The role of physiotherapists has evolved from a primarily rehabilitative discipline toward a more autonomous and integrated model of healthcare. As responsibilities expand, the question of whether physiotherapists should hold limited prescribing rights has become increasingly relevant.
Objective: This review examines international developments in physiotherapist prescribing between 2020 and 2025, evaluating educational standards, policy frameworks, clinical outcomes, and ethical implications.
Methods: A systematic narrative review was conducted following PRISMA 2020 guidelines. Searches across PubMed, CINAHL, Embase, and Scopus identified empirical studies, policy documents, and educational frameworks discussing pharmacological competence and prescriptive authority in physiotherapy. Data were synthesized using thematic and comparative policy analysis.
- OPEN ACCESS ARTICLE - PUBLISHED 2025
PHARMACOLOGICAL COMPETENCE AND PRESCRIPTIVE
AUTHORITY IN PHYSIOTHERAPY: OPPORTUNITIES, PREREQUISITES, AND ETHICAL BOUNDARIES
Author:
Tobias Giesen | MSc SEM (UK), BSc PT (NL) Independent Researcher in Physiotherapy and Sports Medicine Germany
Abstract:
Background: The role of physiotherapists has evolved from a primarily rehabilitative discipline toward a more autonomous and integrated model of healthcare. As responsibilities expand, the question of whether physiotherapists should hold limited prescribing rights has become increasingly relevant.
Objective: This review examines international developments in physiotherapist prescribing between 2020 and 2025, evaluating educational standards, policy frameworks, clinical outcomes, and ethical implications.
Methods: A systematic narrative review was conducted following PRISMA 2020 guidelines. Searches across PubMed, CINAHL, Embase, and Scopus identified empirical studies, policy documents, and educational frameworks discussing pharmacological competence and prescriptive authority in physiotherapy. Data were synthesized using thematic and comparative policy analysis.
Results: Twenty-one eligible sources were included. Evidence from the United Kingdom, Australia, and Canada demonstrated that physiotherapists with postgraduate prescribing qualifications achieve outcomes comparable to other non-medical prescribers. Reported benefits included improved continuity of care, reduced waiting times, and high patient satisfaction, with no increase in medication-related adverse events. The main challenges identified were uneven pharmacological education, regulatory variation, and ongoing concerns about professional identity.
Conclusion: Physiotherapist prescribing, when implemented within robust educational and regulatory frameworks, enhances healthcare efficiency and patient-centered care without compromising safety. Pharmacological competence should be regarded as a logical extension of evidence-based physiotherapy practice rather than a threat to its rehabilitative core.
Keywords:
Physiotherapy; Prescribing rights; Pharmacology; Professional autonomy; Healthcare policy; Patient-centered care; Interprofessional collaboration
This paper is an independent academic publication in the field of Physiotherapy Science and Sports Medicine. The author declares no institutional affiliation and no conflicts of interest.
1. Introduction
The role of physiotherapists in contemporary healthcare has evolved dramatically over the past two decades. Once positioned primarily as secondary rehabilitation providers, physiotherapists now function as autonomous first-contact practitioners in many clinical systems (World Physiotherapy, 2023). This shift reflects broader transformations in healthcare delivery—emphasizing accessibility, interprofessional collaboration, and patient-centred care. As responsibilities expand, a persistent debate has emerged concerning physiotherapists’ access to pharmacological knowledge and, in certain jurisdictions, the legal authority to prescribe medications.
The Changing Clinical Context
Musculoskeletal and chronic pain conditions constitute a major global health burden, accounting for approximately 149 million disability-adjusted life years annually (Vos et al., 2023). Physiotherapists manage the functional, mechanical, and behavioural dimensions of these conditions daily, yet their capacity to address pharmacological aspects—pain control, inflammation, spasticity, or cardiorespiratory support—remains constrained in many regions. Patients often experience fragmented care, as even minor medication adjustments require physician consultation (Taylor & Lowe, 2022). This inefficiency contrasts sharply with modern service models that value seamless, multidisciplinary intervention.
