Advanced practice physiotherapy has reached an important juncture in its development.

Physiotherapists across the country are taking on greater responsibility for patients with complex presentations, working in environments traditionally dominated by medical practitioners and contributing to new models of care. 

However, the development of these roles has varied between states, with differences in how advanced practice is defined, trained, credentialed and recognised.

The publication of the APA’s National Advanced Practice Physiotherapy Competency Framework in 2024 (see breakout below), followed by the development of a new national titling pathway, provides a foundation for addressing that variation, says Maree Raymer MACP, chair of the APA’s Advanced Practice (including Emergency Department) national group. 

The work is intended to establish recognition against a national standard, strengthen clinical governance, enhance workforce mobility and demonstrate the contribution advanced practice physiotherapy can make to health service delivery.

From emerging roles to a career pathway

So, what distinguishes an advanced practice physiotherapist from an experienced clinician? 

That distinction is not simply the number of years a physiotherapist has worked or the postgraduate qualifications they hold.

Instead, it relates to the level of responsibility, accountability and decision-making required within the role, particularly when managing complex and undifferentiated conditions, says Maree, an APA Titled Musculoskeletal Physiotherapist.

‘Advanced practice physios are taking on responsibility for assessment, diagnosis, management and planning for patients who present with complex, undifferentiated or undiagnosed conditions,’ Maree says. 

Those responsibilities are often undertaken in complex environments such as hospital emergency departments and specialist services, where clinicians must make decisions amid clinical uncertainty and potential risk.

Advanced practice physiotherapy extends beyond direct patient care, though, Maree says. 

Leadership, education, service innovation, quality improvement, research, advocacy and health system development are also part of the broader role. 

Depending on the clinical setting, practitioners may require additional knowledge and skills related to diagnostic imaging, medicines, care pathway planning and procedural interventions.

The competency framework captures this broader understanding through seven professional roles: physiotherapy practitioner, communicator, collaborator, leader, health advocate, scholar and professional. 

It aligns advanced practice with Milestones 3 and 4 of the APA’s physiotherapy competency framework, representing highly developed and expert levels of performance.

Maree says advanced practice is not simply an automatic expansion of scope for an experienced physiotherapist. 

It requires an appropriate combination of clinical experience, role-specific education, workplace training, professional judgement and organisational governance. 

The framework, she says, recognises that these capabilities might be developed through different educational and professional pathways, provided the required competencies can be demonstrated.

Developing across different systems

Advanced practice physiotherapy roles have emerged in response to local health service needs rather than through a single national strategy. 

Although some services have been in operation for more than 20 years, the pace and nature of development have varied considerably between the states, territories and individual health services. 

This, Maree says, has produced a diverse range of models of care.

APA Advanced Practice (including Emergency Department) national group chair Maree Raymer MACP.

In hospital emergency departments and health services across the country you will find physiotherapists taking primary responsibility for assessing and managing patients with musculoskeletal presentations, working in a range of different specialist clinics (like orthopaedics; neurosurgery; pelvic health; ear, nose and throat; and neurology), triaging referrals and providing diagnostic assessment and management pathway planning.

Variation has allowed services to respond to their own populations and clinical priorities, Maree says. 

However, it has also created challenges for practitioners moving between states and, in some instances, between health services in the same state. 

Clinicians who have undertaken extensive workplace-based training in one service may face accreditation or assessment hurdles elsewhere.

The competency framework was created in response to that, Maree says. 

As chair of the Advanced Practice (including Emergency Department) national group and with involvement in the team effort over more than a decade to help create the framework, Maree says it provides a common description of advanced practice physiotherapy competence and sets a standard against which training, assessment and recognition can be developed, while allowing organisations to adapt requirements to their clinical environments.

‘Being able to share the nature of roles and an understanding of what it takes to make them effective and embed them in health services is important,’ she says.

Move towards titling

In August this year, the APA announced that the council of the Australian College of Physiotherapists had approved a pilot of the advanced practice physiotherapy titling evidence portfolio pathway (see Final Word article here).

