The global burden associated with musculoskeletal (MSK) disorders is substantial and is expected to increase with population ageing. Advanced practice physiotherapy (APP) holds significant promise for addressing challenges in MSK care, across both high-income and low- and middle-income countries. To improve patient flow and address challenges related to care access and inefficient management of MSK disorders, including inappropriate opioid prescribing and imaging overuse, APP models have been implemented worldwide. In these models, physiotherapists work to their full scope of practice and, in some contexts, beyond usual scope, including in leading first-contact roles, to deliver patient-centered, effective, and accessible care. However, their implementation and impact remain highly context specific.

We will first discuss the overall evidence on key metrics for APP models in MSK care. This first part will provide an overview of current evidence and present novel data from our group. It will examine the impacts and cost-effectiveness of APP models, as well as documented factors influencing successful implementation and challenges across diverse settings, including emergency departments and specialized MSK care services. It will also address the evolution of these models beyond traditional MSK service frameworks to support sustainability.

In a second part, we will focus on implementation challenges in developing countries. Barriers to healthcare programmes are often insufficiently identified and addressed prior to implementation in developing countries, which can contribute to program failure. This presentation will highlight the complexity of implementing APP in MSK care in contexts where traditional physiotherapy roles and direct access are not yet fully established or recognized. Drawing on experiences from multiple countries, it will illustrate how the introduction of APP represents a significant shift in practice, requiring not only regulatory and educational developments but also broader cultural and professional adaptation. Key challenges include limited awareness of physiotherapy roles, workforce constraints, infrastructure limitations, and the need to build acceptance among medical professionals and stakeholders.

We will then focus on the evolution of scope of practice, including for independent medication prescription. Internationally physiotherapy has generally evolved without the ability to prescribe or deliver prescription drugs, but this is changing. As the profession increasingly finds itself delivering a lead role in MSK care, the patient-need for physiotherapists to prescribe medicines is also increasing. Prescribing has the potential to supplement traditional and APP care, promote safety in the use of medicines, reduce reliance upon medicines and improve the cost-effectiveness of care as prescribing physiotherapists deliver both physical and pharmaceutical stewardship reducing unnecessary medical consultations. We will present an update on prescribing rights for physiotherapists internationally, evidence surrounding the impact of physiotherapy prescribing in APP MSK care, and discuss the challenges, including role boundaries, legal and infrastructure considerations.

Overall, this session will provide attendees with current evidence on APP MSK care models and will also inform on the documented relevant issues in the deployment and implementation of APP models of care in various clinical contexts and countries. We will also review strategies to facilitate successful implementation of these models that are globally useful and applicable in various environments.

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