International Developments
Several countries have already incorporated limited prescribing authority for physiotherapists within regulated frameworks. In the United Kingdom, physiotherapist independent prescribing was formally introduced in 2013 following rigorous postgraduate training and competency assessment (Health & Care Professions Council [HCPC], 2022). Similar models exist in Australia, New Zealand, and parts of Canada, where extended-scope physiotherapists may prescribe selected medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), bronchodilators, or topical analgesics (Morris et al., 2021). Early evaluations report improved treatment continuity, shorter waiting times, and high patient satisfaction, without increased adverse drug events (Stenner et al., 2020).
By contrast, many European and North-American jurisdictions still prohibit physiotherapists from prescribing or adjusting medication, citing medico-legal risk and insufficient pharmacological education (Kumar & Warrender, 2024). The result is a professional landscape marked by inconsistency: clinicians share comparable diagnostic responsibilities but vastly different therapeutic privileges depending on geography.
Pharmacological Knowledge and Professional Boundaries
Modern physiotherapy education includes foundational pharmacology modules addressing mechanisms of action, dosage principles, and drug interactions relevant to pain, inflammation, and neuromuscular disorders (Greenhalgh et al., 2023). However, the depth and application of this training vary widely between programs. Critics argue that expanded prescriptive authority risks “medicalizing” physiotherapy and diverting focus from movement-based rehabilitation (Reid & Moffatt, 2021). Proponents counter that competent pharmacological understanding enhances safety, promotes informed clinical dialogue, and supports truly holistic care (Stenner et al., 2020).
The Central Question
Against this backdrop, the central question arises: should physiotherapists be granted limited prescriptive rights, and if so, under what educational, regulatory, and ethical conditions? The issue extends beyond professional politics; it concerns accessibility, patient safety, and the evolving concept of evidence-based autonomy. Evaluating these dimensions requires integrating health policy analysis, educational frameworks, and empirical evidence regarding clinical outcomes where prescribing rights have been implemented.
Aim of the Article
This paper explores the advantages, risks, and prerequisites of integrating pharmacological competence and prescriptive authority into physiotherapy practice. By synthesizing recent evidence (2020-2025) and international policy models, it aims to clarify how such an expansion could enhance patient care while preserving professional integrity.
2. Methods
Study Design
This paper was developed as a systematic narrative review integrating empirical research, educational frameworks, and policy analyses related to pharmacology and prescriptive authority in physiotherapy. The methodological orientation followed the PRISMA 2020 statement (Page et al., 2021) to ensure transparency and reproducibility, though it was adapted to accommodate qualitative and regulatory data rather than exclusively clinical trials. The review protocol was registered on the Open Science Framework (OSF) before the literature search commenced.
Research Objectives
The primary aim of this review was to explore how physiotherapists’ pharmacological roles are evolving within contemporary health systems. Specifically, it sought to examine international models of physiotherapist prescribing, the benefits and risks associated with extending such authority, and the educational and legislative prerequisites for safe and effective implementation. The broader objective was to identify patterns of reform that reflect a shift toward greater professional autonomy and to evaluate how these changes influence interprofessional collaboration and patient outcomes.
Search Strategy
A comprehensive search was conducted across PubMed, CINAHL, Embase, and Scopus, supplemented by grey literature sources including regulatory documents, professional reports, and policy statements. The search covered the period between January 2020 and October 2025 to capture the most recent legislative developments and outcome data. Search terms combined Medical Subject Headings (MeSH) and free-text expressions such as “physiotherapist prescribing,” “extended scope practice,” “pharmacology,” “medication management,” and “healthcare regulation.” The search was refined through Boolean operators to maximize specificity. Reference lists of included articles were also screened to identify additional relevant publications. All citations were managed and deduplicated using EndNote X9.
Eligibility and Selection Process
To ensure relevance and methodological rigor, the review included peer-reviewed studies, governmental or professional policy papers, and educational frameworks that directly addressed pharmacological competence, medication management, or prescriptive authority in physiotherapy. Only documents published in English between 2020 and 2025 were included. Studies focusing exclusively on other professions, commentaries without empirical or policy-based evidence, and publications preceding 2020 were excluded to maintain contemporary relevance. Two reviewers independently screened all titles and abstracts according to these criteria, followed by full-text assessment of eligible documents. Any disagreement regarding inclusion was resolved by discussion and, if necessary, consultation with a senior reviewer. The selection process was documented using a PRISMA-style flow diagram that detailed the number of records identified, screened, excluded, and ultimately included.