Initially, the pilot – for which 17 candidates from across the country have been recruited and assessors appointed – will focus on emergency department and musculoskeletal screening clinics.

Maree says the pathway is designed to recognise physiotherapists who can demonstrate that they meet the knowledge, skills and professional capabilities described in the national competence framework for advanced practice. 

It is not intended to prescribe a single service or employment model or to replace the role of individual organisations in determining their clinical governance and role-specific requirements.

The pilot, which is due to conclude midway through next year, includes an application demonstrating the eligibility and prerequisites, submission and assessment of an evidence portfolio and a viva voce examination.

Candidates will need to demonstrate extensive musculoskeletal physiotherapy learning and experience and the education and work-based training that has underpinned their preparation for their advanced role. 

Three workplace-based assessments will form part of the evidence portfolio requirements, reflecting the importance of demonstrating competence within the clinical environment, Maree adds. 

This is something unique to the advanced practice titling pathway.

A broad range of candidates were selected to enable comprehensive evaluation of the pilot, from practitioners who are more recently appointed to their advanced roles to those who have been in an advanced practice role for a decade or more, and including physiotherapists across the two different practice areas and from metropolitan as well as rural and regional settings.

Evaluation of the pilot will help inform potential refinements before broader implementation. 

Feedback from assessors, candidates and other stakeholders will help assess the pathway’s design, assessment methods and useability (see breakout below). 

Maree sees the pathway as an important step towards creating a nationally recognised benchmark.

For employers, having the pathway may provide greater confidence in a practitioner’s preparation for a role that involves higher clinical responsibility. 

For physiotherapists, titling could offer recognition that is more portable across health services and jurisdictions.

‘The process of development has been going on for a long time, more than 10 years, and it’s been very challenging to navigate the nature and pace of development of advanced practice in the different jurisdictions and to design a pathway that meets the needs of a variety of stakeholders,’ Maree says. 

‘Starting the pilot now will help us implement the pathway at a time when health services are increasingly looking for an opportunity to reform pathways to try to maximise the value of the whole workforce.’

The longer-term ambition, Maree says, includes recognition in a broader range of practice areas and at the specialist level through the College. 

However, the immediate focus is on testing and evaluating the titling pathway. 

She says the potential benefits extend to discussion about scope of practice, funding arrangements and the role of physiotherapists within multidisciplinary services.

‘Having a nationally consistent standard and a pathway of recognition is fundamental to maximising the opportunity to embed advanced practice in health services and for physios to take on roles that improve pathways of care on a much larger scale in health services,’ she says.

Developing the workforce

Patrick Swete Kelly FACP has spent much of his professional life working in advanced practice physiotherapy roles and education.

A musculoskeletal physiotherapist with extensive experience in Queensland, Patrick entered an advanced practice role in 2006 and became a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists
in 2007) the following year.

Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2007) Patrick Swete Kelly FACP.

Patrick’s current work includes a statewide education coordinator role to prepare physiotherapists to work in advanced practice roles in musculoskeletal screening clinics in Queensland public health facilities. 

He has a part-time role at the Royal Brisbane and Women’s Hospital, leading a multidisciplinary allied health team assessing and managing patients referred to these screening clinics with complex and undifferentiated musculoskeletal conditions. He also has a small, casual role at the University of Queensland.

This combination of clinical and educational responsibilities has shaped his expansive understanding of the capabilities required for advanced practice physiotherapy.

Postgraduate education can provide a strong foundation, Patrick says. However, the transition to advanced practice also requires clinicians to develop comprehensive knowledge and skills in the assessment, diagnosis and management of patients with undifferentiated conditions. 

Patrick says by nature these clinics see patients referred with complex and undifferentiated presentations and must consider a broad range of possible diagnoses including conditions outside the musculoskeletal system.

Patrick describes this challenge as developing the ability to ‘consistently consider complex and undifferentiated presentations’. 

The process involves more than expanding a collection of clinical tests or treatment techniques; it requires the diagnostic reasoning and professional judgement to make decisions amid uncertainty.

Beyond assessment and treatment

In Patrick’s advanced practice role, patients are referred to specialist outpatients services for an opinion on diagnosis and management. 

