Background: A contemporary musculoskeletal physiotherapy curriculum taught in Aotearoa must be responsive to the unique contexts of Aotearoa that shape healthcare and clinical practice. However, more needs to be formally known about what it means to be a musculoskeletal physiotherapist in Aotearoa, to influence physiotherapy education.

Purpose: Inquiry into contemporary perspectives and the physiotherapy landscape in Aotearoa is needed to inform the newest generations of physiotherapists and guide future curriculum development. We sought to understand what clinicians perceive as shaping musculoskeletal physiotherapy practice in Aotearoa.

Methods: Fifteen musculoskeletal physiotherapists practising across the country were purposely recruited and interviewed. We used a qualitative Interpretive Descriptive approach alongside a reflexive thematic analysis framework. TN and RE coded data, and the research team contributed to the theme structure

Results: Four themes were constructed. Theme 1, ‘Musculoskeletal physiotherapy is much more’, described a narrow public view of musculoskeletal physiotherapy. In Theme 2, ‘Evidence versus (patient) expectations’, participants shared tensions between patient expectations and best practice, alongside value being placed in the privilege of therapeutic touch. Theme 3, ‘Being conflicted’, referred to professional conflicts shaped by bespoke Aotearoa conditions. Theme 4, ‘My navigator’, explored the need for patient support to navigate the health system, alongside professional mentorship and career support.

Conclusion: The participants shared valuable insights that influenced their musculoskeletal physiotherapy practice alongside their views of contemporary education development in Aotearoa. Challenges identified by the participants centred around the perception of physiotherapy, balancing research evidence and professional expectation, maintaining professional identity, and the need for advocacy and mentoring.

Implications: Physiotherapy is a global profession, with similarities in practice internationally. However, Aotearoa is a unique country that shapes many aspects of our lives, including our professional identity. Future generations of musculoskeletal physiotherapists need to appreciate and embrace the unique cultural influences that shape their practice.

Background: Osteoarthritis and low back pain (LBP) are the most common chronic musculoskeletal conditions in adults in Aotearoa, affecting approximately 13% and 9% of the population, respectively. Physiotherapists are commonly involved in managing both conditions. However, little is known about the range of publicly funded physiotherapy services available to people with osteoarthritis and LBP across Aotearoa.

Purpose: This study aimed to describe physiotherapy services and clinical pathways delivered across Aotearoa's 20 District Health Boards (DHBs*) for people with osteoarthritis and LBP.

Method: Semi-structured interviews with fourteen DHB physiotherapists occurred between March 2022 and August 2023. Interview questions focused on describing clinical services for people with osteoarthritis, and LBP. Data were analysed using direct content analysis.

Results: Four main themes were identified: the ambiguity of primary, secondary, and tertiary care (overlap of services and different designations), organizational structure, getting into the system and what is on offer. An overarching theme was the variation in service provision, organisational structure, and people's experiences navigating the system.

Conclusion: Our study shows significant inequities in healthcare services for people with osteoarthritis and LBP. It highlights the necessity of implementing systematic changes to ensure fair access to high-quality treatment, irrespective of payment status, ethnicity, or geographical location. This requires addressing these concerns at relevant forums and policy-making platforms.

Impact: Our findings demonstrate that while a diverse range of services are available for people with osteoarthritis or LBP, the lack of consistency may lead to inequities in patient experience, depending on location and ability to navigate the healthcare system. This inconsistency in service delivery could potentially cause confusion for patients, healthcare providers, and funders, resulting in gaps and overlaps in care. This is crucial for all stakeholders in the healthcare system.
*NB DHB used as Te Whatu Ora to be established at the time of data collection