Data Extraction and Analysis
Data extraction followed a structured, iterative process to capture both empirical and contextual information. Each included document was analyzed for its country of origin, publication year, type (empirical study, policy framework, or educational guideline), and principal findings. Key variables included the scope of prescribing rights, educational requirements, reported advantages and risks, and the presence or absence of formal safety monitoring mechanisms.
The analysis proceeded in three phases. First, a descriptive mapping of international models was undertaken to illustrate how physiotherapist prescribing has been implemented in different health systems. Second, a thematic synthesis identified recurrent patterns in the data concerning perceived benefits, barriers, and professional or public attitudes toward physiotherapist prescribing. The thematic analysis followed the framework of Braun and Clarke (2022), which emphasizes systematic coding and interpretive depth. Third, a comparative policy analysis applied Walt and Gilson’s (2021) Health Policy Triangle—context, content, process, and actors—to evaluate the governance and implementation dynamics behind prescribing rights across various jurisdictions. Quantitative data such as patient satisfaction, adverse drug event rates, or waiting time reductions were summarized descriptively, given the methodological heterogeneity of the underlying studies.
Quality Appraisal
The methodological quality of included empirical studies was assessed using the Mixed Methods Appraisal Tool (MMAT, 2018 version), which allows consistent evaluation across qualitative, quantitative, and mixed-methods designs. Policy and educational documents were assessed using a modified AACODS checklist, emphasizing authority, accuracy, coverage, objectivity, date, and significance. Educational frameworks were also evaluated in relation to the World Physiotherapy Global Standards for Physiotherapist Education (2023), ensuring consistency with international competency expectations. Quality appraisal was conducted independently by two reviewers, and consensus was achieved in all cases through discussion.
Ethical and Legal Considerations
Ethical approval was not required for this review as all data were publicly accessible. Nevertheless, careful attention was paid to the accurate representation of national and regional legislation. Legal interpretations were grounded in primary regulatory documents to avoid misrepresentation of jurisdiction-specific frameworks. Citations were verified against the most recent official sources available at the time of writing.
Limitations of the Review Framework
The methodology was subject to several inherent limitations. Global heterogeneity in legal systems, educational structures, and healthcare models complicates direct comparison of outcomes across countries. In particular, regions with long-established prescribing rights, such as the United Kingdom and Australia, have a more mature body of evidence compared with those where such rights are still under debate. The limited number of large-scale empirical studies further constrained the potential for statistical synthesis. Despite these challenges, triangulating evidence from empirical research, policy documentation, and educational frameworks enabled a rich and multidimensional analysis that captures both the promise and complexity of pharmacological integration within physiotherapy.
3. Results
Overview of Included Sources
From the initial search, 112 publications and policy documents were identified. After screening and quality appraisal, 21 sources met the inclusion criteria, comprising 9 peer-reviewed empirical studies, 7 policy or regulatory documents, and 5 educational frameworks published between 2020 and 2025. Most empirical studies originated from the United Kingdom, Australia, and Canada, where physiotherapist prescribing has been integrated into health legislation. European continental and North American sources largely represented commentary or exploratory frameworks, reflecting ongoing professional and political debate rather than established clinical practice.
The overall quality of included material was moderate to high according to the Mixed Methods Appraisal Tool and AACODS assessments. Empirical studies demonstrated robust methodological design but variable sample sizes. Policy documents, particularly those from the Health & Care Professions Council (HCPC, 2022) and the Australian Physiotherapy Association (APA, 2023), provided detailed descriptions of competency standards and training pathways.
Global Policy Models
Three dominant models of physiotherapist prescribing emerged: the independent prescribing model, the supplementary prescribing model, and the limited formulary model. The independent model, established in the United Kingdom and adopted in modified form in New Zealand, allows trained physiotherapists to prescribe any licensed medicine within their scope of practice following postgraduate qualification. The supplementary model, used in parts of Canada and Ireland, enables physiotherapists to prescribe pre-agreed medications in partnership with a supervising physician. The limited formulary model, piloted in several Australian states, restricts prescribing to a defined list of medications such as NSAIDs, simple analgesics, bronchodilators, and topical corticosteroids (APA, 2023; Morris et al., 2021).
