Direct access and patient/client self-referral to physiotherapy: a review of contemporary practice within the European Union

Physiotherapy. 2013 Dec;99(4):285-91. doi: 10.1016/ Epub 2013 Mar 26.


Background: Direct access refers to service users being able to refer themselves to physiotherapy without a third-party referral. It represents a model of practice supported globally by the profession, growing research evidence and health policy in some health systems. To the authors' knowledge, no research has been reported to ascertain the extent to which direct access is available within the physiotherapy profession within the European Union (EU).

Objectives: To survey member organisations of the World Confederation for Physical Therapy (WCPT); establish the number of member states within the EU where it is possible for individuals seeking physiotherapy services to self-refer; describe the legislative/regulatory and reimbursement contexts in which physiotherapy services are delivered; examine if physiotherapy practice is different in member states where direct access is permitted compared with member states where direct access is not permitted; and to describe the barriers and facilitators to direct access perceived by member organisations of the WCPT.

Design: Cross-sectional, online survey using a purposive sample.

Participants: Member organisations of the WCPT in the EU.

Results: Direct access is not available in all member states of the EU, despite the majority having legislation to regulate the profession, and entry-level education programmes that produce graduates with the requisite competencies. Key barriers perceived are those that can influence policy development, including the views of the medical profession and politicians. Support of service users and politicians, as well as professional autonomy, are seen as key facilitators.

Conclusion: These results represent the first report of a comprehensive mapping of direct access to physiotherapy and contexts within the EU. In over half of member states, service users can self-refer to physiotherapists. These results provide insights to further individuals' understanding about the similarities and differences in working practices and service delivery factors, such as reimbursement across and within EU member states. The synergies between barriers and facilitators indicate the importance of targeted advocacy strategies in the introduction of direct access/self-referral to physiotherapy.

Keywords: Autonomy; Barriers; Direct access; Education; Health policy; Patient self-referral; Regulation.

MeSH terms

  • Cross-Sectional Studies
  • European Union
  • Health Services Accessibility / organization & administration*
  • Health Services Accessibility / trends
  • Humans
  • Physical Therapy Modalities*
  • Referral and Consultation / organization & administration*
  • Referral and Consultation / trends