When physiotherapists Jonathon Pearce and Jeremy Bottega joined Royal Darwin Hospital’s renal service, they stepped into new territory—both geographically and professionally. 

As part of a small, dedicated team, they are helping to reshape renal care across the Territory, with a strong focus on supporting Aboriginal and Torres Strait Islander communities.

The inclusion of physiotherapy in the renal service began in 2023, following a pilot project led by nephrologist Dr Jaqui Hughes.

The study explored frailty among patients with chronic kidney disease and showed that structured physiotherapy could significantly improve mobility and quality of life.

‘That pilot gave us the evidence base we needed,’ Jeremy says. 

‘It supported the case for dedicated renal physiotherapy positions covering both inpatients and outpatients.’

For Jonathon and Jeremy, who both relocated to the Top End several years ago, embedding physiotherapy into renal care has been rewarding and eye-opening. 

Jonathon moved to Darwin in 2019 after working at Westmead Private Hospital in Sydney. 

Jeremy, a Curtin University graduate, arrived from Western Australia the year before.

‘I find working in the Top End addictive,’ Jeremy says. 

‘It’s challenging but incredibly fulfilling. 

'There’s such a strong need for dedicated, passionate allied health professionals and the lifestyle here is unmatched.’

Their work spans Royal Darwin Hospital and several satellite clinics in Nightcliff, Palmerston and the Tiwi Islands, combining inpatient and outpatient rehabilitation, exercise prescription, frailty assessment and functional mobility support.

‘We offer physiotherapy to anyone admitted under the renal team,’ Jonathon says. 

‘That includes patients in our dedicated renal ward and across the hospital. 

'Then we visit Nightcliff twice a week, Palmerston every fortnight and the Tiwi Islands every six months.’

While each setting presents its own challenges, the approach remains the same—evidence-based, patient-centred rehabilitation that supports strength, independence and dignity.

The renal physiotherapy team—Phoebe Lynch-Grant, Jeremy Bottega and Jonathon Pearce. Photo: courtesy of the Northern Territory Government

At Royal Darwin Hospital, the physiotherapy gym is located alongside the dialysis unit, creating seamless integration between inpatient and outpatient care. 

‘We can see patients before or after dialysis, sometimes even during treatment, depending on their condition and fatigue,’ says Jeremy.

That proximity is particularly valuable for new dialysis patients. 

‘The first six weeks are life-changing,’ Jeremy says. ‘People are away from family, adjusting to treatment and often frightened. 

'We try to provide physiotherapy support during that phase, when they’re most vulnerable and isolated.’

A high proportion of renal patients in the Territory are Aboriginal or Torres Strait Islander. 

Many relocate from remote communities for dialysis, often living far from family and Country. 

This dislocation has deep emotional and social impacts, which can affect engagement and outcomes.

‘Trust is everything,’ says Jeremy. 

‘When patients see familiar faces and don’t have to retell their stories, they feel safe.’

Jonathon agrees, saying, ‘A lot of our First Nations patients have never had access to physiotherapy before and the feedback has been overwhelmingly positive.’

Culturally safe care is strengthened through collaboration with Aboriginal Health Practitioners and Aboriginal Liaison Officers, who play a crucial role in communication and trust-building. 

‘They help us gather feedback through story-based methods that align with cultural communication styles. 

'Those stories tell us that patients feel stronger, more confident and more connected because of the service,’ Jeremy says.

The renal physiotherapy team often goes beyond traditional roles to ensure that patients receive ongoing support. 

Jonathon says, ‘We do a lot of case coordination and advocacy. 

'We work closely with social workers, Aboriginal Health Practitioners and other allied health professionals to make sure that our patients have what they need to live day to day.’

Geography adds another layer of complexity. ‘Patients are always motivated to go home,’ says Jonathon. 

‘But home might be hundreds of kilometres away, with limited power or water. That makes setting up home dialysis really challenging.’

Despite these barriers, the team remains focused on helping patients regain strength and independence. 

‘We see people in their 20s and 30s already facing end-stage renal failure,’ Jeremy says. 

‘That’s confronting but it pushes us to keep improving the service.’

In late 2024, the renal physiotherapy team received a Chief Minister’s Award—the Northern Territory’s highest public service honour—for its patient-centred innovation. 

‘It was exciting recognition for physiotherapy and it shows young clinicians that you can do meaningful, impactful work here in the Territory,’ says Jeremy. 

Jonathon agrees. ‘We’d developed something that didn’t exist 12 months earlier. To see it valued like that was very special,’ he says.

While the award is significant, the real reward lies in the outcomes.

‘We see people regain confidence, mobility and a sense of control. 

'They feel stronger, they trust the service and they’re proud of their progress. That’s what it’s all about,’ Jeremy says.

Chronic kidney disease affects Aboriginal and Torres Strait Islander people at up to eight times the rate of non-Indigenous Australians, with some of the highest rates recorded in the Northern Territory. 

For many, dialysis is a lifelong necessity that requires relocation from Country. 

Physiotherapy is helping bridge that gap—functionally and culturally—by reducing frailty, improving physical resilience and enhancing independence.

‘We’d love to see more dialysis happening on Country,’ Jeremy says. 

‘That’s the long-term goal, supporting people to be strong enough to live independently, wherever possible. 

'A less frail population means people can participate more fully in life, whether that’s walking to the shop, caring for family or returning home.’

The next challenge is ensuring sustainability. 

‘Our first priority is permanence. We need long-term funding to make the service sustainable. 

'Beyond that, we’d like to build on research and innovation—there’s growing global interest in renal physiotherapy and we want to contribute to that evidence base,’ says Jeremy.

Jonathon says growth also relies on strengthening the multidisciplinary model. 

‘Physiotherapy is one part of the puzzle,’ he says. 

‘We’d love to see our allied health colleagues—occupational therapists, social workers, exercise physiologists—grow alongside us.

'It takes a whole team to deliver the right care in the right place at the right time.’

For now, the renal physiotherapy team continues to combine expertise, compassion and cultural awareness to make a tangible difference in chronic disease management. 

‘It’s challenging but incredibly rewarding,’ Jeremy says. 

‘When you see someone walk out of dialysis stronger, more confident and ready to take on life again—that’s what keeps you going,’ Jonathon adds.