e-Health in Musculoskeletal Primary Care Physiotherapy: Evidence, Facilitators, and Barriers – A Scoping Review

Background Advances in healthcare and technology highlight the potential of e-Health in physiotherapy, yet its use and implementation in primary care musculoskeletal settings remain unclear. Objectives This scoping review aimed to 1) map e-Health solutions used in primary care physiotherapy and identify knowledge gaps, and 2) explore barriers and facilitators to their use and implementation. Data sources PubMed, Embase, Web of Science, Cochrane Library, CINAHL, ClinicalTrials.gov, and Google Scholar. Study selection Eligible studies were published or unpublished, in Danish or English, conducted in primary care physiotherapy, and focused on musculoskeletal disorders, regardless of study type. Data extraction and synthesis Data on study characteristics, clinical use and modalities of e-Health use, barriers, facilitators, and adverse events were extracted and synthesized using deductive content analysis. Results 3767 studies were screened and 45 were included, varying in design, population, and intervention. Most investigated internet-based solutions (n=17), mobile applications (n=15), and video consultations (n=15). Evidence on wearables, virtual reality, machine learning and artificial intelligence was limited. Across seven e-Health modalities, 21 facilitators and 23 barriers were identified, with no reported adverse events. Limitations Heterogeneity of study methods and e-Health modalities, predominance of high-income country studies, and rapid technological advancement limit generalizability of our findings and highlight the need for continuous research. Conclusion E-health appears well-received in primary care physiotherapy, particularly in blended care. However, barriers from both patients and clinicians persist. Clear guidelines, structured training, and thoughtful implementation strategies are needed to optimize digital physiotherapy integration. Funding This work was supported by the Danish Fund for Physiotherapy Practice. Protocol Registered on the Open Science Framework (DOI: 10.17605/OSF.IO/82UD5). Contribution of paper Key messages of the article •e-Health interventions such as internet-based solutions, mobile apps, and video consultations are increasingly used in primary care physiotherapy for musculoskeletal disorders. •Multiple Barriers and facilitators to e-Health implementation and use exists across multiple modalities, with no adverse events reported. •Evidence on newer technologies like wearables, virtual reality, and artificial intelligence remains limited. What this paper adds to the current literature •This study comprehensively mapped e-Health use in primary care musculoskeletal physiotherapy. •Multiple patient- and clinician-related barriers exists and needs to be addressed for effective integration of e-Health in practice. •Structured training, clear guidelines, and ongoing research is essential to support sustainable digital physiotherapy.