Many, he says, present with complex and chronic musculoskeletal problems complicated by medical and psychosocial factors, requiring a comprehensive assessment and consideration of the differential diagnosis.

Management within the model of care may involve recommending further investigations, communicating with GPs or medical specialists, referring or requesting advanced investigations or interventions, determining whether surgical opinion is required and/or developing a conservative treatment pathway. 

Collaboration with physiotherapists, dietitians, occupational therapists, psychologists, pharmacists and other members of the multidisciplinary team may also be necessary. 

Decisions made during the initial assessment can influence care delivered by several practitioners over subsequent months.

Recognising sinister presentations is another important component of Patrick’s work. He describes encountering a greater incidence of sinister pathology in advanced practice public health settings compared with his specialist private practice work.

Clinicians must routinely assess and identify red flags, determine if alternative care is required and any urgency of referral and coordinate with medical specialists regarding any escalation of care.

These responsibilities reinforce the importance of structured education and supervision. Advanced practice, he says, involves a specific level of clinical responsibility and accountability, in addition to development of a physiotherapist’s existing skills.

‘It’s stimulating; it’s a fortunate role and well accepted by our medical colleagues. 

'We have the opportunity to assess, develop management plans, case-manage these patients with complex presentations and liaise with all stakeholders,’ he says.

Working together

As chair of the APA Advanced Practice Career Pathway working group, Patrick has contributed to the development of the national competency framework and titling pathway. 

The work has involved clinicians, APA representatives and other stakeholders in identifying the capabilities required for advanced practice and developing a consistent recognition process.

Although the pilot to titling in advanced practice focuses on musculoskeletal roles in emergency departments and screening clinics, it has broader relevance across advanced practice settings, he says. 

The intent is to provide a common foundation while allowing different clinical environments to retain their specific requirements.

Patrick says the pathway has potential value for practitioners moving between jurisdictions. 

A nationally recognised standard may reduce duplication in assessment and provide employers with greater clarity about the capabilities demonstrated by clinicians who may have trained elsewhere.

He says that advanced practice competence can develop through different combinations of postgraduate training, workplace-based learning and professional development. 

The important consideration, he emphasises, is whether the required competencies have been achieved and can be demonstrated. 

This approach may help physiotherapists at different stages of their careers to understand the education, experience and training needed to progress into advanced practice. 

It also recognises that advanced practice is not limited to clinical expertise.

The clinician as educator, leader and scholar 

Patrick says the APA framework identifies leadership, collaboration and scholarship as integral to advanced practice. 

Clinicians may be expected to contribute to service development, support the education of colleagues, engage with stakeholders and participate in quality improvement.

Patrick’s education role demonstrates how advanced practitioners can contribute to workforce development while maintaining a clinical focus. 

His experience highlights the need to support clinicians in developing their capabilities beyond assessment and treatment, including the responsibilities that accompany autonomous practice in complex environments.

He says that while a formal titling pathway provides a mechanism for recognising these capabilities, effective education, supervision and workplace support will remain essential. 

The profession’s challenge, he argues, is to ensure that advanced practice development is accessible across different clinical settings and stages of a physiotherapist’s career.

Advanced practice and the patient pathway

David Jovic APAM’s physiotherapy career across Tasmania, Queensland and Victoria provides insight into the different ways advanced practice roles can be developed and supported. 

APA Advanced Practice (including Emergency Department) national group deputy chair David Jovic APAM.

His interest in the field grew from a desire to improve patient access and determine how physiotherapists could contribute earlier in the care pathway.

An early-onset osteoarthritis triage and advanced practice musculoskeletal project in Launceston, Tasmania, was supported by a $25,000 grant that funded one day per week for a year. 

While the project was well received, it did not secure ongoing funding. And as there were no advanced practice roles in Tasmania at the time, David subsequently moved interstate to gain experience – to Victoria and Queensland, where advanced practice models were already well established. 

He found work in an emergency department advanced practice role in Hervey Bay, before returning with his family to Tasmania around the time of COVID-19.

