Telerehabilitation in regional, rural and remote Australia: a scoping review of physiotherapy-led models, outcomes, and implementation challenges

In regional, rural and remote Australia, individuals face significant barriers to accessing physiotherapy services, including geographic remoteness, shortages of allied health professionals, and high travel costs. Telerehabilitation has emerged as a strategy to improve service access and continuity; however, evidence specific to physiotherapy-led models in regional, rural and remote Australia remains fragmented. This scoping review aimed to map the scope, characteristics, and outcomes of physiotherapy-led telerehabilitation models of care in regional, rural and remote Australia, alongside the workforce, funding and policy determinants that shape their implementation. A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were classified as core (direct evidence of physiotherapy-led telerehabilitation) or contextual (system-level, policy or workforce evidence) sources. The search strategy included MEDLINE, CINAHL, EMBASE, Scopus, PEDro, and Google Scholar, and identified studies reporting physiotherapy assessment and intervention delivered via telerehabilitation in regional, rural or remote Australian settings published since 2014. Extracted data were charted and synthesised descriptively, with specific consideration of service delivery models, outcome measures, and barriers and facilitators to implementation. A total of 25 studies met the inclusion criteria, of which 18 were designated core sources directly reporting physiotherapy-led or physiotherapy-relevant telerehabilitation and seven were contextual sources providing system-level, policy or workforce evidence informing implementation. By study design, the included studies comprised service/programme evaluations ( n = 6, 24%), intervention/pilot clinical outcome studies ( n = 4, 16%), cross-sectional surveys ( n = 5, 20%), mixed-methods/qualitative/service mapping studies ( n = 2, 8%), systematic, narrative and scoping reviews ( n = 5, 20%), and conceptual/viewpoint/policy analyses ( n = 3, 12%). Telerehabilitation was associated with improved access to physiotherapy services, reduced travel requirements and high patient satisfaction. Hybrid models incorporating both telehealth and in-person physiotherapy were consistently favoured over telehealth-only approaches. Identified barriers included limited digital connectivity, workforce shortages, insufficient clinician training in telehealth-enabled physiotherapy, cultural safety concerns and funding instability. Physiotherapy-led telerehabilitation appears to be a feasible and acceptable model for improving access to rehabilitation services in regional, rural and remote Australia, though the evidence for clinical effectiveness remains limited and heterogeneous. While some studies reported improvements in functional and patient-reported outcomes, the heterogeneity of study designs and outcome measures precludes firm conclusions about equivalence to conventional care; long-term sustainability depends on infrastructure investment, workforce training, and policy support.