From Japan to Canada, best practice examples demonstrate how physiotherapy, prevention and digitalisation can work seamlessly together. If we take a wider view, we’ll see that rehabilitation doesn’t end at the practice door – it begins in everyday life. This article inspires us to learn from others.

Rehabilitation is much more than physiotherapy on prescription. It reveals how truly committed a society is to health, personal responsibility and active participation. While rehabilitation in Germany remains trapped in rigid bureaucratic structures, insurance disputes and regulations, other countries demonstrate better approaches – simpler, more flex­ible, more people-centred. The challenges are similar everywhere: chronic diseases are on the increase, our population is ageing, skilled professionals are in short supply, and waiting times continue to grow. Nevertheless, progress in Germany often fails due to bureaucracy or fear of change (OECD, 2019).

Other countries are leading the way. They integrate physiotherapy with psychology, social work and digital solutions. They bring rehabilitation to where it matters most: in the community, village, workplace or even on a mobile phone. If we take a wider view, we’ll see that rehabilitation is not a single appoint­ment with a healthcare professional, but a process that begins well before the first symptom appears and is an effective tool well beyond the last appointment (WHO, 2017).

Japan: prevention as a guiding principle for society

Japan has one of the oldest populations in the world. To prevent this demographic change from leading to a crisis in care, prevention has become a national priority (Tsuji et al., 2018). Cities like Matsudo actively promote exercise programmes and neighbourhood groups supervised by physio­therapists. Studies show that these programmes not only enhance physical function, but also decrease social isolation – a key protective factor against depression and care dependency (APA, 2021).

Scandinavia: early intervention instead of endless waiting

In Sweden, for example, the “workplace-based rehabilitation model” has been successfully imple­mented. Instead of waiting for reinte­gration after a six-week sick leave period, rehabilitation begins during the sick leave itself (EU-OSHA, 2021). Ergonomic adjustments and therapeutic support are provided frequently and consistently. This approach is endorsed by the WHO, which highlights the impo­rtance of early, community-based interventions in its rehabilitation framework (WHO, 2017).

Scientific background: prevention pays off

International evidence clearly shows that preventive approaches in rehabilitation not only benefit indi­viduals, but also deliver significant economic value at the national level. The WHO emphasises in its global Reha­bilitation 2030 initiative: early, accessible local services reduce downstream costs, prevent hospital­isation and create lasting improvements in quality of life.

According to EU-OSHA and ILO, businesses save an average of €2.00 to €2.50 for every euro invested in workplace prevention measures (EU-OSHA 2021; ILO 2019).

What does that mean in practice?

“Prevention” must be more than just a buzzword. Success depends on creating the right structures:

• easy access (no complicated bureaucracy)
• local exercise initiatives with physiotherapists
• early screening to identify at-risk patients
• integration with businesses: rehabilitation alongside sick leave, not after it

Germany has some catching up to do here. While prevention is firmly established in guidelines and laws, it often lacks consistent implementation. This is due to funding gaps, sectoral boundaries – and the fact that prevention in physiotherapy often cannot be billed to cover the true costs.

Canada, Australia and Denmark embrace multi-professional teams. In Canada, physiotherapists, occupational therapists, psychologists and nutri­tional therapists collaborate seamlessly – the biopsy­chosocial model is a living reality there (Journal of Rehabilitation Medicine, 2020). Studies from Norway, where muni­cipal teams collaborate on planning and share access to digital patient records, demonstrate improved mobility scores and enhanced quality of life (Rønningen et al., 2021).

Rehabilitation is rarely a single discipline. Whether you are dealing with chronic pain, stroke after-effects or psychological challenges, complex health journeys require a coordinated team approach. Countries like Canada, Australia or Denmark show that the closer physiotherapy works with other disciplines, the greater the effectiveness, patient satisfaction and sustainability of treatment. In Canada, interdisciplinary collabora­tion in rehabilitation centres is part of everyday practice. Patient, physiotherapist, occupational therapist, psychologist, nutritionist – none of these professions see themselves as lone operators, but rather as a closely integrated treatment team. Particularly in cases of musculoskeletal complaints or chronic pain condi­tions, the psychosocial component is actively treated as well. The biopsychosocial model is not just theory, it is a living reality.

Central approach: the roles are clearly defined – the physiotherapist is the movement expert, the psychologist deals with coping strategies, the social worker helps with adjustments to daily life and the nutritionist assists with weight management. Everyone works together in a coordinated manner.

Community health is also a firmly established concept in Australia. Many physiotherapists work in primary health teams in neighbourhoods – together with general practitioners, midwives, psychologists and community nurses. One example is the concept of shared care: patients with chronic back pain are not simply prescribed six sessions, but rather a coordinated long-term management programme. This includes physiotherapy, psychosocial counselling, digital home workouts and group sessions.

