From leadership research to district action: The educational pathway to Advanced Practice for the physiotherapist: A systematic mixed studies review

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Background Advanced Practice Physiotherapy (APP) is a higher level of practice grounded in 4 pillars: clinical practice, leadership, education and research. A critical step toward successful integration and sustainability of APP in healthcare systems is understanding the educational pathway to APP. Objectives 1) To describe the post-licensure educational pathways that physiotherapists engage in to advance their level of practice. 2) To evaluate demonstration of the pillars of APP by the physiotherapist after traversing a post-licensure educational pathway. Methods This systematic mixed studies review is reported in accordance with PRISMA and pre-registered (PROSPERO: CRD42024499563). 8 databases plus the grey literature were searched. 2 independent reviewers determined eligibility, extracted data, assessed quality (QuADS) and determined the overall confidence in the cumulative evidence (GRADE-CERQual). Results 81 studies (18 qualitative, 17 mixed methods, 46 quantitative) were included in a data based convergent qualitative synthesis. 6 distinct post-licensure educational pathways were described and evaluated: Masters level education, residency and fellowship programs, accredited area of practice education, mentorship, multiple encounter courses and single encounter courses. Conclusion There is a high level of confidence (GRADE-CERQual) in the finding that Masters level education consistently resulted in all 4 pillars demonstrated by the physiotherapist. Masters level education appears to be the optimal pathway to APP.

Study methods

This systematic mixed studies review (SMSR) was conducted in line with a pre-defined and published protocol [20], and registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024499563). There were no deviations from the protocol. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist [21] (S1 Table)

Limitations

This SMSR was novel in its exploration of the potential PL-EPs to APP for the PT through the lens of the well-established pillars of Advanced Practice [1]. Rigorous methods were employed at all stages, including a robust search strategy, a complete parallel review approach [136], the use of valid and reliable research tools [28], including assessment of the confidence in evidence supporting the review findings using the GRADE CERQual [137] and lastly the inclusion of a positionality statement of the researchers to enable readers to interpret the findings and judge trustworthiness in their own context [138,139]. Despite these strengths, this review is not without limitations. Studies included were conducted in 5 of 7 continents. While the results are largely representative of EPs engaged in by the PT internationally, applicability of the findings across countries should be considered with caution as global differences in healthcare and education systems may limit generalizability. Additionally, this SMSR facilitated a comprehensive synthesis of diverse evidence but required a pragmatic integrative approach to accommodate studies with varied aims and heterogeneous data sets. The process of qualitizing quantitative data for synthesis introduced inherent challenges, particularly regarding the depth and nuance embedded in qualitative data. While this approach allowed for a unified analytical framework, the transformation of numerical findings into qualitative themes inevitably involved interpretive decisions by the researchers. These decisions, shaped by the coding framework and analytical lens, may have influenced how meaning was constructed from the data, with potential implications for the richness and contextual depth of the synthesized findings. Thus, while this method enabled a more cohesive synthesis, it is important to acknowledge that some intricacies of the original quantitative data may have been lost in translation, highlighting a key consideration when drawing conclusions from qualitized data [31,38,28,139].

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Kaitlyn Maddigan; Chris Davis; Brendan Saville; Kathryn Nishimura; Jennifer Van Bussel; Andrews K Tawiah; Katie L Kowalski; Alison B Rushton. The educational pathway to Advanced Practice for the physiotherapist: A systematic mixed studies review. PLOS One (2025-05-12). https://doi.org/10.1371/journal.pone.0322626

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.