An empirical turn in physical therapy ethics literature: systematic ethics review 2000–2023

OBJECTIVE: This systematic review aimed to characterize the peer-reviewed ethics literature published between 2000 and 2023 (types of literature, authors, countries, audience, and topics) and to examine how these characteristics have changed compared to literature from 1970 to 2000 using systematic ethics review methods and ethics-specific quality criteria. METHODS: A systematic search of eight databases (PubMed, CINAHL, Web of Science, Scopus, PsycINFO, JSTOR, Philosopher's Index, Embase) identified articles (2000-through December 2023). Descriptive statistics and thematic synthesis were used to analyze data. RESULTS: Searches yielded 287 articles from 2,974 records. Empirical publications (63.4%) outnumbered normative (22.6%). Thematic synthesis produced five themes: 1) Significant change and development; 2) Increase in publications, journals, authors, and countries; 3) Shift from predominantly normative to predominantly empirical ethics (empirical turn); 4) Enduring and changing topics; 5) Diverse perspectives. CONCLUSION: This was the first systematic ethics review in physical therapy to use ethics-specific quality criteria. Results provide insight into the changes, growth, limitations, and future directions for physical therapy ethics. While physical therapy ethics matured in volume and diversity from 2000 to 2023, future publications should address current limitations: scant publications in physical therapy clinical specialty journals; underrepresentation of patient, physical therapist assistant, and non-Western perspectives; and integrating empirical (what is being done) and normative analysis (what ought to be done). Systematic ethics review offers a practical pathway for advancing ethical inquiry across physical therapy research, practice, and education.