Musculoskeletal physiotherapy service standards

Eight quality standards that support the development and delivery of high quality musculoskeletal (MSK) physiotherapy services in the public and independent sector.

A physiotherapist treats a patient with a musculoskeletal condition.

The standards are focused on the delivery of physiotherapy for any services managing MSK conditions within MSK pathways. They are intended as a tool for services to demonstrate the value of MSK physiotherapy services with the aim to drive continuous quality improvement. 

These standards cover the delivery of MSK physiotherapy services in the UK, in any setting, for adults of 16 years and over requiring physiotherapy for a MSK condition, their families and carers, and across multidisciplinary, integrated care contexts. 

They should be used in conjunction with health education standards, competency frameworks and workforce guidelines as well as local policies and procedures.

The MSK service standards have been developed for the following key audiences: 

  • Physiotherapy service providers and the physiotherapy workforce

  • People with MSK conditions and the public

  • Commissioners, health boards and provider collaboratives

The eight standards of musculoskeletal physiotherapy service standards 

1: Assessment, diagnosis, management planning and review

People presenting with MSK conditions are offered timely, comprehensive assessment of the MSK condition and their needs, involving shared decision making, to develop a personalised physiotherapy plan with outcome measures.

  1. Conduct and document a comprehensive assessment with the person, including physical, psychological and social/work/education needs and preferences and taking into account any comorbidities and cultural needs the person has
  2. For people with complex presentations, physiotherapy assessment and diagnostics contribute to a multidisciplinary approach and identification of specialist expertise requirements
  3. Undertake case assessment/triage, investigations, diagnosis, screening and stratification and identify patient preferences to inform the appropriate pathway for each person
  4. Physiotherapy goal setting and planninginvolves shared decision making and is based on the person’s knowledge, skills and confidence, preferences and the risks and benefits of evidence-based and locally available options
  5. Families and carers are involved in discussions and decision making if in line with the wishes of the person with MSK conditions
  6. Where appropriate the physiotherapy workforce integrates digital methods including remote, mobile and assistive technologies to assess, monitor and support the person with MSK conditions
  7. Assessments, management planning and reviews are timely and responsive to the person’s needs and use appropriate validated patient reported outcome measures

See an example of standard 1 in practice


2: Personalised physiotherapy

People presenting with MSK conditions are offered personalised, equitable and timely physiotherapy tailored to their individual needs, preferences and goals.

  1. Physiotherapy is holistic and is based on the person’s assessment, a personalised physiotherapy plan and utilising outcome measures
  2. Physiotherapy management is in line with current best practice
  3. Personalised physiotherapy includes facilitation of functional roles important to the person with MSK conditions
  4. Timing, intensity, frequency, location and mode of delivery of physiotherapy is personalised and flexible to the person’s individual needs
  5. The use of digital-enabled management is considered, where available, and as appropriate to the person’s needs and preferences

See an example of standard 2 in practice


3: Supported self-management

People presenting with MSK conditions are offered supported self-management as part of the management plan to recognise and develop their capability to manage their own health and wellbeing.

  1. Actively involve people with MSK conditions in decision making about managing their own health and wellbeing and in co-creating a personalised self-management plan
  2. Ensure the self-management plan is tailored taking into account a person’s level of engagement with their health and well-being, level of dependency on others, health literacy and understanding and accessibility obstacles
  3. Provide appropriate evidence-based self-management resources to support implementation of any personalised self-management plan
  4. Where appropriate, utilise the expertise of families, carers, peers, communities and charities as part of supported self-management
  5. Utilise technology where appropriate and available to support self-management taking into account digital inclusion considerations
  6. A personalised, structured, documented plan for ongoing self-management is co-created and is readily accessible to the person, including when and how to seek further help from the healthcare system

See an example of standard 3 in practice


4: Communication

Communication with people with MSK conditions is offered in an accessible way, and information is personalised to their needs and preferences.

