A Decade of Insights From New Graduate Physiotherapists on a Large Statewide Transition to Practice Program: A Repeated Cross‐Sectional Survey Study

ABSTRACT

Backgrounds and Aims

The transition period typically refers to the first 2 years of work and is known to be challenging for new graduate health professionals. Transition to practice programs are designed to provide support during this period. Limited research has examined formalized programs for physiotherapists. This study aimed to explore new graduate physiotherapists' perspectives on a statewide transition to practice program within a public health organization, focusing on satisfaction with support, perceived benefits, and areas for program improvement.

Methods

A repeated cross‐sectional study was undertaken. Survey data were analyzed from 701 new graduate physiotherapists who completed the program from 2016 to 2025 at 60 hospitals in New South Wales, Australia. Quantitative data were analyzed descriptively to summarize participant and program characteristics and responses. Qualitative data, gathered through open‐ended text responses regarding program benefits and suggestions for improvement, were analyzed via thematic analysis.

Results

Most participants (93%) reported that the program provided suitable levels of support. The program's support components, including the orientation, professional development, and feedback mechanisms, were highly rated. Participants perceived that the structured, supportive environment enabled a progressive transition from university to practice. Areas for improvement included protected time for learning opportunities, strategies to prevent burnout and ongoing employment opportunities. Some participants suggested extending the program beyond 12 months.

Conclusion

The findings indicate that multifaceted support strategies provided via a transition to practice program, including mentoring, clinical supervision, and peer networking, play a critical role in supporting new graduate physiotherapists during their transition into the public health workforce. Whilst programs are generally perceived positively by new graduate physiotherapists, further rigorous studies are needed to establish optimal program length, structure and validated evaluation methods. This study, based on the largest known sample of transition to practice program data to date, contributes evidence to inform national practice on designing effective programs that support new graduates.

1. Introduction

Transition to practice (TTP) for healthcare professionals refers to the period when a student completes their university training and enters the workforce ready for independent practice and, whilst not well defined, typically refers to the first 2 years of work [1, 2]. This period is known to be challenging for health professionals [1, 3, 4]. For new graduate physiotherapists, the TTP period can be stressful and dissatisfying which may contribute to burnout [1, 5, 6, 7]. New graduate physiotherapists are challenged with complex caseloads, considerable responsibilities, and the physical and mental demands of practice [1, 8, 9, 10, 11]. The hospital environment, particularly inpatient settings, is particularly demanding for new graduate physiotherapists due to the high intensity of work [6, 12].

A lack of professional support, access to professional development or mentoring, as well as burnout, have been identified as factors contributing to high attrition rates [8, 13, 14], shorter career intentions [15], and job dissatisfaction [5, 6, 8, 15] for new graduate physiotherapists. Conversely, retention and job satisfaction have been shown to be dependent on the provision of support structures [8, 14, 15, 16, 17, 18]. Various distinct workplace strategies, such as peer and supervisor support, mentorship, orientation, or professional development opportunities, have been associated with a smoother transition [1, 7, 9, 16, 18] and improvement in job satisfaction [8, 10, 17, 19].

Structured TTP programs, sometimes referred to as “new graduate programs” or “graduate programs,” have been developed to provide support to new graduates as they transition into independent work across various healthcare professions and environments [20, 21]. TTP programs in nursing and medicine are mandated in many countries and may involve preceptorships and longer training periods to bridge the gap from university to the workplace [21, 22, 23]. Research on TTP programs in these fields is more prevalent and some programs have demonstrated effectiveness in transitioning students to novice practitioners [20, 22] and in workforce retention [23], with bundled support components seen as essential [23].

In Australia, whilst TTP programs for physiotherapists exist, they are not mandated or standardized. Existing research shows that support initiatives, ranging from structured interdisciplinary sessions to professional development and mentoring, can enhance graduate support, confidence, reflective practice, and retention [9, 24, 25]. There is, however, a paucity of research evaluating formalized TTP programs, particularly with multifaceted support components and in the public sector which is a major employer of new graduate physiotherapists [9, 21].

