Neonatal physiotherapy is supported by strong evidence—yet remains inaccessible to most infants globally. Globally, approximately 13 million infants are born preterm each year, with over 90% occurring in low- and middle-income countries (LMICs). These infants are at increased risk of adverse neurodevelopmental outcomes, yet access to early rehabilitation remains profoundly inequitable. Nearly 43% of children in LMICs fail to reach their developmental potential, highlighting a major global health challenge. Despite decades of research and clear clinical guidelines, neonatal physiotherapy remains inconsistently implemented where it is needed most raising a critical question: why does evidence fail to translate into practice?

Two uncomfortable realities underpin this gap. First, much of the current evidence base is generated in high-income settings and assumes resources, workforce capacity, and health system structures that do not exist in LMICs. Second, implementation strategies often prioritise fidelity to protocols over feasibility in context, limiting real-world adoption. Together, these tensions contribute to a persistent “evidence–equity gap” in neonatal care.

Neonatal physiotherapy aims to optimize early neurodevelopment through timely identification, prevention of complications, and enhancement of parent–infant interaction. The early postnatal period represents a critical window of neuroplasticity, where targeted interventions can significantly influence long-term outcomes. Evidence supports interventions incorporating environmental enrichment, task-specific practice, active infant participation, and family-centred care. However, uncertainty remains regarding optimal delivery models, sustainability, and contextual adaptation across diverse health systems.

Implementation in LMICs is shaped by complex and interrelated challenges, including workforce shortages, limited training opportunities, financial constraints, and fragmented health systems. Families central to early intervention, often face additional barriers related to health literacy, access, and continuity of care. Addressing these challenges requires a paradigm shift: from focusing solely on intervention efficacy to embracing implementation science, context-sensitive adaptation, and family empowerment as core components of care delivery.

This symposium presents a cohesive and multidisciplinary narrative bridging evidence, clinical practice, and implementation. The moderator will frame the global landscape and key controversies. Presentations will: (1) synthesise evidence from systematic reviews and randomized controlled trials; (2) present real-world clinical and community-based experiences from LMIC settings, highlighting practical adaptations; and (3) explore scalable implementation pathways, including family-centred models and task-sharing approaches.

Interactive elements including real-time polling, case-based decision-making, and audience prioritisation exercises will actively engage participants in addressing context-specific challenges. A moderated panel discussion will facilitate critical reflection on balancing evidence fidelity with feasibility.

Participants will leave with actionable, scalable strategies to integrate neonatal physiotherapy into diverse healthcare systems. By directly addressing the gap between evidence and practice, this session aims to inform clinical decision-making, strengthen health systems, and improve developmental outcomes for high-risk infants and their families globally.

These insights will also inform policy-level decision-making and workforce development strategies for integrating neonatal physiotherapy into health systems globally. If evidence cannot be implemented, it is not enough. This session challenges the profession to redefine success as scalable impact rather than controlled efficacy.

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