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

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.