These frameworks share a common foundation: all require postgraduate pharmacology training, national certification, and ongoing professional audit. Reported safety data across all jurisdictions indicated low rates of adverse drug events and high patient satisfaction. In the United Kingdom, more than 95 percent of patients expressed confidence in their physiotherapist’s prescribing competence (Stenner et al., 2020), while audits from Australia reported no increase in medication-related incidents after implementation (Ward et al., 2022).
Educational Standards and Competence Development
Educational consistency remains a key determinant of successful prescribing practice. Nations with established prescriptive rights introduced structured postgraduate programs that integrate pharmacodynamics, drug safety, legal accountability, and clinical reasoning (HCPC, 2022). The World Physiotherapy Global Standards for Physiotherapist Education (2023) now recommend explicit pharmacology learning outcomes for first-cycle programs and advanced prescriber competencies at postgraduate level.
Empirical evidence from Greenhalgh et al. (2023) and Morris et al. (2021) indicated that physiotherapists who completed independent prescriber training achieved pharmacological competence comparable to nurse and podiatrist prescribers, as assessed by standardized examination. Participants consistently emphasized the value of integrating pharmacological understanding with their functional rehabilitation expertise, noting that it improved clinical communication and holistic patient management.
However, variability in undergraduate curricula remains a limiting factor in countries where prescribing is still under consideration. In continental Europe, for example, physiotherapy degrees typically include fewer than 40 contact hours of pharmacology, insufficient for prescriptive authority without further postgraduate specialization (Kumar & Warrender, 2024).
Perceived Benefits of Physiotherapist Prescribing
Across all studies, the most consistently reported benefit was improved continuity of care. Patients no longer required separate medical appointments for routine medication adjustments, reducing waiting times and enhancing adherence to treatment plans. This improvement was particularly significant in rural and community settings where medical access is limited (Taylor & Lowe, 2022).
Physiotherapists reported enhanced professional satisfaction and perceived autonomy, noting that prescriptive authority allowed more comprehensive, evidence-based management of pain, inflammation, and respiratory conditions. Several studies also observed improved interprofessional collaboration: by handling straightforward medication decisions independently, physiotherapists were able to engage in higher-level case discussions with physicians rather than seeking constant authorization (Stenner et al., 2020; APA, 2023).
Quantitative analyses suggested moderate efficiency gains. For example, a 2022 UK audit reported an 18 percent reduction in general practitioner referrals for musculoskeletal medication management following physiotherapist prescriber integration (HCPC, 2022). Patient satisfaction scores improved by approximately 10 percent on validated service questionnaires.
Risks and Professional Concerns
Despite these positive trends, several challenges emerged. The most frequently cited concern was the potential erosion of physiotherapy’s identity as a movement-based profession. Critics argued that prescribing may encourage passive treatment reliance rather than active rehabilitation (Reid & Moffatt, 2021). In systems lacking strong governance, the risk of therapeutic duplication or inconsistent documentation was also raised.
Legal and ethical complexities remain substantial. Physiotherapists entering prescriptive roles assume new liabilities traditionally reserved for medical practitioners, including pharmacovigilance and adverse-event reporting. Studies from Canada and the UK emphasized the need for continuous professional development and clear regulatory oversight to prevent scope drift and maintain public trust (Ward et al., 2022; HCPC, 2022).
Another recurring issue was the uneven recognition of prescribing qualifications across borders. Physiotherapists trained as independent prescribers in one country often face restrictions when relocating, reflecting the absence of global harmonization in professional regulation (Kumar & Warrender, 2024).
Comparative Policy Trends
A comparative policy analysis revealed that the introduction of prescribing rights generally followed similar stages: first, pilot programs with restricted formularies; second, longitudinal evaluation of safety and effectiveness; and finally, gradual expansion to independent prescribing. This evolutionary pattern mirrors that observed in other allied health professions, such as nursing and podiatry, suggesting that physiotherapy is undergoing a predictable trajectory of role extension.