David is the deputy chair of the Advanced Practice (including Emergency Department) national group. His current role at the Royal Hobart Hospital involves working as an advanced practice physiotherapist in the emergency department. 

He assesses musculoskeletal presentations, helps streamline patient pathways and manages appropriate musculoskeletal presentations, providing improved access in support of the medical system’s needs. 

He says patients commonly present with peripheral musculoskeletal injuries including sprains, fractures, dislocations and soft tissue injuries involving the elbow, wrist, hand, knee, ankle and foot.

The work, he says, requires clinical reasoning, timely decision-making and the ability to determine when a patient needs medical or surgical assessment. 

Advanced practice in this environment is not simply about reducing the workload of doctors. 

It involves using physiotherapy expertise to improve access, provide appropriate assessment and direct patients towards the most suitable next step in their care.

More than an individual role

David describes advanced practice as involving both the individual patient and the broader healthcare pathway.

While the clinician is responsible for the assessment and management of each patient, the role also creates opportunities to consider how groups of patients can be managed more effectively. 

This may include contributing to referral guidelines, working with medical teams, identifying opportunities for earlier conservative management or helping redesign services around patient needs.

The distinction, David says, is particularly relevant in musculoskeletal care, where patients may be referred to orthopaedic services without receiving an adequate trial of conservative treatment. 

An appropriately trained physiotherapist can help determine whether surgery is required or whether a patient would benefit from further non-operative management.

Advanced practice does not replace medical or surgical expertise, David says. Rather, it provides an opportunity to ensure that patients are assessed by the practitioner best equipped to address their presentation, with escalation when medical assessment or intervention is required.

‘At the clinical coalface, that is seeing individual patients but it’s also thinking about how we as physios can make this pathway better for patients. 

'Advanced practice is clinical but it’s also found in collaboration and in engagement with a range of stakeholders to support those pathways,’ he says.

What health services expect

David’s recent work as part of his PhD investigating education and training in advanced practice examined an advanced practice physiotherapy statement of duties, posing the question ‘What do health services expect of advanced practitioners?’ 

He says the results showed that health services wanted the clinical expert practitioner but also the collaborator, the leader and the scholar. 

This, he says, has far-reaching implications for how physiotherapists stepping into those roles are educated.

Historically, advanced practice roles were developed within localised health services based on the needs of specific populations and this made the portability of skills across the country a challenge. 

‘I think we don’t want to move to a point where everyone has the same training but you’re not fitting the needs of the location and the population you’re seeing. That would be a problem,’ he adds.

Acknowledging the decades of evolution that advanced practice has taken to get where it is today and the many physiotherapists who have ‘battled in this space for a long time’ to get it here, David says he hopes the future of advanced practice will include growth in areas such as women’s health, paediatrics and cardiorespiratory clinical contexts. 

He would also like to see physiotherapists build on the research that demonstrates the cost-effectiveness, safety and improved access that advanced practice physiotherapy offers.

‘I hope the pathway to competency becomes clearer. 

'I hope that the standards of education and training become more readily taken up across the different parts of advanced musculoskeletal physio and I hope that they get a sense of the potential breadth of the advanced practice role, that this opens up opportunities to deliver care but also opportunities to impact care that may not have been available or that others have fought for over time,’ he says.

Models of care, education and the Victorian experience

APA Titled Musculoskeletal Physiotherapist Bridget Shaw AM MACP’s advanced practice career has included emergency departments, orthopaedic services and specialist spinal clinics. 

Her current work in Melbourne’s Northern Health Orthopaedic Spinal Surgical Specialist Clinic demonstrates how advanced practice physiotherapy can operate within a specialist medical service, while her experience in Victoria provides insight into the development of the field.

APA Titled Musculoskeletal Physiotherapist Bridget Shaw AM MACP.

Patients are referred to the spinal clinic, mostly by GPs, for an opinion on diagnosis and intervention for their often complex presentations. 

Patients are comprehensively assessed by an advanced practice physiotherapist, with clinical reasoning for the initial differential diagnoses that considers their signs and symptoms, imaging, medical history and previous management, with vigilance for indications of possible serious pathology. 

