ABSTRACT
Introduction
Physiotherapy has been proven to be highly cost‐effective in managing some health conditions, reducing the demand for surgery, pharmacological treatment, hospitalisations, and long‐term care. Several organisations and policymakers have already acknowledged that physiotherapy is essential in any health care system, but services need improvement. However, improving physiotherapy services requires efficient collection of real‐world data and more in‐depth data management. Electronic Health Records (EHRs) have proven to be reliable in managing data in various health care service settings, yet there continues to be little investment in these platforms, especially in physiotherapy. This scoping review aims to map the evidence on the multiple uses of EHRs in physiotherapy, to better understand their applicability in this field.
Methodology
This protocol will follow the Joanna Briggs Institute methodological guidelines for scoping reviews. Original studies and grey literature from 2010 onwards, written in English, Portuguese, or Spanish, concerning the characteristics, development, implementation process, and outcomes of Physiotherapy registry platforms will be included. Search will be conducted on four electronic databases (PubMed, Scopus, Science Direct, and Web of Science). Two independent reviewers will assess and select the articles. Data extracted will include information regarding EHRs main characteristics (e.g., types of users, type of data collected, functions, context), development and implementation processes, and outcomes of registry platforms, in all fields of physiotherapy. The information will be registered, aggregated by categories, and displayed in tables and charts mapping the distribution of studies alongside a narrative summary.
Discussion
The proposed scoping review will synthesise key knowledge to provide significant literature‐based insights into the steps, strategies, and procedures necessary for developing and implementing physiotherapy EHRs.
Keywords: EHRs, electronic health records, electronic medical records, health outcomes, physiotherapy
1. Introduction
Physiotherapy is a health profession focused on optimising or restoring movement and physical function throughout life, primarily targeting the human motor system. The scope of physiotherapy ranges from health promotion, disease prevention, and protection to habilitation, rehabilitation, palliative care, and functional maintenance for individuals, groups, and communities in diverse settings. As health professionals trained in movement and function, physical therapists integrate their specialised knowledge into a matrix of interdisciplinary competencies, providing safe, effective, and person‐centred care. These interventions are essential to achieving efficient, high‐quality health systems worldwide, as continuous improvement in the organisation and delivery of physiotherapy services directly contributes to population health and the sustainable use of resources [1, 2, 3].
Considering that health care expenditures have been increasing over the last years [4], system leaders, policymakers, and educators have emphasised the importance of physiotherapy in health care systems, since integrating physiotherapy into health care pathways has proven to be remarkably cost‐effective, reducing the demand for surgery, drug therapy, hospital readmissions, and long‐term care [5]. Economic evaluations highlight that physiotherapy interventions, particularly for musculoskeletal conditions, are often more cost‐effective than pharmacological or medical treatment and contribute to the overall sustainability of the health care system [5, 6]. Likewise, the World Health Organisation encourages the development and implementation of robust multidisciplinary rehabilitation strategies at the national level, recognising the fundamental role of physiotherapy [7, 8]. However, assessing and improving the quality of physiotherapy services requires clear documentation, standardised outcome measures, and accessible patient data, based on real‐world data [9]. Such data are crucial to support health policy, management, and clinical care decision‐making processes.
Some countries have successfully implemented national feasible, valid, and reliable Electronic Health Records (EHRs) with the potential to improve physiotherapy delivery by reporting data on patient characteristics and outcomes, cost effectiveness, and health care provision processes [10, 11, 12]. EHRs are technology platforms designed to centralise patient information, streamline documentation, facilitate multidisciplinary communication, and support decision‐making in clinical environments. EHRs can help physiotherapists track interventions, monitor outcomes, coordinate care, and demonstrate the value and effectiveness of services delivered [13, 14, 15, 16, 17]. While EHRs have been demonstrated to be reliable and efficiently supporting information, evidence regarding their overall effectiveness is still scarce and inconsistent. Concerns about usability, ethics, and data security have been raised, which can weaken trust in these systems [18, 19]. However, when accurate and optimised, EHRs serve as valuable tools in reducing low‐value care delivery [20, 21] and can be used to improve physiotherapy by collecting real‐world data and highlighting the best practice models across the domains of practice, education, and research [1]. Nevertheless, integration challenges persist, and a systematic understanding of current EHR platforms, their use, added value, and their impact is needed for optimal adoption in physiotherapy practice.
Hence, this scoping review aims to systematically map the existing evidence on the content and use of EHR within physiotherapy, with a particular focus on their implementation, functionality, and impact across clinical practice, research, professional development, and service delivery.
