Background: The COVID-19 pandemic prompted rapid adaptations of first contact physiotherapy services (FCPS) in primary care and emergency departments in the UK and Australia respectively. This study explored the rapid adaptations of FCPS for patients with musculoskeletal conditions during the COVID-19 pandemic in the UK and Australia.

Methods: A three-phase sequential mixed-methods design, underpinned by frameworks of readiness, responsiveness, and sustainability, including the Consolidated Framework for Implementation Research (CFIR) was employed. Phase one used a cross-sectional survey of physiotherapists (n = 153). Phase two comprised a multiple case study (UK: n = 2; Australia: n = 2), using semi-structured interviews of physiotherapists and key stakeholders (n = 22), supported by reviewing organisational document for contextual information. Phase three included mixed-methods integration through a joint display, triangulation with literature, and expert consultation on study recommendations (n = 17).

Results: Phase one results indicate that 75.7% of initial changes occurred within three months of COVID-19 being declared a global pandemic. Inadequate readiness and moderate level of responsiveness were identified. Phase two shows the implementation of various strategies within the first three-six months, particularly telehealth adoption. New challenges not currently identified in CFIR emerged, including the initial lack of acceptability (particularly of telehealth) and the unpredictable nature of the pandemic, which affected the speed and sustainability of implemented adaptations. In phase three, the mixed-methods integration, including triangulation with the literature through a joint display, confirmed convergence of findings. Twenty-one recommendations were identified, of these, 20 (95.2%) received a high level of agreement, ranging from 70% to 100%.

Conclusion: This thesis provides a contextually rich account of what constitutes rapid adaptation of FCPS, offering key insights into factors that could influence a responsive rapid adaptation during public health emergencies, supporting the development of evidence-based recommendations to prepare and for implementation during public health emergencies.