Exploring Physiotherapists' Role in Work-Focused Health Care and Fit Note Use: Barriers, Facilitators, and Recommendations

Objectives The Fit Note (FN) may help people return to work and avoid prolonged sickness absence. However, its utilisation by physiotherapists is not understood. This study explored physiotherapists' views and practices regarding work-focused health care and FN use. Design A mixed methods study involving an online survey followed by six online focus groups. Participants United Kingdom (UK) physiotherapists (n = 401) working in a variety of settings responded to the survey. Sixteen also participated further in the focus groups. Results Participants (89%) viewed supporting patients to stay-in or return-to-work as part of their role, yet only 31% regularly issued FNs. Key themes were developed: physiotherapists recognise work as integral to care, and those issuing FNs do so in line with guidance, recommending strategies to help patients remain in or return to employment. Barriers included organisational, individual factors, such as limited recognition of physiotherapists’ role and lack of confidence or knowledge, and perceived patient barriers including lack of awareness. Facilitators included training, organisational support, and a multidisciplinary approach to work-related issues. Conclusion This study, the largest of its kind in the UK, indicates that physiotherapists regard work and health as integral to their professional responsibilities; however, FN implementation remains inconsistent. Qualitative findings reveal organisational, practitioner, and perceived patient barriers. Recommendations include improved mentorship and consistent digital FN access across all clinical settings. Further research should explore task-shifting consequences and patient perspectives. Contribution of the paper • This study represents the largest UK investigation to date examining physiotherapists’ (n=401) perspectives on FN implementation, using a mixed-methods approach. • Although physiotherapists consider work-related issues integral to their practice, the study identifies barriers to FN implementation at multiple levels, including confidence gaps, systemic constraints, and concerns regarding scope-of-practice. • The study provides actionable, multi-level recommendations to address the identified barriers, such as structured training, organisational support systems including mentorship programmes, and policy guidance to clarify scope-of-practice. Additionally, it highlights areas for future research, including patient perspectives and task-shifting.