1.1. The Context and the Knowledge Gap

In Australia, physiotherapy TTP programs differ by geographic location and healthcare setting and may not be formalized. The Australian Physiotherapy Association 2023 Physiotherapy Workforce Census revealed that 14% of Australian physiotherapists are foundational practitioners, with 23% having graduated within the past 5 years [8]. Considering that early career physiotherapists constitute a large proportion of the physiotherapy workforce, research evaluating TTP programs is crucial. Despite the known existence of TTP programs for physiotherapists in both public and private sectors in Australia, there are currently no national recommendations or guidelines for these programs. There is also limited information on the experiences of new graduates undertaking TTP programs, including their views on the support provided, the perceived benefits of programs and where programs could improve. Findings from this study may inform the inclusion of new graduate support components within TTP programs, which may contribute to retention and the sustainability of the allied health workforce.

1.2. The New South Wales (NSW) Physiotherapy Allocation Program

For over 40 years, a 12‐month program has supported new graduate physiotherapists entering select NSW public hospitals. It offers entry‐level roles with diverse clinical experience across both inpatient and outpatient hospital settings. Participants are based at a primary hospital and may rotate to other metropolitan or rural sites. Eligibility is limited to registered physiotherapists with under 6 months' clinical experience, Australian work rights, and NSW residency [26]. The primary hospital provides a 12‐month contract without assurance of ongoing substantive employment.

The program is governed by a committee that aims to bridge the gap between university and workforce needs. This committee comprises approximately 25 members, including heads of physiotherapy departments, university representatives, an indigenous liaison representative, and a recent graduate representative. The committee facilitates the administration of the program and coordinates annual assessments of program quality. A self‐accreditation framework was developed by the committee in conjunction with the National Safety and Quality Health Service Standards in 2016 to improve consistency and quality of the new graduate experience across all participating hospitals [27].

The program includes a range of key structured support components, including an induction process, senior and peer support, feedback mechanisms, clinical rotations, and professional development. Further details are provided in Table 1.

TABLE 1.

Key support components of the New South Wales Physiotherapy Allocation Program.

Component	Details
Formal induction process	Introduction to the hospital and mandatory training, access to hospital policies, procedures, and business rules of the physiotherapy department. Introduction and explanation of the hospital, Australian Physiotherapy Association, and Physiotherapy Board of Australia Codes of Conduct.
Orientation	An orientation program to the hospital, physiotherapy department, and work requirements provided at the beginning of the year. One‐on‐one near‐peer or senior orientation to clinical area at the beginning of each clinical rotation or secondment (on average every 10 weeks). Provision of a clear position description.
Senior clinical support	Near‐peer or senior clinical shadowing focusing on competency development (number of sessions flexible to the needs of the new graduate). Clinical supervision sessions with reflective practice (one‐on‐one or group, average monthly). Regular physiotherapy department staff meetings (minimum monthly). Access to an employee assistance program.
Feedback mechanisms for new graduate and program	Formal written performance appraisal between senior physiotherapist/s and new graduate during each rotation (on average every 10 weeks). Formal feedback via competency checklists and/or one‐on‐one assessments during clinical supervision. Feedback on program – Opportunity for an exit interview at 12 months, formal survey at 12 months.
Regular rotations through a variety of clinical areas	Core clinical experience provided in areas of practice (cardiopulmonary, rehabilitation/neurology, orthopedic, and musculoskeletal physiotherapy). Secondment opportunities to one or more secondary hospitals in metropolitan or rural settings (dependent on main hospital).
Professional development	Formal in‐services through a continuing education program (minimum monthly), including during secondments, with a focus on core clinical areas (i.e., acute, rehabilitation, and primary care) and more “specialized” areas (e.g., spinal cord injury). Access to a clinical resource library. Involvement in at least one quality improvement project.
Peer support	Majority of new graduates (96%) had a cohort of > 1 at the primary hospital allowing for informal peer support. Some hospitals providing a formal peer buddy.

A post‐program survey explored new graduate physiotherapists' perceptions of a TTP program and its support components, addressing a knowledge gap in evidence on these programs. This study aimed to explore new graduate physiotherapists' experiences of a statewide TTP program within a public health organization. The specific objectives were to (a) assess satisfaction with the support provided through the program, (b) identify perceived benefits of participation in the program, and (c) gather recommendations for program improvement from participants.

2. Methods

A repeated cross‐sectional study was conducted using survey data from new graduate physiotherapists who completed the NSW Physiotherapy Allocation Program. Surveys were administered annually at program completion between 2016 and 2025. Reporting of this study was guided by the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guideline [28].