2. Methods
A scoping review is going to be conducted as it is the most appropriate method for examining the evidence on the use of EHRs platforms in physiotherapy, reporting on their core components and use, and pinpointing knowledge gaps in this area [22, 23]. Scoping reviews have effectively identified, collected, mapped, and synthesised information through systematic searches in other fields, providing valuable insights for guiding future investigations [13, 14, 16, 17, 18, 19, 20]. Elaborating this review according to the Joanna Briggs Institute (JBI) framework, proposed by Peters et al. will guarantee the methodological integrity, review robustness, and clarity of the outcomes [24]. It will be reported according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) [25], which identifies key elements to guide and report reviews. The present protocol is registered in the Open Science Framework Registries (https://osf.io/8sw52).
2.1. Research Questions
Scientific implementation frameworks such as CFIR [26], ERIC [27], and RE‐AIM [28] provided the conceptual foundation that guided the research team in developing the study's research questions:
-
1.
What types of patient and service‐related data are typically included in EHRs used in physiotherapy?
-
2.
What are the intended purposes and applications of EHRs in physiotherapy, including their roles in clinical practice, research, professional development, and service management?
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3.
Which barriers are perceived in the use of EHRs in physiotherapy, and what facilitators have been identified as contributing to their successful implementation?
-
4.
Which implementation frameworks and strategies have been utilised to support the adoption of EHRs in physiotherapy, and what implementation outcomes (e.g., usability, adoption rates, and clinician satisfaction) have been used to evaluate their effectiveness?
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5.
What is the impact of implementing EHRs on the delivery, quality, and efficiency of physiotherapy services?
2.2. Eligibility Criteria
The eligibility criteria were developed concerning the PCC—Population, Concept, and Context framework [29] to find documents reporting on the characteristics, development, and outcomes of registry platforms, concerning all fields of physiotherapy.
2.2.1. Population
The population considered in this review includes all users or developers of EHRs related to physiotherapy, such as clinicians, researchers, students, educators, and patients. Studies that do not specify users or users not related to physiotherapy practice will be excluded.
2.2.2. Concept
This review aims to include studies that address the characteristics of EHRs (e.g., types of users, types of data collected, functions, context), core modules, data and variables commonly considered, users, barriers, and facilitators to implementation, implementation strategies and processes, and the impact of EHRs in clinical practice. Only studies mentioning at least one of the following criteria will be considered for inclusion: EHRs characteristics, functions, implementation strategy, barriers, facilitators, and outcomes.
2.2.3. Context
This review aims to explore the use of EHRs within physiotherapy. It will include studies on outcome recording and electronic data collection platforms in digital format. Studies focusing only on patient‐reported outcome measures and/or patient‐reported experience measures, or those from domains outside physiotherapy, will be excluded.
This review will consider original studies published from 2010 onwards and published in English, Portuguese, or Spanish. This timeframe was chosen because the evidence concerning EHRs has been emerging during the last decade, and we aimed to provide a contemporary view on EHRs in physiotherapy. Furthermore, limiting publications to the last 10−20 years balances the need for accurate evidence with the ideal reviewer workload [30, 31]. Systematic, narrative and scoping reviews, letters to the editor, guidelines, websites, policy documents, conference abstracts, and opinion or editorial articles will be excluded, as we want to focus on first‐hand experiences with the EHRs. However, reference lists will be checked to identify potential additional studies. Studies that include EHRs but do not explore them as the main goal/topic will also be excluded.
2.3. Search Strategy
The search will occur in four electronic databases: PubMed, Scopus, Science Direct, and Web of Science, using keywords and terms related to physiotherapy and EHRs (Table 1). Besides language and years of publication, no additional filters will be applied to the search options so that does not limit the number of articles presented, leaving to the reviewers the responsibility of excluding articles. Grey literature will also be included, looking for relevant literature, screening the study's references, visiting suggested studies, and contacting the authors to gather additional information.
Table 1.
Search strategy (limited from 2010−2025 and written in English, Portuguese, or Spanish).
| Database | Search terms | N |
|---|---|---|
| PubMed | (‘Physiotherap*’ OR ‘Physical therap*’ OR ‘Rehabilitation’ OR ‘Rehab’) AND (‘electronic health record*’ OR ‘EHR’ OR ‘electronic record*’ OR ‘outcome registry’) | 1158 |
| Scopus | (‘Physiotherap*’ OR ‘Physical therap*’ OR ‘Rehabilitation’ OR ‘Rehab’) AND (‘electronic health record*’ OR ‘EHR’ OR ‘electronic record*’ OR ‘outcome registry’) | 1110 |
| Science Direct | (‘Physiotherapy’ OR ‘Physical therapy’) AND (‘electronic health records’ OR ‘electronic records’ OR ‘digital records’ or ‘outcome registry’ OR ‘health registries’) | 2789 |
| Web of Science | (‘Physiotherapy’ OR ‘Physical therapy’ OR ‘Rehabilitation’ OR ‘Rehab’) AND (‘electronic health records’ OR ‘electronic records’ OR ‘outcome registry’ OR ‘health registries’ OR ‘patient records’) | 616 |
2.4. Study Selection
Results will be imported into Rayyan for titles and abstracts screening and then passed to Covidence software to screen full texts. Once the duplicates are excluded, two independent reviewers will screen titles and abstracts regarding eligibility criteria and, afterward, screen the full text of the selected articles to establish those included. Authors will be contacted up to three times when the full text of an article is not available. A pilot test (10−15 randomly selected references) will be performed at the beginning of both screening phases (titles/abstracts and full‐text screening) to address the concordance between the two reviewers. Reasons for exclusion of full‐text articles will be recorded and reported. The two reviewers will discuss the discrepancies in the study′s selection to reach a consensus. Any disagreements will be solved with a third team member. The study's selection process will be reported with a PRISMA‐ScR flow diagram [25].