Further investigations may be arranged if needed prior to the final diagnosis being determined. 

Bridget then determines whether a surgeon’s opinion is required or whether the patient can be discharged with reassurance, education and an appropriate conservative management plan in the community.

The knowledge and clinical reasoning required in these settings is substantial, Bridget says. 

A patient presenting with leg pain may have symptoms originating from the lumbar spine but clinicians must also consider other possible contributors including peripheral neuropathy, vascular disease and other medical conditions. 

She describes differential diagnosis and clinical reasoning as aspects of the work she particularly enjoys. 

‘Emergency department practice, in particular, requires clinicians to unpack complex presentations and recognise when something more immediately serious may be occurring,’ she says.

The Victorian history

From around 2003, experienced physiotherapists were working alongside orthopaedic specialists in Victorian metropolitan and regional hospital specialist clinics with published outcomes, Bridget says. 

For example, in the Better Skills Best Care project of the Victorian Department of Health (Oldmeadow 2007), in Osteoarthritis Hip and Knee Services (Brand 2011, Kapakoulakis 2011), in various emergency department primary contact roles (Gill 2013) and in post-arthroplasty clinics (Large 2014).

In 2012, Health Workforce Australia funded a large national project, Physiotherapists in the Emergency Department, involving three states and one territory. 

The program was to implement and evaluate innovations and assess their impacts on workforce productivity, recruitment and retention. 

Funding was for two streams, involving different states and territories with two lead sites with capacity to provide guidance and support to a number of implementation sites. 

Over 14,000 patients presenting with musculoskeletal problems were seen by the advanced practice physiotherapists during this project. This represented 2.4 per cent of all emergency department presentations at participating hospitals (Thompson 2014). 

In Victoria, Alfred Health was the lead site for implementation sites at Southern Health, St Vincent’s, Ballarat and Sandringham Health Services.

The methodology and resources developed by Alfred Health and others for the Health Workforce Australia Physiotherapists in the Emergency Department project provided the foundation for the subsequent Department of Health-led Advanced Musculoskeletal Physiotherapy Implementation Program (2013–15) for the Victoria-wide implementation of advanced musculoskeletal physiotherapy in orthopaedic and neurosurgical outpatients and emergency departments (Harding et al 2017, Shaw et al 2018).

Resources developed at the time by the Alfred, including the Advanced Musculoskeletal Physiotherapy Operational Framework and Clinical Education Framework (supported by Monash Health), were published in 2016, providing extensive workplace-focused resources to support advanced musculoskeletal physiotherapy services in public hospitals. 

These included competency-based training and assessment, mentoring and guidance for development and evaluation of services in orthopaedics and neurosurgical screening, osteoarthritis and emergency departments.

Bridget highlights the importance of these education and governance structures in supporting new models of care. She believes these operational frameworks, training pathways and resources, and competency assessment processes have influenced advanced practice development beyond the state.

Broader responsibilities

Bridget entered advanced practice after completing postgraduate master’s musculoskeletal physiotherapy education and working across clinical and management roles. 

Her subsequent experience at the Royal Melbourne Hospital and St Vincent’s Hospital emergency departments and spinal clinics has involved clinical practice, supervision, education and senior leadership.

She says that advanced practice roles carry risks that require robust governance. 

Clinicians need the relevant clinical knowledge and experience, considerate role-specific education, supervision during competency development and the ability to demonstrate safe, autonomous practice while also recognising when it is critical to escalate concerns to our medical colleagues.

The clinical environment, Bridget says, determines the capabilities required. 

Advanced practice physiotherapists need to recognise serious pathology across a broad range of presentations and manage complex diagnostic and management decisions.

‘A patient presenting with knee pain, for example, may have a condition associated with inflammatory disease, malignancy, significant trauma or another medical issue. 

'The clinician must recognise when the presentation does not fit the expected pattern and ensure appropriate escalation,’ she says.

Barriers to expansion

Funding and regulatory arrangements continue to be ongoing barriers to the broader expansion of advanced practice physiotherapy, Bridget says, adding that specialist clinic funding structures do not always recognise the contribution of physiotherapists working alongside medical staff in assessment and management roles. 

