Physiotherapy Service Models in Obstetric and Gynaecological Care in Public Hospitals: A Scoping Review

Abstract

Physiotherapy addresses pelvic floor dysfunction, pregnancy-related musculoskeletal pain and recovery after childbirth and gynaecological surgery, yet in many public hospitals of low- and middle-income countries it is not organised as a defined service. This scoping review, conducted according to Joanna Briggs Institute guidance and reported against the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), mapped evidence and policy on physiotherapy roles, service models, referral arrangements, implementation determinants and equity in obstetric and gynaecological care in public-hospital and low-resource settings. An exploratory arm combined an academic search tool with grey-literature searches; a formal arm searched PubMed/MEDLINE, CINAHL Ultimate and Scopus (2010–2026, English). Screening used titles, abstracts and bibliographic records; a second reviewer checked every decision, and included sources were verified against publication records. Charted data were mapped to a five-tier stepped-care structure, to the Consolidated Framework for Implementation Research, to PROGRESS-Plus equity factors and to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) dimensions. Of 35,237 records, 29 sources were included (26 empirical or review, three policy; 14 India-based). Stated awareness of physiotherapy consistently ran ahead of referral and uptake. Midwife-led task-shifting, primary-care-integrated outreach, quality-improvement referral redesign and telehealth were each demonstrated in single studies; no low- or middle-income public-hospital example of specialist multidisciplinary care, no maintenance outcome and no parity- or digital-access-stratified finding emerged, and India’s national maternal-health strategy does not name physiotherapy. The map supports a tiered, equity-informed service framework built on structured screening, a written referral pathway and task-appropriate delivery.