Perceptions of the barriers, facilitators, and impact of manual therapists (Chiropractors, Osteopaths and Physiotherapists) integrated into first contact National Health Service roles:A scoping review.

Introduction &amp; Aim: Aging populations, overburdened healthcare systems, and<br/>dissatisfaction with musculoskeletal (MSK) care are driving new approaches to care.<br/>One potential solution is more strategic integration of manual therapists (MTs -<br/>chiropractors, osteopaths, and physiotherapists) into primary care models within<br/>national health systems. This scoping review aimed to explore the current peerreviewed primary research studies on integrating MTs into primary care settings.<br/>• Methods: PubMed, CINAHL, EBSCO, Connected Papers, and Google scholar<br/>databases were searched from inception to 30 July 2024. Additional papers were<br/>retrieved through hand searches of reference lists. One author screened the retrieved<br/>articles in title/abstract then full-text stages, and extracted the data, whilst another<br/>author spot checked decisions. Results were reported in tables and narratively.<br/>• Results: The search returned 855 articles, of which 29 were included in the review.<br/>Eight articles reported on chiropractors, 18 on physiotherapists, two on chiropractors<br/>and physiotherapists and one on all three MTs. Service users perceived MTs<br/>positively in a primary contact role and valued good communication and empathetic<br/>practitioners. MTs reported that co-location and shared values with medical<br/>practitioners facilitated integration through improved interprofessional communication<br/>and timely service delivery. Lack of MSK care as a priority was identified as a barrier.<br/>• Conclusion: Given the overall positive perceptions and impact of physiotherapists<br/>and chiropractors as first contact practitioners, all three manual therapy professions<br/>should make efforts to expand integrative MSK care pathways. More study is needed<br/>on chiropractors and osteopaths in primary contact national health service roles