2.5. Data Extraction
For each study included, variables will be extracted by categories into a pre‐developed data extraction form with the help of Covidence software. Each reviewer will record the selected articles and report the corresponding information in the data extraction table according to the categories and variables presented in Table 2. A small pilot test will occur with a sample of 10% of the studies selected for full‐text analysis to assess the forms' reliability, consistency, and suitability and to test the reliability of the reviewers. Any doubts regarding the form will be discussed with the team and modified as needed. Two independent reviewers will extract the data. Disagreements will be solved with a third team member.
Table 2.
Overview of data to extract.
| Variables | |
|---|---|
| Summary | Title, authors, year of publication, aims, study design, population and sample size |
| Research question 1. EHRs core components | Type of data (e.g., clinical data, costs, interventions, treatment availability, performance feedback, interoperability features, patient satisfaction) |
| Research question 2. Uses of physiotherapy platforms in different contexts |
Users (e.g., clinicians, educators, professional exclusive vs. patient‐reported outcomes) Context (e.g., private practice, public hospital, intensive care facilities) Functions (e.g., gather and share information, scientific or academic purposes, decision‐making support) |
| Research question 3. Barriers and facilitators |
Determinants of implementation success or unsuccess of these platforms in different contexts Theoretical frameworks used |
| Research question 4. Implementation processes and outcomes |
Implementation strategies, classified through the Expert Recommendations for Implementing Change (ERIC) taxonomy [27] Implementation outcomes, described using Proctor and colleagues' taxonomy [32] |
| Research question 5. Impact on physiotherapy practice | Outcomes and effects of the implementation of EHRs on physiotherapy services |
2.6. Presentation of Results
The quality of the evidence or the risk of bias in the included studies will not be assessed, as this is not the aim of this review. Instead, a qualitative content analysis will be carried out [29]. The information collected from the articles will be listed, aggregated by categories, and displayed in tables and charts. A narrative summary will accompany the tables to synthesise the key findings, highlight the most important data, and clarify how it relates to the review objectives and research questions. A descriptive summary of the number of studies and their characteristics (design, year of publication, population, geographical distribution) will also be provided.
3. Discussion
Given that EHRs have been implemented in various contexts but face the problem of a limited number of synthesised appraisals, we believe it is essential to better understand these systems' panorama. The proposed scoping review has the potential to provide significant insights and contribute to the development of physiotherapy EHRs through clarity and uniformity of evidence.
Understanding the implementation results makes it possible to reflect on the system, services, and practices. Identifying the main barriers and facilitators and the most common implementation strategies can anticipate some of the implementation challenges and help to develop appropriate responses and more effective implementation plans. Therefore, investing in EHR research has the potential to influence the creation of instruments (e.g., checklists and guidelines) to support the development of these systems or to evaluate their suitability in the clinical context.
This study will synthesise key knowledge and may guide the EHR development process, enabling researchers and stakeholders to make informed decisions about the necessary steps, strategies, and procedures. Ultimately, this review is expected to promote the development of EHRs capable of improving services' efficiency and approximating them to high‐value physiotherapy care services.
Results from this study will contribute to the advancement of evidence‐based EHRs in the physiotherapy context.
Ethics Statement
No primary data will be collected during this scoping review, which excludes the need for a formal ethical review.
Findings from the review will be submitted to relevant journals and will serve as core data to inform meetings with stakeholders to aid the development and implementation of a physiotherapy‐specific EHR.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
This work was supported by FCT ‐ Fundação para a Ciência e Tecnologia, I.P. under the project with the reference 2023.04334.BDANA and DOI identifier https://doi.org/10.54499/2023.04334.BDANA. Open access publication funding was also provided by FCT. The funding source was not involved in the study design; collection, analysis, and interpretation of data; writing nor in the decision to submit the article for publication. Open access publication funding provided by FCT (b‐on).
Fernandes M., Souto‐Miranda S., Pires D., et al., “The Use of Electronic Health Records in Physiotherapy Practice: Protocol for a Scoping Review,” Journal of Evaluation in Clinical Practice 31 (2025): 1‐5. 10.1111/jep.70324.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.