2.1. Survey Design

The survey was developed by the program committee to align with the accreditation framework [26] and to capture both quantitative and qualitative data relevant to participants' experiences of the TTP program, including satisfaction with support, perceived benefits, and suggestions for improvement. The survey underwent an iterative refinement process, with multiple revisions to enhance clarity and readability. Expert validity was established through review by experienced physiotherapy educators and clinicians, who assessed the relevance and coverage of items in relation to the questionnaire's objectives. The final instrument comprised a mix of open‐text, multiple‐choice, and Likert scale questions (Appendix 1). Six items captured respondent and hospital demographics, 11 addressed satisfaction with program supports, one open‐text question addressed the benefits of the program, and one open‐text question focused on recommendations for improvement. Over the 10 years, some items were subsequently added, removed, or slightly adjusted based on the information collected in previous years. For the purposes of the current study, only survey items that remained consistent over the 10 years and related to the research aim and demographics were analyzed and reported.

2.2. Participants

Participants were new graduate physiotherapists employed on a 12‐month full‐time contract at the main hospital, completing the program between 2016 and 2025 inclusive. As this was a retrospective study using all available program participants, no a priori sample size calculation was conducted.

2.3. Data Collection

New graduates were invited to participate in the anonymous survey via email from the program committee annually at the program completion. Surveys were hosted on Microsoft Forms or REDCap, depending on the year, and the survey was available to participants for 1 month. Ethics approval for the study was obtained from the South Eastern Sydney Local Health District Human Research Ethics Committee (2025/ETH00222).

2.4. Data Analysis

As the proportion of missing data was small (< 3%), a complete case analysis of the data was undertaken. Quantitative data were analyzed descriptively by calculating the number (n) and percentage (%) of responses by response level for categorical variables in Microsoft Excel version 2502 (Microsoft Corporation, Redmond, WA, USA).

Qualitative data was gathered through responses to the open‐ended questions regarding benefits of the program and suggestions for improvement. These responses were analyzed via thematic analysis consistent with Braun and Clarke's six‐step approach [29, 30].

2.5. Trustworthiness

To enhance trustworthiness and credibility of the qualitative data, two members of the research team (JN and DT), with experience in qualitative data analysis, independently coded the data and developed initial themes using NVivo 14 (QRS International). Coding discrepancies were resolved through discussion until consensus was reached. Three other researchers (RF, ML, and AS) then reviewed the themes to confirm accuracy and meaning. An audit trail of coding decisions was maintained, and themes were reviewed against the data to ensure coherence and representativeness. Representative quotes were included in the results to illustrate key themes and provide transparency.

2.6. Reflexivity

The lead researcher had previously completed the TTP program as a participant 19 years ago but had no current affiliation with the program and was not involved in its development. This prior experience provided contextual understanding about the program during data analysis, including the jargon used by participants. One member of the research team had prior managerial involvement in one hospital participating in the program, while the remaining two senior researchers had no previous experience with the program. To minimize potential bias, data interpretation was discussed collaboratively among the research team.

3. Results

3.1. Participant Demographics

From 2016 to 2025, 1096 participants completed the program, and 701 unique survey responses were received (64% response rate).

Participants completed their physiotherapy degrees at eight universities: seven in NSW and one in another Australian state. Table 2 outlines participant demographics.

TABLE 2.

Participant and hospital demographics.

Participant characteristic	n (%)
Type of entry‐level physiotherapy degree
Undergraduate	469 (66.9)
Postgraduate	232 (33.1)
Physiotherapy as first degreea
Yes	408 (62.8)
No	242 (37.2)
Allocated main hospital graduate preferencea
First preference	443 (68.9)
Second preference	123 (19.1)
Top 5 preferenceb	626 (97.4)
Hospital locations (NSW) based on Modified Monash Model (MM)
Main hospital
Metropolitan area (MM1)	687 (98.1)
Large rural town (MM3)	4 (0.6)
Medium rural town (MM4)	9 (1.3)
Secondment hospital (at least one secondment)
Metropolitan area (MM1)	145 (20.7)
Large rural town (MM3)	358 (51.1)
Medium rural town (MM4)	60 (8.6)

^a Asked from 2016 to 2024.

^b Includes all top 5 preferences, including the first and second preference provided.

3.2. Program Demographics

A total of 29 main hospitals participated in the program and 37 hospitals were listed as secondment hospitals. With six hospitals serving as both main and secondment hospitals, a total of 60 hospitals were involved. The average length of clinical rotations was 10 weeks.