She also points to differences in access to investigations and medicines across jurisdictions. The activities a physiotherapist can undertake depend on the relevant regulatory and organisational context, alongside the clinician’s training and competence.

These issues raise questions about how advanced practice should be supported within the Australian health system. 

Where physiotherapists take greater responsibility for assessment and management, regulatory, funding and governance arrangements need to reflect the capabilities and responsibilities of those roles, she adds.

Bridget is not suggesting that every physiotherapist should undertake prescribing or other activities outside traditional scope (see advocacy article here). 

Instead, she argues that appropriately trained practitioners should be able to contribute to patient care within a system that recognises their capabilities and supports safe, evidence-based practice.

She sees opportunities for advanced practice physiotherapists in urgent care clinics and other settings as well as in areas such as women’s health, paediatrics and vestibular physiotherapy. 

Expansion, however, must be supported by appropriate education, competency assessment and clinical governance, she concludes.

Heading in the right direction

Like her peers, Bridget believes formal titling could help health services and jurisdictions recognise advanced practice more consistently. 

A national benchmark may address variation in training and assessment, while supporting greater portability for physiotherapists moving between organisations.

The potential benefits extend to professional advocacy (see below), including discussions about scope of practice, funding and service development. 

Bridget hopes advanced practice physiotherapy will become more widely recognised, better supported and embedded in additional health services. 

Demonstrating competence through agreed standards and assessment will support that ambition. Recognition, she says, should reflect the capabilities required for the role rather than relying on an individual’s experience or reputation.

Shaping the future

The development of the national titling pathway marks an important stage in the evolution of advanced practice physiotherapy in Australia. 

The APA National Advanced Practice Physiotherapy Competency Framework provides a shared description of the capabilities required, while the titling pilot offers an opportunity to test how those capabilities can be assessed and recognised.

The success of the work will depend on more than completing the pilot. Health services will need to recognise the value of advanced practice roles, support education and supervision and establish appropriate clinical governance. 

Continued research into patient outcomes, service efficacy, workforce development and sustainability will also be important.

For physiotherapists considering advanced practice, the emerging pathway offers a framework for career development beyond traditional clinical progression. 

Education, workplace learning, supervision, research and clinical experience can all contribute to the capabilities required at higher levels of practice.

The longer-term ambition is to ensure that patients receive care from the practitioner most equipped to meet their needs at the appropriate point in the pathway. 

Advanced practice physiotherapy can contribute to that objective when roles are properly designed, clinicians are appropriately trained and services are supported by effective governance.

Building the path to success

The advanced practice physiotherapy titling pathway has moved from concept to implementation. 

An upcoming pilot of the pathway, expected to conclude in late 2027, represents an important step towards recognising physiotherapists who are already working in advanced practice roles and creating a nationally consistent way to demonstrate that expertise.

The project has required considerable investment, persistence and collaboration to reach this point. 

The Advanced Practice Career Pathway working group, chaired by Patrick Swete Kelly FACP and including experienced practitioners Maree Raymer MACP, Bridget Shaw AM MACP, Katherine Maka APAM, Pippa Flanagan MACP and Kirby Tuckerman APAM, has contributed subject matter expertise to the pathway and assessment design.

The work has been supported by the APA education team, whose role extended beyond project coordination to collaboration
with the working group on the design of the pathway and its assessment processes.

Some of the most exciting aspects of the pilot are the novel elements built into the assessment model. 

Alongside a comprehensive evidence portfolio, candidates will undertake mandatory workplace-based assessments and a structured viva voce examination, supported by assessment tools and decision matrices tailored to the advanced practice competence framework.

The pilot is ultimately about learning as much as credentialing. Its evaluation will consider the experience of candidates and assessors, assessment consistency and operational processes, with feedback used to refine the pathway and potentially inform other approaches to physiotherapy titling through the APA’s optimising titling project, which is currently underway.

As the project moves into the pilot delivery phase, it marks an important moment for advanced practice physiotherapy and for the profession’s broader ambition to build contemporary, meaningful and substantial career pathways.

