Inpatient physiotherapy is traditionally delivered on a five-day (Monday to Friday) schedule. Although prolonged bed rest leads to rapid physiological deconditioning, the clinical and economic justification for comprehensive seven-day physiotherapy remains contested, with notable disparities in implementation across hospital departments. This narrative review, with systematic components, synthesises evidence on the clinical effectiveness, economic viability, and implementation challenges of seven-day versus five-day physiotherapy models across various hospital specialties. Twenty-three studies, including randomised controlled trials, large-scale cohort studies, and systematic reviews, were analysed to evaluate outcomes such as hospital length of stay, functional independence, and cost-effectiveness (incremental cost per quality-adjusted life year). The evidence indicates that seven-day physiotherapy provides consistent, high-value benefits in specific settings. In subacute rehabilitation, weekend therapy reduces length of stay by approximately 2.35 days and is highly cost-effective, saving over 41,000 Australian dollars per quality-adjusted life year. Among post-hip fracture and intensive care populations, continuous therapy accelerates discharge readiness, improves survival, and reduces severe deconditioning, with a clear dose-response relationship between therapy frequency and functional recovery. In contrast, in acute general medical and surgical wards, data from large stepped-wedge cluster trials show that routine weekend physiotherapy does not provide consistent clinical benefit, making universal coverage in these settings economically unjustified. Effective implementation requires addressing staffing skill mix, staff work-life balance, and structural inequities that limit access for vulnerable populations. Healthcare systems should therefore prioritise the implementation and funding of seven-day physiotherapy in subacute rehabilitation, acute stroke units, post-hip fracture pathways, and intensive care units while adopting targeted, criteria-based interventions in acute general internal medicine wards.
Xumet et al. (Mon,) studied this question.