003c/p\u003e\u003cp\u003eIn Brazil, the reorganization of PHC\u0026mdash;particularly through the creation of a model now known as \u003cem\u003eeMulti\u003c/em\u003e\u0026mdash;has redefined the role of physiotherapists within this level of care. The inclusion of physiotherapists in this new arrangement required a rethinking of professional practice, incorporating approaches focused on the territory, the collective, and interdisciplinarity (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies indicate that physiotherapists working in \u003cem\u003eeMulti\u003c/em\u003e teams employ tools such as relational technologies, shared consultations, home visits, therapeutic groups, and family planning interventions\u0026mdash;actions that go beyond the traditional logic of individual rehabilitation and integrate the professional into a model of comprehensive and territory-based care (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite progress, structural barriers remain to the consolidation of this model. In municipalities such as Crate\u0026uacute;s (CE), limitations such as lack of resources, shortages of professionals, and a prevailing culture that demands individual appointments hinder the implementation of more collective and interdisciplinary practices (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInterprofessional collaboration is another critical aspect. The development of integrated care networks to avoid fragmented actions requires spaces for dialogue, joint planning, and shared responsibility among health professionals. Tools such as Singular Therapeutic Projects (PTS), team meetings, and integrated care appointments are important strategies to ensure continuity of care (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Italy, for instance, fragmentation across levels of care and poor communication between services have hindered the implementation of rehabilitation models within PHC. Overcoming these challenges involves strengthening care coordination and intersectoral integration (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Australia, studies highlight that administrative barriers, restricted hours, insufficient funding, and hierarchical service cultures can limit the full participation of physiotherapists, even within advanced practice models (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). Financial feasibility and institutional support are considered decisive factors for the success of initiatives such as APP.\u003c/p\u003e\u003cp\u003eThe same applies to the experience in the Netherlands, where resistance from general practitioners (GPs) to delegate responsibilities to physiotherapists and the lack of adequate funding were identified as the main obstacles to consolidating advanced practice models (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus, the SoP of physiotherapists is closely linked to how services are designed, financed, and managed. Expanding the SoP depends on work environments that promote interprofessional collaboration, innovation in practice, and alignment with the principles of PHC\u0026mdash;comprehensiveness, equity, and resolvability.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003ePhysiotherapy has emerged as a strategic profession in the face of current health challenges, such as population aging and the rise of non-communicable chronic diseases. In this context, several countries have invested in expanding the SoP as a way to improve care quality and address persistent issues such as waiting lists.\u003c/p\u003e\u003cp\u003eThe analysis of international experiences highlights this trend. In the Netherlands, there is shared practice between physiotherapists, physicians, and nurses; in the United Kingdom, the NHS has developed models such as FCP and APP to respond to musculoskeletal demands with greater speed and quality. In Brazil, the development of the model now known as \u003cem\u003eeMulti\u003c/em\u003e represented a collective expansion of the SoP within PHC, requiring changes in professional practices, education, service organization, and even the population\u0026rsquo;s adaptation to a new model of care.\u003c/p\u003e\u003cp\u003eThese examples illustrate how public policies, professional education, regulation, and service organization both influence and are influenced by the expansion of SoP. The Brazilian case shows how responding to population needs can trigger transformations across multiple dimensions of the health system. For this reason, policymakers should consider these interconnected aspects to ensure effective progress. Future research that explores the SoP of physiotherapy in PHC across different contexts may reveal new forms of care\u0026mdash;not to promote standardization, but to serve as reference points for building more equitable and integrated health systems.\u003c/p\u003e\u003cp\u003eAs limitations of this study, it is important to note that the choice to use broad search descriptors aimed to capture the widest range of relevant information concerning the physiotherapy SoP in PHC across different countries. Additionally, the study did not aim to exhaustively define the SoP of physiotherapists in the countries analyzed. The absence of specific practices in the results does not necessarily mean they are not part of the physiotherapist\u0026rsquo;s routine in those contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is worth noting that this study did not require submission to a Research Ethics Committee, as it is based solely on bibliographic data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol for this scoping review was registered in the Open Science Framework (https://osf.io/pkuct/).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Coordena\u0026ccedil;\u0026atilde;o de Aperfei\u0026ccedil;oamento de Pessoal de N\u0026iacute;vel Superior \u0026nbsp;(CAPES), grant number 001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eStudy conception and design: LH and PH\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eData collection: LH and EP\u003c/li\u003e\n \u003cli\u003eData analysis and interpretation: LH\u003c/li\u003e\n \u003cli\u003eManuscript writing: LH and PH\u003c/li\u003e\n \u003cli\u003eCritical revision of the content: LH and PH\u003c/li\u003e\n \u003cli\u003eFinal approval of the version to be published: All authors\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Graduate Program in Public Health at the University of S\u0026atilde;o Paulo (USP) for the academic support. 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Aust Health Rev. 2015;39(3):249\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Primary Health Care, Physiotherapy, Scope of Practice","lastPublishedDoi":"10.21203/rs.3.rs-6917826/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6917826/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePhysiotherapy, historically associated with rehabilitation in hospital and clinical settings, has been expanding its role within Primary Health Care (PHC), reflecting the need for more responsive and accessible health systems capable of addressing population health demands. This study aimed to investigate the physiotherapist\u0026rsquo;s role in PHC, analyzing how their scope of practice (SoP) adapts to different health system configurations. Specific objectives included understanding the organization of physiotherapy work within PHC, identifying factors influencing the SoP, and describing practice models across diverse contexts. A two-stage methodological approach was employed. The first stage involved a scoping review conducted according to PRISMA-ScR guidelines, covering publications from 2004 to 2024 in Portuguese, English, and Spanish. Studies that explicitly addressed physiotherapy practice in PHC and described the SoP were included, resulting in 28 studies selected for final analysis. The second stage involved a documentary analysis of official documents from national and international organizations, legislation, and institutional websites, focusing on three dimensions for each country: health system characteristics, PHC organization, and physiotherapy regulation. Data were organized into a comparative matrix, enabling identification of practice models and key factors shaping the professional scope. The analysis covered eight countries (Brazil, Canada, Spain, France, Italy, the Netherlands, the United Kingdom, and Sweden), highlighting different configurations tailored to local contexts. Findings indicate that the physiotherapist\u0026rsquo;s SoP in PHC is shaped by the interaction of four main factors: (I) population and epidemiological characteristics; (II) professional education and training models; (III) regulatory frameworks; and (IV) service organization and funding mechanisms. The study demonstrates that context-specific adaptations influence professional roles, with universal health systems like SUS (Brazil) and NHS (UK) showing greater capacity for innovation and interdisciplinary integration. The results suggest opportunities for cross-country learning, particularly in enhancing service efficiency and care quality.\u003c/p\u003e","manuscriptTitle":"The Role of Physiotherapy in Primary Health Care in Different Health Systems: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 11:16:30","doi":"10.21203/rs.3.rs-6917826/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"255020551690429389327019851661582862840","date":"2025-08-01T13:20:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253003589206846368235668445703039585341","date":"2025-07-24T17:45:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T09:12:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-20T09:04:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-20T01:50:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-20T01:49:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-06-18T00:24:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cfc2956e-db40-46d6-a989-02f8be0544ee","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T14:27:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 11:16:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6917826","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6917826","identity":"rs-6917826","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}