Most participants (71.6%) had at least one secondment, while 28.4% had none. The majority (59.3%) had only one secondment to hospitals outside their main hospital, 7.7% had two and 4.6% had three secondments.

Table 2 summarizes the program's main and secondment hospital locations based on the Modified Monash Model (MM) [31]. Figure 1 maps the locations.

FIGURE 1.

Location of (a) all program hospitals (b) hospitals in NSW metropolitan area.

3.3. Key Support Components of the Program

3.3.1. Orientation

Figure 2 outlines orientation ratings at each time point across the program.

FIGURE 2.

Orientation rating at time points.

3.3.2. Level of Support

Most participants (93%) reported a suitable level of support was provided across the program whilst 6.6% reported too little support, 0.3% reported no support and only 0.1% reported too much support.

3.3.3. Feedback Mechanisms

A total of 56% of participants reported that their performance appraisals were very helpful or indispensable whilst 33% found them to be moderately helpful, 10% a little helpful and only 0.85% to be no help.

3.4. Continuing Professional Development

Figure 3 outlines the ratings for in‐services and training at the main and secondment hospitals.

FIGURE 3.

In‐services and training rating.

3.5. Benefits of the Program

Where direct quotes have been used, they have been updated to maintain grammatical integrity.

Theme 1: The supportive learning environment

Participants valued accessible guidance and supervision from senior clinicians, including regular feedback, mentorship, and working alongside experienced staff. Continuous professional development activities, such as in‐services, training, workshops, and quality projects were also seen as beneficial. Some noted the program offered more structured support than non‐TTP pathways.

“[I was] able to enhance a wide spectrum of clinical skills and gain experience in a very supportive environment with very experienced colleagues and seniors. Ample opportunities were available to improve clinical skills and knowledge through attending workshops and symposiums.”

Working alongside fellow new graduates was reported to foster a supportive social environment, enhance learning opportunities and facilitate the development of peer connections and friendships. Working within a multidisciplinary team was highlighted as supportive and helpful for understanding the dynamics of the hospital environment.

“Working with other health professionals placed emphasis on the importance of holistic health and the importance of communicating between professions to ensure the patient gets the best care.”

Theme 2: Building autonomy with support to develop a global set of skills

Participants felt empowered to grow as independent practitioners through strong colleague support. They valued the balance between developing autonomy and having help when needed, which built confidence and competence.

“I believe I am a much more confident, competent, effective practitioner because of this experience and believe the quality of the care I provide is thorough and of a high standard.”

Participants appreciated the steep learning curve, supported by what was described as a safety net.

“The high expectations and workload make you step up and force you to improve. It would be easy to crumble but, given the high level of support, that doesn't seem to happen.”

Participants noted growth in key skills, such as assessment, treatment, reasoning, communication, and prioritization, forming what they felt was a strong foundation for their skills and their careers.

“[The program] really provided an opportunity to start working on key areas of clinical skills, time management and prioritization and build a good foundation to continue working on.”

Theme 3: A bridge to practice

Participants described the program as a supportive bridge for their transition from university to practice, easing the transition without feeling “thrown in the deep end.” They saw it as an extension of their education and a gateway into the workforce.

“When I apply for jobs now, it's very direct how my experience applies and that gives me a lot of confidence. I want to continue working in the hospital setting and I just cannot imagine trying to pick up everything I've learned over the last year if not in the program.”

Many participants shared that clinical rotations and secondments offered diverse experiences that broadened their practice and informed future career choices.

“The different rotations were helpful in giving a “taste” of each field and helped with developing an idea of what field interested me the most… and with building more options for jobs.”

3.6. Areas for Improvement

Theme 1: Increased supported learning opportunities

Participants desired more structured mentoring and supervision across the program. Some participants suggested that protected time should be provided for support activities outside of clinical duties. One participant suggested that this could include a progressive increase in clinical load.

“The program should reduce the clinical load of new graduates‚ particularly at the start of the year or start of a rotation. This would allow us to focus on learning the different processes and ensuring we are doing a thorough and accurate job when treating our patients.”

Clinical shadowing opportunities, competency‐based learning, structured feedback mechanisms and the opportunity to discuss and debrief on complex cases were suggested. Regular practical education sessions were wanted with a focus on clinical skills, foundational knowledge, complex conditions, and quality improvement processes.

