Reimagining Territorial Rehabilitation: A Modern Framework for Physiotherapy Practice in Chronic Disease Management

Background Italy is undergoing a profound transformation in the management of chronic diseases, driven by demographic aging, increasing multimorbidity, and the territorial reorganization introduced by Ministerial Decree 77/2022. Despite these developments, rehabilitation pathways remain constrained by regulations that require physician‑led access and repeated formal transitions between outpatient, community, and home‑based settings. This structure limits continuity, delays treatment initiation, and hinders the integration of physiotherapists, professionals whose role in chronic care is strongly supported by international evidence. Material and methods This article analyzes the misalignment between current Italian rehabilitation regulations and modern territorial care models, proposing an operational framework that enhances physiotherapists' responsibilities, improves continuity of care, and reduces bureaucratic barriers for patients with chronic conditions. A narrative, evidence‑informed approach was adopted, integrating national regulatory documents, Italian rehabilitation guidelines, international territorial physiotherapy models, and emerging Italian experiences. The aim was to construct an interpretative framework capable of supporting organizational redesign rather than producing quantitative estimates. Results The review highlights that the current requirement for repeated PRI formalization fragments care pathways and is inconsistent with the principles of continuity and proactivity promoted by Ministerial Decree 77/2022. Evidence indicates that, in stabilized chronic conditions, the Individual Rehabilitation Project should remain unique and updated over time, while transitions between settings should be managed through the Rehabilitation Program. International models demonstrate that physiotherapist‑led assessment, monitoring, and adjustment of rehabilitation plans improve timeliness, diagnostic efficiency, patient satisfaction, and resource allocation. Italian pilot experiences confirm the feasibility of physiotherapist‑led territorial management and its positive impact on functional recovery and service efficiency. Conclusions Aligning Italian rehabilitation regulations with territorial care principles requires redefining operational responsibilities and enabling physiotherapists to ensure continuity of care for chronic patients. The proposed framework supports proactive, integrated, and person‑centered rehabilitation, contributing to system sustainability and facilitating the full implementation of Ministerial Decree 77/2022.