In perspective: Window on the world - physiotherapy differs from country to country

It’s easy to assume we know about our profession. Physiotherapy is a well-established and autonomous female-dominant graduate profession serving the population in a variety of settings. Simple isn’t it?

Not really – at least if you look beyond a UK perspective. It’s easy to forget that despite physiotherapy having a strong practice and value core wherever it is practised, there are substantial variations from country to country.

First, it isn’t always called physiotherapy. Physical therapy (as in the US and Japan) is the most common variation, but in some south American countries it’s also known as kinesiotherapy.

As part of an ongoing major project, the World Confederation for Physical Therapy (WCPT) has gathered information from its member organisations which reveal some other important variations. In the UK we assume that the profession is largely female, but the same can’t be said for Belgium, Sri Lanka, Japan and several African countries where around half of physios are men.

On the other hand, the UK comes nowhere near the female dominance of some other countries, particularly in eastern Europe. We found that in the Czech Republic 94 per cent of physiotherapists are women.

There are some significant variations in the numbers of physiotherapists, with some countries having 1,000 times more physical therapists available for their population than others. The ratio of physical therapists to populations ranges from an estimated high of one to 354 people in Finland, to a low of one to 530,375 in Malawi.

In between there are some interesting nuances. Compared to other high income European countries, Britain has a relatively low professional density: each UK physiotherapist serves nearly twice the number of people as their counterpart in the Netherlands (1,344 compared with 742 estimated). In the countries we have surveyed, more than half have direct access to physical therapy.

And there’s also variation in professional entry level education. Any British physiotherapist who has wanted to work abroad knows that minimum professional entry requirements vary hugely around the world. In countries such as Germany, Cambodia and Afghanistan, the lowest entry-level qualification is a diploma. In Nigeria, the minimum is a five-year bachelor’s degree. In the US and Canada it is a master’s, with the standard qualification in the US a professional doctorate. Somewhere in the middle, with a three-year bachelor’s degree, lies the UK.

Such global variations should not lead us into easy value judgements about the profession in other countries. But international differences are important. The information WCPT is collecting helps us identify the contribution and characteristics of the profession, and this is particularly important to support informed decision-making by health policymakers. The profession in each country stands to gain by knowing more about its neighbours.

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