Learnings from a rural primary care physiotherapy program and its practice registry: A synthesis of clinical patterns, Primary Health Care Team Competencies, and Care Access in Southern Rajasthan, India.

Abstract

In 2022, the Basic Healthcare Services (BHS) primary care physiotherapy program was embedded at three rural primary clinics in southern Rajasthan. The intent was to address critical rehabilitation needs in underserved rural communities, strengthen primary care teams, and improve functional outcomes. The aim of the paper is to share systematic insights from our practice on the burden of musculoskeletal, neurological, and respiratory conditions in a rural, underserved population, while also documenting the role and outcomes of community-based physiotherapy. BHS operates in deeply underserved tribal regions of southern Rajasthan through a network of rural primary care centers (AMRIT Clinics). Within this model, physiotherapy services are designed to emphasize accessibility, continuity, and collaboration, with care provided across clinic, community, and home settings. To systematically document service delivery and outcomes, a prospective clinical registry was maintained from July 2022 to July 2024 in two phases across three rural clinics-Manpur, Ghated, and Bedawal. Service delivery challenges were analyzed using the three-delays framework, which considers barriers in recognizing the need for care, reaching care, and receiving adequate care. This approach highlights both obstacles to rehabilitation access and the solutions emerging from a community-anchored physiotherapy model. Between June 2024 and July 2025, over 1000 physiotherapy encounters were documented. The program served a diverse age range from children under 10 years to elders over 70, with the majority being working-age adults between 20 and 50 years (45%) and older adults >50 years (50%). Patients predominantly presented with musculoskeletal disorders (~70%), followed by respiratory sequelae such as post-tuberculosis lung disease and chronic obstructive pulmonary disease (~15%), and neurological impairments (~10%). Autoimmune conditions, particularly rheumatoid arthritis, were most prevalent among women aged 20-50 years. Seventy six percent of patients were new and 24% were follow-up visits. Occupational analysis indicated that 32% of patients were unemployed and reported disability or functional limitations. The program employed a holistic, low-cost approach integrating pain relief, mobility enhancement, and progressive strengthening tailored to individual needs. Evidence-based interventions-including hot packs, strengthening exercises, breathing routines, and functional rehabilitation-were the most common modalities used. Analysis of 2 years of registry data from a rural physiotherapy program offers a snapshot of the clinical scope, utilization patterns, and major syndromes encountered in primary care. Three key insights emerge: physiotherapy functions as a core component rather than an ancillary service, clinical data serve as a powerful learning and improvement tool, and the physiotherapist's role must remain flexible and context-sensitive. A matrix of key individual and interprofessional competencies emerged for members of the primary care teams. For health systems and practitioners aiming to replicate or scale such models, we recommend investing in integrated primary care teams, ensuring continuity of care, and developing adaptive systems responsive to local realities.