In most jurisdictions, legislative change was catalyzed by documented service gaps and workforce shortages rather than purely professional advocacy. Governments recognized that empowering physiotherapists to prescribe within defined boundaries reduced system inefficiencies and improved patient access to care. Importantly, no reviewed jurisdiction reversed or suspended physiotherapist prescribing once implemented, indicating both safety and sustainability of the model.
4. Discussion
Interpretation of Findings
The results of this review highlight a clear and steady international progression toward integrating pharmacological competence and prescribing authority into physiotherapy practice. While the pace and extent of implementation differ between countries, the overall direction is unmistakable. The evidence demonstrates that physiotherapist prescribing, when underpinned by rigorous education and regulatory oversight, improves continuity of care and patient satisfaction without compromising safety. The absence of significant adverse drug events in all examined jurisdictions strengthens the argument that physiotherapists, once appropriately trained, can manage limited pharmacological responsibilities safely and effectively (Stenner et al., 2020; Ward et al., 2022).
At its core, this development reflects a broader transformation within healthcare: the gradual dismantling of rigid professional hierarchies in favor of integrated, competency-based models. Physiotherapists increasingly operate as autonomous clinicians whose expertise in movement, function, and rehabilitation naturally intersects with pharmacological management of pain, inflammation, and chronic disease. Denying access to prescribing rights in such contexts risks creating unnecessary dependency, duplication, and inefficiency—conditions already identified as barriers to optimal patient outcomes (Taylor & Lowe, 2022).
Professional Identity and Ethical Boundaries
Despite the practical benefits, the expansion of physiotherapist prescribing continues to evoke philosophical and ethical concerns about professional identity. Physiotherapy has historically defined itself through the restoration of function and movement rather than the pharmacological modulation of symptoms. Critics worry that prescribing authority may lead to a drift toward medicalization, encouraging clinicians to rely on pharmacological interventions rather than promoting active rehabilitation (Reid & Moffatt, 2021).
However, such concerns assume a binary division between “medical” and “physical” care that no longer reflects clinical reality. The essence of physiotherapy lies not in what interventions are used, but in how they are applied — guided by evidence, patient goals, and functional outcomes. Integrating limited pharmacological tools does not dilute professional identity; it strengthens it, allowing physiotherapists to manage acute pain and inflammation in a way that facilitates rather than replaces movement-based recovery. The ethical imperative, therefore, is not to reject pharmacology outright, but to use it judiciously within a framework of functional rehabilitation.
Educational Foundations and Competency Assurance
The review identified education as the decisive determinant of safe and effective prescribing practice. Jurisdictions that embedded postgraduate pharmacology training, supervised practice, and standardized assessment — such as the United Kingdom and Australia — achieved high patient confidence and safety outcomes. The inclusion of pharmacological education in the World Physiotherapy Global Standards for Physiotherapist Education (2023) is therefore both timely and essential.
Nevertheless, educational disparities remain stark. In many European countries, physiotherapy programs provide minimal pharmacological content, insufficient for clinical decision-making beyond basic drug awareness. If prescriptive authority is to be expanded internationally, harmonized curricula and tiered competency frameworks are needed. This should include not only pharmacodynamics and drug safety but also clinical reasoning, legal accountability, and ethical prescribing principles.
Legal and Regulatory Considerations
The transition from a non-prescribing to a prescribing profession demands robust governance.
Effective regulation must delineate scope, ensure ongoing professional development, and establish mechanisms for pharmacovigilance and audit. The experience from existing models suggests that the safest path forward involves gradual implementation, beginning with restricted formularies and collaborative supervision before progressing to independent prescribing rights (HCPC, 2022; APA, 2023).
Legal liability presents a legitimate concern. Physiotherapists entering prescriptive practice assume responsibilities traditionally reserved for medical practitioners, including reporting adverse events and maintaining up-to-date drug knowledge. However, this challenge is not unique to physiotherapy. Similar transitions occurred in nursing and podiatry, where clear legal frameworks, mandatory training, and shared professional indemnity have mitigated risk successfully. There is no empirical evidence that physiotherapist prescribing increases medicolegal incidents when appropriate safeguards are in place (Ward et al., 2022).
