There is a growing body of evidence-based physiotherapy interventions, but these are not always implemented in practice. This gap is particularly critical in low- and middle-income countries (LMICs), where over 50% of people still lack access to the rehabilitation services they need. Therefore, there is an urgent need to adapt and translate evidence-based interventions to suit diverse cultural and healthcare contexts. However, language, cultural, and resource-related barriers remain major challenges to their implementation.

This symposium draws on the Knowledge-to-Action cycle and Participatory Action approach to show how evidence can be made more accessible and applied in real-world practice. We will present three case studies demonstrating the mobilisation, adaptation, and implementation of physiotherapy interventions in LMICs.

In Brazil, an upper-middle-income country, only about 5% of people report knowing English which limits access to evidence resources in English. This case study discusses how a digital course on an evidence-based, physiotherapist-led intervention was translated into Brazilian Portuguese language in partnership with the original intervention developers in a high-income country. Terminology and clinical examples were adapted. This ensured the course was understandable and relevant to Portuguese-speaking physiotherapists. This example illustrates how the language barrier was tackled to increase access among non-English speaking physiotherapists. Impact evaluation of the course is ongoing.

In India, a lower-middle-income country, about 66% of people experience low back pain compared to the global prevalence rate of 40%. But there is a lack of culturally relevant patient materials to support self-management recommended in treatment guidelines. This case study examines how a low back pain self-care toolkit informed by evidence was co-produced with patients, carers, and other stakeholders. The toolkit contains patient education, exercises and images adapted for local culture and literacy levels of Tamil-speaking people (70 million population). Patients reported it to as a useful self-help resource. This example demonstrates how co-production and cultural sensitivity helped adapt high-quality evidence for patient use.

In Nigeria, a lower-middle-income country, limited access to high-quality evidence and patient resources such as printed intervention materials and exercise equipment remain key challenges to evidence-based practice. This case study examines how free access to a digital learning course on an evidence-based physiotherapy intervention enhanced knowledge, skills, and confidence among Nigerian physiotherapists, who then implemented the intervention in their clinical setting. They were able to use available limited resources while implementing the core components of the intervention. Patients showed improvements in pain and function, comparable to the original trial. This example demonstrates how an evidence-based intervention was successfully delivered in a resource-limited setting and led to patient benefit.

In summary, these three case studies provide practical insights on addressing local contextual factors in applying evidence-based physiotherapy interventions across diverse cultural and health systems and offer guidance for future interventions. It also highlights how digital knowledge mobilisation can support making evidence globally accessible.

Polls, quizzes, and word cloud activities will be used in this session for active engagement and shared learning among the participants.

1. World Health Organization. World Rehabilitation Alliance: meeting report, Geneva, Switzerland, 12-13 July 2023. World Health Organization; 2024 Jan 22.

2. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Dec 19;396(10267):2006-17.

3. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map?. Journal of continuing education in the health professions. 2006 Jan 1;26(1):13-24.

4. Kuper H, Hameed S, Reichenberger V, Scherer N, Wilbur J, Zuurmond M, Mactaggart I, Bright T, Shakespeare T. Participatory research in disability in low-and middle-income countries: what have we learnt and what should we do?. Scandinavian Journal of Disability Research. 2021 Nov 11;23(1):328-37.

5. Hopewell S, Keene DJ, Marian IR, Dritsaki M, Heine P, Cureton L, Dutton SJ, Dakin H, Carr A, Hamilton W, Hansen Z. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2× 2 factorial, randomised controlled trial. The Lancet. 2021 Jul 31;398(10298):416-28.

6. University of Exeter. INTERSECT: Interdisciplinary Translational Rehabilitation & Surgery Research Centre [Internet]. Exeter: University of Exeter; [cited 2026 Apr 2]. Available from: https://medicine.exeter.ac.uk/phss/research/intersect/trainingopportunities/

7. Shetty GM, Jain S, Thakur H, Khanna K. Prevalence of low back pain in India: A systematic review and meta-analysis. Work. 2022 Oct 17;73(2):429-52.

8. McKenzie BJ, Haas R, Ferreira GE, Gorelik A, Cyril S, Han JX, Gilbert S, Grobler L, Maher CG, Buchbinder R. Agreement between high-quality clinical practice guidelines in their treatment recommendations for low back pain: A systematic review. The Spine Journal. 2025 Jul 8.

9. Olowe OO, Salisu A, Srikesavan C. Implementation of an evidence-based advice and exercise programme for rotator cuff-related shoulder pain in Nigeria. [BSSH & BAHT Combined Autumn Scientific Meeting 2025]; [cited 2026 Apr 2]; [Birmingham, UK]. Poster abstract. https://www.bssh.ac.uk/about/events/4738/bssh__baht_combined_autumn_scientific_meeting_2025