Rapid adaptation of first contact physiotherapy services for musculoskeletal patients in the UK and Australia during the COVID-19 pandemic: a multiple case study

Background: The disruption of health services by the COVID-19 pandemic prompted the WHO to advocate for rapid adaptation of healthcare. Little is known about the specific rapid adaptation strategies deployed in first contact physiotherapy services (FCPS) and how they were experienced by providers and patients. Study Aim: To explore views and experiences of physiotherapists and key stakeholders on the rapid adaptation of FCPS during the COVID-19 pandemic in the UK and Australia. Methods: A multiple case study design was employed across four case sites; UK (n = 2), Australia (n = 2), involving online semi-structured interviews with 22 participants in 2024 and document review. A case-based approach using framework analysis was applied, drawing on the public health emergency framework of readiness, responsiveness, and sustainability, alongside the consolidated framework for implementation research (CFIR). Results: Gaps in readiness for adaptation, particularly in terms of planning and resources, were evident across FCPS in both countries. However, the findings highlight FCPS as an adaptable service, with strategies implemented within the first three to six months following the declaration of COVID-19 as a pandemic. The most notable adaptation variation was in telehealth, where alignment with service contexts influenced implementation and ongoing sustainability. New challenges not fully captured within CFIR constructs emerged, including the initial lack of acceptability, particularly related to telehealth, and the unpredictable nature of the pandemic. Conclusion: To strengthen FCPS preparedness for the future, policies should proactively equip services with the resources and capabilities required to manage emergencies and associated contingencies, while accounting for contextual variations. Such forward planning would support an effective response and the long-term integration of beneficial adaptations, thereby strengthening service resilience.