Result: studies from Victoria show that patients in these interdisciplinary programmes are less likely to relapse, return to the workplace more quickly and require fewer painkillers (APA, 2021).

In Norway and Denmark, interdisciplinary care is closely linked to the municipalities. Municipal rehabilitation centres often work with established multi-professional teams. A special feature is that the patient does not have to organise each appointment separately. Instead, planning is done jointly. All data comes together in a digital patient record. This ensures every therapist knows what the other is doing – eliminating redundancies and preventing duplicate patient exami­nations. Numerous meta-analyses, including those in the Journal of Rehabilitation Medicine, show that interdisciplinary rehabilitation programmes achieve significantly better results – measured in terms of mobility, quality of life and relapse rates.

Particularly for stroke patients, chronic pain sufferers, and those dealing with long COVID, this interdisci­plinary approach delivers measurable advantages. The reason is simple: many problems are not purely physical. Without psychosocial support, there is a risk of chronification. Without occupational therapy, barriers in daily life persist.

In the Netherlands, patients have direct access to physiotherapy. According to the KNGF (Royal Dutch Society for Physiotherapy), participation in decisions and voluntary co-payments lead to higher therapy adherence (Nivel, 2020). Australia goes even further: self-management programmes actively engage patients in defining their goals and monitoring their progress. Shared Decision Making (SDM) is an established standard there (APA, 2021).

The future of rehabilitation belongs to patients – and not as passive recipients, but as active partners. In Germany, rehabilitation programmes typically operate on a “prescribe and comply” basis, but examples from the Netherlands and Australia demonstrate how genuine patient involvement can achieve far more than prescriptions and co-payments ever could.

The Netherlands: freedom of choice, greater self-esteem

In the Netherlands, access to physiotherapy has been intentionally streamlined. Patients can go straight to the physiotherapist – without any referral at all. Many practices have adapted to this and now combine traditional therapy with prevention courses, training areas and individual counselling on health issues. An important principle is that patients schedule their own sessions, have a say in deciding which priorities they want to set, and pay privately as well if needed. This requirement for a financial contribution might seem off-putting at first, but it leads to a remarkable side benefit: those who make their own decisions and share the costs typically stay committed for longer. According to a study by the Dutch KNGF, adherence to treatment among patients with chronic back pain significantly exceeds the European average – in part because patients have the flexibility to extend or adjust their therapy as needed (Nivel, 2020).

Australia: patients as co-therapists

Australia is regarded as a pioneer when it comes to patient involvement in decision-making. Many rehabilitation programmes are structured so that patients define their own treatment goals. Physiotherapists are more like coaches: they support patients and provide expertise, but they do not micromanage every exercise. An example of this is the self-management programmes for people with arthritis or chronic back pain. Following an introductory phase, patients largely manage their own training, with digital tools or group meetings. The therapists remain available as points of contact – often via tele-rehabilitation. Outcome: studies by the Australian Physiotherapy Association show that this type of autonomy reduces relapses. Those who understand how their body reacts recognise warning signs earlier – and take appropriate action. The concept of Shared Decision Making (SDM) is now firmly established in many international rehabilitation guidelines. It describes a structured process in which patient and therapist decide on equal terms which goals are realistic and which measures are practical. SDM not only boosts patient satisfaction, but also enhances treatment adherence – a significant advantage for managing chronic conditions. The WHO therefore recommends not only involving patients in treatment plans but actively empowering them with health education, easy-to-understand materials and digital tools.

Obstacles in Germany

In Germany, the issue of patient autonomy often still takes a back seat to statutory requirements. While Shared Decision Making is gaining momentum in hospitals – for example in tumour boards or oncological rehabilitation centres – in the outpatient sector the model often remains wishful thinking. Reason: time pressure, rigid remuneration structures, insufficient scope for individual target planning. Early pilot projects demonstrate that this approach can be successful. Some practices offer hybrid models – face-to-face therapy enhanced by online coaching and digital exercise programmes. Patients are guided to document and assess their own progress.

Norway and Sweden are embracing tele-rehabilitation solutions, such as the E-Rehab programme featuring apps, wearables and weekly video sessions (University of Oslo, 2022). The results demonstrate fewer therapy discontinuations, enhanced flexibility and consistent quality (Meisingset et al., 2021). In Canada and Australia, virtual platforms provide patients in remote areas access to healthcare services – with proven comparable effectiveness (Jirasakulsuk et al., 2022; Cottrell et al., 2017).

Whether in Scandinavia, Canada or Australia, digital­isation in many countries is no longer an emergency stopgap, but an established part of healthcare provision. Rehabilitation becomes more flexible, less dependent on location and more personalised – without losing the quality of personal care.