Read more about the advanced practice titling pathway.

Advancing the APA’s advocacy priorities

A key focus of the APA’s advocacy for advanced practice physiotherapy has been on achieving greater consistency in how advanced practice roles are defined, recognised and implemented across Australia.

While most states and territories have some form of advanced practice role, there is variation in their scope and recognition. 

The APA’s National Advanced Practice Physiotherapy Competency Framework provides an important reference point, outlining the competencies expected of advanced practice physiotherapists and supporting a more consistent approach to role development across jurisdictions.

APA Policy and Government Relations senior policy advisor Lowana Williams says another priority is ensuring that advanced practice physiotherapy is appropriately recognised and funded within hospital settings. 

The Tier 2 Non-Admitted Services Classification, which sets out funding for a range of outpatient services, does not currently reflect the complexity and specialised nature of advanced practice physiotherapy. 

Advanced practice physiotherapists provide autonomous assessment, diagnosis and management of complex conditions, often for patients referred to medical consultants, yet the existing classification does not distinguish these services or account for their extended appointment times and complexity, Lowana says.

She notes that this contrasts with nurse practitioners, whose advanced clinical roles are recognised through specific classification codes. 

The APA has been advocating for a distinct Tier 2 classification for advanced practice physiotherapy that appropriately reflects the services provided and enables hospitals to allocate resources accordingly. 

Lowana says better recognition and funding could also encourage the adoption and expansion of innovative models of care that have the potential to improve efficiency, reduce costs and alleviate pressure on the health system.

A third area of advocacy is ensuring that advanced practice physiotherapists can work to the full extent of their scope of practice.

This includes capabilities such as direct referral for imaging and scans as well as prescription and administration of medications where physiotherapists are appropriately trained and authorised.

Lowana says enabling physiotherapists to use these skills and capabilities would support more streamlined patient pathways, reduce unnecessary steps in care and improve timely access to assessment and treatment.

Together, these priorities are about ensuring that advanced practice physiotherapy is appropriately recognised as an established
and valuable component of contemporary healthcare, she adds. 

Consistent role definitions, appropriate funding mechanisms and the ability to practise at top of scope would support the continued growth of advanced practice physiotherapy while helping hospitals deliver more efficient, accessible and patient-centred care.

Read the APA’s submission on the Tier 2 classification.

Putting a framework around expertise

The APA National Advanced Practice Physiotherapy Competency Framework provides a national reference point for what advanced practice looks like in physiotherapy. 

Published in 2024 with support and funding from the APA, the framework aims to provide consistency in advanced practice standards for patients, health services and physiotherapists working in or preparing for advanced practice roles.

Rather than defining advanced practice through a particular job title or clinical setting, the framework focuses on the capabilities required to practise at this level. 

It describes advanced practice as requiring highly developed knowledge, skills, experience and clinical reasoning, supported by relevant postgraduate education and role-specific training. 

Practitioners take responsibility for patients with complex, undifferentiated or undiagnosed presentations and work with a high degree of autonomy in complex environments.

Seven roles complete the framework: physiotherapy practitioner, communicator, collaborator, leader, health advocate, scholar and professional. 

Adapted from the CanMEDS competency model for physiotherapy, these roles recognise that advanced practice extends well beyond clinical decision-making to encompass communication, multidisciplinary collaboration, leadership, advocacy, scholarship and professional responsibility.

The framework also recognises that advanced practice develops over time. Competencies are mapped to Milestone 3, highly developed and Milestone 4, expert, with each level building on the capabilities developed at earlier milestones. 

The framework provides general descriptions of performance rather than prescribing a single way of achieving competence, allowing for individual variation while establishing expectations for practitioners working at each level.

A key feature of the framework is its emphasis on work-based learning and assessment. 

The framework can be used by health services and education providers to develop training and assessment programs, while physiotherapists can use it to evaluate their own capability and identify areas for further development. 

It also recognises qualifications, experience, education and workplace training as important components of competency development.

Access the APA National Advanced Practice Physiotherapy Competency Framework here.

References