“Providing a checklist/appraisal system that must be completed following each rotation or maybe throughout [would allow] improvements to be made and further feedback.”

An initial transition week shadowing junior clinicians, longer handover periods between rotations, and clearer expectations of the rotations were sought.

“A day or two shadowing the previous year's new graduates [would] help understand day‐to‐day working. It was very stressful initially…not knowing all the particulars.”

Some participants suggested that peer networking would enhance the program, including opportunities for interhospital education events, forums and social media support pages. More supported secondment opportunities, including in rural areas, were also recommended to increase exposure to varied clinical practice and teams.

Theme 2: Program Structure

Some participants preferred longer clinical rotations, while others wanted shorter ones for more varied clinical exposure. Participants wanted more musculoskeletal outpatients, emergency department, orthopedics, intensive care, and pediatrics rotations.

It was suggested the application process could be improved by balancing academic grades with interview performance, providing earlier acceptance notifications, and offering detailed program information. Receiving program application support from their university was also desired. Increased program positions across the state were also suggested to address the application competitiveness.

“A greater number of hospitals should participate in the program. With ever‐growing numbers of students graduating into the profession, public hospital jobs and experience are becoming increasingly difficult to get.”

Many participants also wanted study and annual leave allowances to prevent “burnout.”

“You are learning so much every single day, it is stressful and challenging and I know I worked very hard this year. I was exhausted and burnt out by the end of the year. I would have loved to have some time off.”

“Having some annual leave would be beneficial as it can be quite stressful when fatigue accumulates both physically and mentally.”

Theme 3: Beyond the First Year

Some participants proposed a longer program of 18 months to 2 years to aid their workforce transition.

“Make it a 2‐year program – I feel there is more to gain from the hospitals, and much more could be learnt.”

Ongoing employment opportunities or guidance on job applications and interviews at the program conclusion were also desired.

“Structured workshops and tutorials should be provided regarding getting a job after the year is finished, for example, mock job interviews, feedback sessions, and resume writing.”

4. Discussion

This study evaluated the perspectives of new graduate physiotherapists on a TTP program in a large statewide public health organization over the last decade. To the best of our knowledge, this is the largest analysis of the experiences of new graduate physiotherapists undertaking a structured TTP program. New graduates reported increased confidence and competence through autonomous practice in diverse clinical areas, strengthened by available support mechanisms. Our findings echo previous research indicating that new graduate physiotherapists value the balance between independence and guided learning as they develop new skills [7].

The program was seen by many new graduates as a continuation of university, offering gradual exposure to independent practice. This supports recent findings from a recent systematic review that TTP programs can help allied health graduates consolidate learning and build confidence [21]. Previous studies highlight that, although new graduates feel broadly prepared, they commonly face challenges with clinical complexity and responsibility [1, 11], reinforcing the need for structured support in the first year.

There are several theories that may explain why new graduates desire support during this period. Benner's Novice to Expert model outlines stages of clinical competence [32]. Although primarily explored in nursing, this theory may be applicable to other health professions. Benner suggests that nurses in the early career stage “need support and back up from experienced, competent nurses… to ensure that important patient needs do not go unattended” [33]. While this theory has not been specifically explored in physiotherapy it is reasonable to hypothesize that new graduates may share similar needs during the TTP period. Complementing Benner's focus on developmental stages, Lave and Wegner's Situated Learning Theory (SLT) emphasizes that learning occurs most effectively when individuals participate in a community of practice with repeated opportunities to apply their skills in real‐world contexts [34]. The structured support provided by TTP programs may facilitate this process, enabling a smoother entry into the health workforce.

Our study also gained insight into the individual components of the program. Mentorship and clinical supervision were perceived as beneficial during the transition period, aligning with previous research demonstrating the value of these strategies in supporting new graduate physiotherapists and in enhancing job satisfaction [7, 9, 17, 19, 35]. Feedback on clinical performance through formal, written performance appraisals, as well as informal discussions was valued by participants, aligning with existing literature that highlights the importance of regular, constructive feedback in supporting new graduate development, clinical competence, and job satisfaction [19, 21]. Formal and informal training were also considered beneficial, which is consistent with existing knowledge that ongoing learning is crucial for early professional competence, should be relevant to work context and learning needs and can significantly influence workplace choice [3, 9, 36, 37].