Interprofessional Collaboration and Healthcare Efficiency
Perhaps the most compelling argument for physiotherapist prescribing lies in its potential to enhance system efficiency. As healthcare demands rise and physician availability declines in many regions, physiotherapists often serve as the first point of contact for musculoskeletal and chronic pain conditions. Allowing them to manage both functional and pharmacological aspects of care reduces unnecessary referrals and accelerates intervention.
Importantly, the introduction of prescribing rights has not undermined collaboration with physicians. On the contrary, evidence from the United Kingdom and Australia suggests improved interprofessional respect and communication, as physiotherapists engage as clinical equals rather than subordinate technicians (Morris et al., 2021). The shift transforms the professional relationship from referral-based to consultative — a model that aligns with modern interprofessional care principles and supports shared decision-making.
Ethical Imperatives and Patient-Centered Care
Ethically, extending prescribing rights aligns with the principles of beneficence and autonomy. Patients benefit from timely, holistic care delivered by practitioners who understand both mechanical and pharmacological dimensions of their condition. Denying competent physiotherapists access to appropriate medications, when evidence demonstrates safety and effectiveness, could be viewed as paternalistic and contrary to patient welfare.
Nonetheless, ethical integrity depends on maintaining the profession’s rehabilitative ethos.
Prescribing should remain a complementary tool, reserved for situations where it directly supports movement restoration, pain control, or function optimization. This requires ongoing reflection, transparent documentation, and outcome evaluation to ensure that pharmacological interventions remain secondary to active rehabilitation.
Future Directions
The findings indicate several priorities for future research and policy development. Longitudinal studies are needed to assess the long-term impact of physiotherapist prescribing on health outcomes, service efficiency, and cost-effectiveness. Comparative analyses between countries at different stages of implementation could clarify optimal regulatory pathways. Moreover, interprofessional education models should be developed to promote mutual understanding between physiotherapists, physicians, and pharmacists, ensuring safe and cohesive practice.
From a policy perspective, gradual expansion of prescriptive authority should be linked to demonstrated competency and system needs rather than professional lobbying. Establishing international benchmarks for prescriber education would facilitate mobility and consistency, particularly across Europe, where fragmented regulation remains a major obstacle.
Synthesis
The evidence supports a paradigm shift in physiotherapy practice. Pharmacological competence and limited prescriptive authority, far from threatening professional identity, represent an evolution consistent with evidence-based, patient-centered care. The challenge lies not in proving safety or effectiveness — both are already well-documented — but in aligning education, legislation, and professional culture to sustain responsible integration.
Physiotherapists have long occupied a unique position at the intersection of biomedical science and functional recovery. Expanding their pharmacological scope, within clearly defined boundaries, simply acknowledges the reality of modern practice. The future of physiotherapy autonomy will depend not on defending old professional borders but on embracing competence, accountability, and interdisciplinary collaboration as its defining standards.
5. Conclusion
This review shows that granting physiotherapists limited prescribing rights, when supported by structured education and strong regulation, is both safe and clinically valuable. Evidence from countries with established systems demonstrates improved continuity of care, reduced service delays, and high patient satisfaction, without increased medication-related risk.
Pharmacological competence complements rather than compromises physiotherapy’s identity. Used responsibly, it enables clinicians to manage pain and inflammation efficiently, supporting active rehabilitation and faster functional recovery.
Successful implementation depends on three conditions: harmonized postgraduate education in pharmacology, transparent governance with phased prescribing models, and ongoing professional accountability. When these are met, prescribing becomes a natural extension of evidence-based physiotherapy rather than an encroachment on medical practice.
In essence, physiotherapist prescribing reflects an evolution toward integrated, patient-centered care. It allows practitioners to treat the whole person—combining movement, function, and medication when clinically justified—while maintaining the profession’s ethical and rehabilitative core.
Acknowledgments
The author would like to thank colleagues and mentors from the physiotherapy community for their valuable discussions and insights that contributed to the development of this manuscript.
Conflict of Interest Statement
The author declares no conflicts of interest related to this work.
He is an independent physiotherapist and researcher and received no financial or material support for this study.
Funding Statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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- Tobias Giesen (Autor:in), 2025, Pharmacological Competence and Prescriptive Authority in Physiotherapy. Opportunities, Prerequisites, and Ethical Boundaries, München, GRIN Verlag, https://www.grin.com/document/1670681
