Exploring goals, roles, and scopes of advanced practice physiotherapy in French primary and secondary specialized...

The increasing burden of chronic diseases and limited physician availability in France have prompted interest in new care models. Advanced practice physiotherapy (APP), involving greater autonomy and the delegation of certain medical tasks, has been successfully implemented in several countries but remains unexplored in the French healthcare system.

To explore perceptions of healthcare facility managers, physicians, and physiotherapists regarding the integration of APPs into primary and secondary specialized care settings in France, and to co-develop context-specific care models defining their roles, tasks, and target patient populations.

A multi-step qualitative study was conducted, beginning with a scoping review of international APP models. Focus groups were then organized with stakeholders from diverse care settings in the Ile-de-France region. Discussions focused on unmet care needs, the relevance of APP roles, and appropriate tasks. Data were thematically analyzed and used to construct tailored care frameworks.

Across five focus groups, including a total of 30 participants, key objectives for implementing APPs were identified: improving access to care, reducing physician workload, optimizing physiotherapy skills, and enhancing care coordination. Suitable patient groups included individuals with musculoskeletal disorders (acute or post-surgical), stabilized neurological diseases, and chronic respiratory conditions. Stakeholders agreed on core APP competencies: clinical assessment, diagnostic test prescription and interpretation (e.g. imaging, pulmonary function tests), therapeutic management (e.g. rehabilitation, analgesics, ventilatory settings), and coordination within multidisciplinary teams.

APPs are perceived as a promising solution to current challenges in care access and coordination. The co-constructed frameworks demonstrate broad stakeholder support and broad stakeholder support, suggesting perceived feasibility, in both primary and secondary specialized care settings.