Barriers to Care: Patient Inflow Challenges in Physical Therapy Services

Abstract

Physical therapy is central to recovery, disability prevention, and quality of life enhancement. However, patient inflow into physical therapy services is restricted by multiple barriers that undermine access, adherence, and continuity of care.  This narrative review aimed to synthesize evidence on barriers to patient inflow in physical therapy services, identify emerging challenges, and explore strategies to improve equitable access.  A narrative review was conducted using five databases (PubMed, Scopus, Web of Science, CINAHL, Google Scholar) and grey literature from professional and policy organizations. Sources published between 2015 and 2025 were screened, with relevant articles and reports included and synthesized narratively across structural, financial, geographical, cultural, organizational, and pandemic-related factors. Six major categories of barriers were identified. Workforce shortages and infrastructure deficits were most acute in low- and middle-income countries, while financial inequities—such as high out-of-pocket costs and inadequate insurance—were dominant in high-income regions. Geographical disparities, limited rural access, cultural misconceptions, low health literacy, and stigma reduced patient engagement. Organizational inefficiencies, including fragmented referral systems, further constrained inflow. The COVID-19 pandemic magnified these barriers but also accelerated adaptive strategies such as tele-rehabilitation, community-based programs, and direct access models. We concluded that these issues are crucial enough to be put in policy recommendations emphasizing the provision of financial protection, improved referrals, patient education, and incorporation of tele-rehabilitation as an intervention to build a timely resource to mitigate the global burden of disability.