Vol. 2, Issue 2, Part A (2025)

Background: Tele-physiotherapy holds considerable promise for addressing rehabilitation gaps in low-resource settings, yet its adoption remains inconsistent. While evidence supports the effectiveness and acceptability of telerehabilitation, little is known about how physiotherapists and patients in such contexts jointly perceive and use tele-physiotherapy, and which multilevel factors most strongly drive or hinder its uptake.

Objectives: To examine awareness, utilisation and perceived acceptability of tele-physiotherapy among physiotherapists and patients in low-resource settings, to identify key barriers and facilitators to adoption across individual, organisational, technological and policy domains, and to develop a conceptual model to inform context-specific implementation strategies.

Methods: A convergent parallel mixed-methods study was conducted in 18 public and private physiotherapy facilities in urban and rural low-resource settings. Quantitative data were collected via structured questionnaires from 210 physiotherapists and 360 adult patients with chronic conditions. Descriptive statistics, χ² tests, t-tests and multivariable logistic regression were used to explore patterns and predictors of tele-physiotherapy adoption. Qualitative data from semi-structured interviews and small focus groups with purposively selected physiotherapists and patients were analysed thematically. Findings were integrated through joint displays and narrative synthesis.

Results: Awareness of tele-physiotherapy was high among physiotherapists (92.4%) but lower among patients (55.0). Ever-use was reported by 44.8% of physiotherapists and 31.4% of patients, while willingness to use tele-physiotherapy in the future exceeded 75% in both groups. Physiotherapists and patients rated clinical effectiveness and satisfaction around 4/5. Independent predictors of physiotherapist adoption included prior training in tele-physiotherapy, higher digital literacy, reliable workplace internet and strong organisational support. Key barriers included unreliable connectivity, lack of infrastructure and reimbursement mechanisms, low digital literacy, and cost of data, while modifiable facilitators included targeted training, low-bandwidth platforms, patient/family orientation and supportive policies. Qualitative findings highlighted tele-physiotherapy as a pragmatic response to access gaps, but one that reconfigures rather than eliminates inequities.

Conclusions: Tele-physiotherapy is acceptable and valued by physiotherapists and patients in low-resource settings, but its adoption is constrained primarily by modifiable structural, organisational and capability-related factors. Strategic investment in digital infrastructure, organisational readiness, training, patient-facing digital support and clear policy and reimbursement frameworks is essential to translate willingness into sustained, equitable use of tele-physiotherapy and to strengthen rehabilitation systems in resource-constrained environments.