  1. Communication is personalised, accessible and timely in order to support shared decision making and management of the MSK condition
  2. The physiotherapy workforce has communication skills appropriate to all settings and contexts 
  3. Provide information about what to expect of the MSK physiotherapy service and the available care pathways to allow people to navigate the healthcare system
  4. Information giving should be provided in a suitable format for each person, which they can access and understand
  5. Utilise technology where appropriate taking into account access, digital literacy, needs and preferences
  6. Family members, carers and other people chosen by the person are involved in communication and shared decision making as required

See an example of standard 4 in practice


5: Integrated management pathways

People with MSK conditions receive equitable, personalised management that is integrated across all relevant settings and services.

  1. Ensure people with MSK conditions have timely, equitable access to services based on their personalised physiotherapy plan
  2. Personalised physiotherapy of MSK conditions is integrated and coordinated with timely and accurate communication between all relevant organisations and staff
  3. Management delivered by multidisciplinary networks, which may include health, social care, community, third sector and leisure organisations, vocational and mental health services, is based on the assessment and management plan
  4. The physiotherapy workforce is aware of, and contributes to the development of, optimal management pathways, referral criteria, follow-up arrangements and urgent care pathways
  5. People with lived experience of MSK conditions, the public and communities contribute to the development of management pathways

See an example of standard 5 in practice


6: Population health

The physiotherapy workforce is aware of and engages in delivering population health priorities and in promoting preventative MSK strategies to optimise health and well-being and address inequalities.

  1. The physiotherapy workforce is aware of and works in partnership to deliver local, regional and national population health priorities
  2. The physiotherapy workforce identifies risks of poor health to promote prevention and address health inequalities
  3. The physiotherapy workforce utilises evidence-based approaches to actively promote good health and well-being
  4. MSK physiotherapy services promote the importance of factors necessary for good long term MSK health to people with MSK conditions and organisations
  5. MSK physiotherapy services should work in partnership with other organisations to optimise long term MSK health for their communities
  6. The physiotherapy workforce utilises digital and innovative health interventions, when appropriate, to improve health in the population

See an example of standard 6 in practice


7: Evaluation, audit and research

MSK physiotherapy services use data to undertake evaluation, audit, research and quality improvement to understand the needs of people with MSK conditions, improve the quality of services, optimise outcomes and experience and address inequalities

  1. MSK physiotherapy services use data to understand the needs of people with MSK conditions, assess quality of service delivery, measure patient outcomes and experience, and monitor for inequalities
  2. Data are collected for a specific purpose and collection, analysis and reporting are planned
  3. MSK physiotherapy services have robust systems of measurement, monitoring and audit that, where appropriate, are standardised to enable quality improvement and contribute to regional and national research priority setting
  4. MSK physiotherapy services work in partnership with people with MSK conditions to evaluate, improve and redesign services and pathways
  5. Good practice and lessons learnt are shared locally, regionally, nationally and internationally
  6. MSK physiotherapy services are evidence-based, integrating research/evaluation findings into practice

See an example of standard 7 in practice


8: Clinical governance

MSK physiotherapy services have a clinical governance framework with a supporting set of operational policy and procedure documents to implement and monitor clinical governance.

  1. The physiotherapy workforce is familiar with the clinical governance framework of their organisation and any MSK physiotherapy service specific elements
  2. Each physiotherapy staff member is aware of their individual responsibilities within the clinical governance framework
  3. MSK physiotherapy services have a set of standard operating procedures to support the monitoring and implementation of the clinical governance framework
  4. MSK physiotherapy services have a planned programme of clinical audits and/or service evaluations to compare performance against set standards and to direct continuous quality improvement
  5. People with lived experience of MSK conditions, the public and communities contribute to the development of policy, planning and procedures

See an example of standard 8 in practice


The audit tool, intended as a tool for services to examine the quality of their service and identify areas for quality improvement initiatives, is in its final stages of testing and will be available to use soon.