Physiotherapy is a healthcare profession that helps people affected by injury, illness, or disability through movement, exercise, and manual therapy. A more specialized form of this is called Advanced Practice Physiotherapy (APP). This refers to a higher level of practice where physiotherapists have expert skills to diagnose and treat patients with particularly complex health needs.
Patient satisfaction is a measure of how pleased a person is with the healthcare they receive. It is considered an indicator of the quality of care. This satisfaction is influenced by two main factors: "human attributes," which relate to the healthcare provider's skills and personal interaction, and "system attributes," which relate to the logistics and organization of the care, such as clinic location or wait times. While it appears that patients are highly satisfied with APP, a comprehensive review of all the evidence from different settings has not been done. This study aimed to evaluate patient satisfaction with APP internationally and to assess the specific human and system attributes that contribute to it.
To do this, researchers conducted a "systematic mixed studies review." This involved a structured search for all relevant research on the topic, including both studies with numerical data (quantitative) and studies with descriptive data like interviews (qualitative). They searched major research databases as well as "grey literature," which includes reports and documents not published in traditional academic journals. This search continued until September 9th, 2025.
Two reviewers worked independently to screen the search results, select the appropriate studies, extract the key information, and assess the quality of each study. The findings from the numerical studies were combined using a "narrative synthesis," while the findings from the descriptive studies were combined using a "thematic synthesis" to identify common themes. The results from both types of studies were then integrated. The researchers used formal systems called GRADE and GRADE-CERQual to rate how much confidence or certainty could be placed in the combined evidence.
The review included a total of 35 studies, which were rated as being of high (8 studies), moderate (16 studies), or low (11 studies) quality.
The analysis of the numerical data found high overall patient satisfaction. It also showed high satisfaction with the human attributes of care and mostly high satisfaction with the system attributes. However, the researchers rated the certainty of this evidence as "very low," meaning future research could substantially change these findings.
The analysis of the descriptive, non-numerical data yielded findings with higher confidence. It found moderate-to-high confidence evidence that human attributes led to patient satisfaction. These attributes included the physiotherapist's proficient communication and interpersonal skills, their credibility and competence as experts, their ability to empower patients toward self-management, and the thoroughness of their assessments. The analysis also found moderate confidence evidence that system attributes contributed to patient satisfaction. These included fast access to specialist care, convenient locations and facilities, and "integrated care," where different parts of the healthcare system work together smoothly for the patient.
Both the personal skills of the advanced practice physiotherapist (human attributes) and the efficiency of the healthcare delivery (system attributes) lead to high patient satisfaction. The evidence suggests with high confidence that the physiotherapists themselves are central to patient satisfaction, which is consistent with findings from research into other healthcare professions. Because the certainty in the evidence from the numerical studies is very low, more high-quality research is needed to help guide the future development of APP services.