Physiotherapists’ attitudes towards and challenges of working in a referral-based practice setting – a systematic scoping review

Abstract

Background

The World Confederation for Physical Therapy (WCPT) identifies physiotherapists as autonomous practitioners. However, physiotherapists in many countries do not have this ‘right’ to practice due to referral-based practice system. It is unknown how it impacts physiotherapists and their ability to deliver person-centred care.

Objectives

To synthesise physiotherapists’ perspectives of working in countries with limited autonomy in a referral-based physiotherapy setting.

Study design

A systematic scoping review.

Data sources

Major electronic databases including MEDLINE, AMED, EBM reviews, PsycINFO, Scopus, Web of Science, ProQuest and Google Scholar; and Grey literature including EThOS and Open Grey were searched until June 2019.

Study selection

Studies were included if they explored the perspectives of physiotherapists’ towards professional autonomy in countries where there is no self-referral or direct access to physiotherapy services.

Synthesis methods

Thematic analysis was used to extract common themes.

Results

Of the 13 included studies, 9 were qualitative and 4 were quantitative. Four main themes were identified: Physiotherapists reported (1) ‘feelings of frustration’ and ‘low self-esteem’, (2) restrictions with critical thinking and clinical reasoning, (3) limited opportunities to provide evidence-based care and (4) difficulty to develop rapport with clients.

Conclusions

Physiotherapists working in countries with limited autonomy commonly experience a sense of frustration due to their inability to critically think and provide evidence-based care. Ultimately, these frustrations led to increased occupational stress, reduced job satisfaction and global migration. Although physiotherapists aspire to become autonomous practitioners, the socio-political barriers to achieve legal regulation remain a key challenge to provide person-centred care.

Keywords:

• Autonomy
• direct access
• challenges
• attitudes
• referral
• physiotherapy

Acknowledgements

The authors thank their liaison librarian (Ms Thelma Fisher) from the University of Otago, New Zealand for assisting with the search strategy.

Disclosure statement

No potential conflict of interest was reported by the author(s).