Closing the Rehabilitation Gap: Co-Designing Equitable Obstetric and Gynecological Physiotherapy Services in South India Co-designing equitable OBG physiotherapy in India

Abstract

Obstetric and gynecological (OBG) physiotherapy supports women during pregnancy, labor, the postnatal period, and recovery from gynecological conditions and surgery, addressing pelvic floor dysfunction, incontinence, musculoskeletal pain, and post-operative recovery. Rehabilitation is recognized as integral to Universal Health Coverage, yet in India and other low- and middle-income countries it is seldom commissioned as a discrete hospital service: referral is informal, private assessment space is limited, and staffing and documentation remain undefined, so care is delayed. This sequential, multi-phase study will run for 12 months in a government medical college hospital in Puducherry, South India. Phase 0 audits service readiness and care pathways using the Tanahashi coverage model. Phase 1 maps published evidence and policy in a scoping review following Joanna Briggs Institute guidance and PRISMA-ScR. Phase 2 identifies barriers, facilitators, and equity determinants through stakeholder interviews guided by the updated Consolidated Framework for Implementation Research (CFIR 2.0), analyzed by Framework Analysis, reported per COREQ, with a PROGRESS-Plus equity lens. Phase 3 co-designs a tiered, low-resource service framework with clinical, administrative, community, and patient stakeholders. Phase 4 validates the draft by modified Delphi across five domains (four-point scale; 80% consensus; 15–25 panelists). Phase 5 field-tests four core tools over three to four weeks against Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) indicators. The study will yield an evidence-based, feasible, and replicable OBG physiotherapy service model for public hospitals in India and comparable settings, intended to strengthen service organization and inform policy and workforce planning.