“Advanced” Practice Physiotherapy in Musculoskeletal Care, in the UK and Ireland: A Critical Narrative Review

INTRODUCTION: Advanced practice physiotherapy is well established within musculoskeletal (MSK) services in the UK and Ireland, yet the meaning of "advanced" remains inconsistently defined. Although multiprofessional frameworks conceptualise advanced practice as capability across four pillars: clinical practice, leadership, education, and research, how this is represented within the musculoskeletal physiotherapy literature is unclear. METHODS: A critical narrative review with systematic mapping and interpretive synthesis was undertaken. MEDLINE, CINAHL, and Embase were searched from inception to January 2026. Literature describing musculoskeletal advanced practice physiotherapy in the UK and Ireland was included. Data were analysed inductively to examine definitions, governance arrangements, and implicit assumptions underpinning advanced practice. ETHICAL APPROVAL: Ethical approval was not required as this study synthesised published literature. RESULTS: Advanced practice was most commonly operationalised through clinical task expansion, role substitution, and service efficiency. Explicit definitions were uncommon, engagement with non-clinical pillars was inconsistent, and governance and credentialling arrangements were frequently absent or inferred. Implicit assumptions equating experience or task complexity with advancement were widespread. DISCUSSION: The findings highlight a persistent gap between policy intent and enacted practice, contributing to conceptual ambiguity and variability in how advanced practice is understood and implemented. CONCLUSION: Advanced practice physiotherapy in musculoskeletal care is variably defined and weakly governed within the literature. Greater conceptual clarity and alignment with multiprofessional frameworks are required to support role legitimacy and sustainability.