Whilst the type and amount of support was generally received positively, more protected time for structured support activities was desired. Within a TTP program, allocation of protected time for mentoring, clinical supervision, professional development and feedback should be considered, not only for new graduates, but also for mentors and supervisors who are providing the support. It is acknowledged that programs also need to balance support with the organizational needs and the demands of clinical practice.

Our findings support the inclusion of bundled support strategies within a physiotherapy TTP program. The recognized importance of multifaceted support exists in other health profession programs [38], but has not been explored in physiotherapy. More research is needed to identify the optimal combination of components and critical stages for support. Ramped support may benefit from further investigation. This model has been proposed and involves early intensive support, which tapers over time [39].

Peer networks were highly valued, with increased interhospital collaboration sought. Previous research has shown that these relationships enhance confidence and belonging among new graduate physiotherapists and other health professionals [1, 3, 21, 23]. Interdisciplinary TTP programs have also been successfully used [24, 25]. Incorporating peer support systems and cross‐disciplinary interactions should be considered by clinical supervisors and organizations.

Our study suggests that a TTP program may benefit from being extended for continued support past the first year and that assistance with career progression may be advantageous. Most allied health TTP programs reported in the literature are 12 months [21], however the ideal length of program for physiotherapists has not been investigated and is an area for future research. In nursing, existing TTP programs vary from 1 to 36 months [23] whilst medical programs in Australia involve a 1‐year internship before a 1‐year supported residency program.

Leave was desired within the first year to prevent fatigue, aligning with growing evidence that the TTP period can be stressful and contribute to burnout, which short breaks can alleviate [1, 5, 6]. Poor work‐life balance can reduce new graduate physiotherapists' job satisfaction and career longevity [15]. The Australian Health Practitioner Regulation Agency's Code of Conduct stresses the importance of maintaining health, well‐being, and proper work‐life balance [40]. Breaks and well‐being initiatives are worth considering when implementing a TTP program.

4.1. Strengths and Limitations

While this study was conducted within a single Australian state, the large sample size enhances the robustness of the findings and may support cautious national extrapolation. Differences in regulatory frameworks, funding models, and workforce dynamics may limit the transferability of findings to all contexts, particularly outside of the public health system.

The use of a non‐validated survey instrument is a limitation. The tool was developed with input from expert stakeholders to evaluate participant perspectives on the program. The absence of validated instruments for evaluating physiotherapy TTP programs reflects a broader gap in the field and underscores the need for tool development to ensure standardized measurement of graduate experiences and program effectiveness. This study may be affected by nonresponse bias. To mitigate this, multiple follow‐up attempts were made to encourage participation.

To gain a deeper understanding of TTP programs, future studies could incorporate interviews or focus groups to provide richer insights into individual experiences of TTP programs.

It is also acknowledged that the working environment may have changed considerably over the past decade, particularly during the COVID‐19 pandemic. This may have altered participants' perceptions of the program over time, but this was not specifically analyzed.

5. Conclusion

This study found that a structured 12‐month TTP program with integrated support strategies was generally positively perceived by new graduate physiotherapists entering the public health workforce. The findings offer valuable insights to guide the development and implementation of effective TTP programs in hospital settings. This warrants future research to explore how the design and content of TTP programs can be informed by the perspectives of a broader range of stakeholders, including new graduates, employers, educators, organizations, and consumers. There is also a need to develop comprehensive program evaluation strategies that reflect the diverse priorities and experiences of these groups, ensuring that program effectiveness and cost‐efficiency are assessed in a context‐sensitive way.

Author Contributions

Jacqueline North: conceptualization, methodology, investigation, formal analysis, funding acquisition, writing – original draft, writing – review and editing. Michael Lee: conceptualization, methodology, formal analysis, supervision, writing – review and editing. Alexandre S. Stephens: conceptualization, methodology, formal analysis, supervision, writing – review and editing. Daniel Treacy: conceptualization, methodology, formal analysis, supervision, writing – review and editing. Roma Forbes: conceptualization, methodology, formal analysis, supervision, writing – review and editing.

Disclosure

The lead author Jacqueline North affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Ethics Statement

Ethical approval was obtained from the certified South Eastern Sydney Local Health District (SESLHD) Human Research Ethics Committee (2025/ETH00222) prior to the commencement of this study.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the New South Wales Physiotherapy Allocation Committee. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of the New South Wales Physiotherapy Allocation Committee.