Scandinavia: tele-rehabilitation as standard, not as replacement

Tele-rehabilitation has long been part of everyday life in Norway and Sweden. Physiotherapists use video calls, wearables and app-based programmes to support patients even when face-to-face appoint­ments are not possible due to location or scheduling issues or for health reasons. A key element is the principle of blended care: digital units complement face-to-face appointments but do not completely replace them. Especially for patients with chronic conditions or those recovering from surgery, this approach provides continuous care without the wait times associated with face-to-face appointments.

Taking Norway as an example: the E-Rehab programme combines digital back training with weekly live sessions. Patients document their progress via an app. Wearables measure range of movement and provide feedback on posture or load. The physiotherapist receives data automati­cally and adjusts the plan accordingly.


Result: studies from the University of Oslo demon­strate that tele-rehabilitation in Norway reduces treatment discontinuations by up to 35% – pri­­marily because patients remain more flexible.

Canada: extending access in rural areas

Canada is vast – but sparsely populated. For many patients, it would be impossible to get to a reha­bili­tation clinic on a weekly basis. Tele-rehabili­tation is therefore not just an option but a necessity. Virtual care models are particularly successful because they combine physiotherapy, psychological support and medical consultations. Patients follow digital instruc­tions while trai­ning at home, interact in virtual groups and connect via video call whenever they have ques­tions. The Ontario Telemedicine Network Clinics (OTN) connect over 600 rehabilitation ther­apists with patients in remote areas. In orthopaedic and neurological indications, the results are hardly any different from traditional face-to-face care – patients often feel they receive better care because they have more points of contact.

Australia: digital platforms as a key element

Australia has increasingly focused on national plat­forms in recent years that connect patients, therapists and doctors.

One example: Healthdirect Australia offers mo­dular programmes alongside information tools, enabling physiotherapists to compile perso­nalised home exercise routines. Key component: digital care is not isolated, but part of holistic healthcare provision. Many practices combine online programmes with face-to-face appoint­ments. This preserves the human touch – while increasing flexibility.

Numbers and evidence: does it work?

Yes – if the quality is right. A meta-analysis from the Journal of Telemedicine and Telecare (2022) shows that tele-rehabilitation for orthopaedic and musculoskeletal indications can be just as effective as face-to-face rehabilitation – when it is conducted in a structured manner.

Key success factors:

• clear objectives and individual adaptation,
• digital competence on both sides,
• regular personal contact to ensure patient bonding,
• seamless integration into existing treatment workflows.

Germany: great potential, significant challenges

Whereas COVID-19 boosted digitalisation in Germany, the structures for sustainable tele-services are largely still lacking in rehabilitation. Many prac­tices lack both the technical infrastructure and time resources needed to sustainably incorporate online support into their operations. Furthermore, billing procedures are often unclear or too bureaucratic. Pilot projects show that the demand is enormous. Patients in rural areas, those with limited mobility or family responsibilities are particularly interested in digital options – whether as a homework programme, a video check-in or a hybrid model. Some rehabil­itation centres in Bavaria and Baden-Württemberg are currently testing hybrid models. Patients begin as inpatients, but after discharge continue their treatment plans or breathing therapy using an app – including a chat function with the physiotherapist. Initial evaluations show that relapses and rehabilita­tion discontinuations fall significantly. Digitalisation does not replace humans – instead, it creates new access points, eliminates unnecessary travel and makes room for greater continuity. Countries like Canada, Norway and Australia demonstrate that modern tele-rehabilitation is not just a temporary solution, but a valuable addition to plug the gaps in healthcare delivery.

For Germany: it is essential that digitalisation does not become a faint echo of the pandemic. Stable plat­forms, reliable remuneration and ongoing training for therapists are critical. Patients are ready – now it’s time for the system to deliver. The intention is clear, but we lack proper structures, secure billing systems and adequate training programmes. The WHO recommends integrating digital elements into existing processes, not as a replacement, but as an extension (WHO, 2021).

Future outlook: rehabilitation 2035 – radically reimagined

Let’s imagine a 2035 where rehabilitation func­tions as a complete health ecosystem rather than just a repair shop. AI-assisted screening tools iden­tify risks before any symptoms appear. Physio­therapists coach and connect rather than just treat. Wearables provide real-time data and digital tools enable hybrid care. The individual is transformed from a passive patient into an active participant – a co-therapist with responsibility and knowledge (cf. WHO 2021; APA 2022).

Instead of regulations there are flexible budgets, instead of waiting lists there are smart interfaces. And the best thing of all: prevention and re­habilitation are merged. Investing in rehabilitation today not only reduces costs, it adds healthy years to people’s lives, benefitting both companies and society.

Final thoughts

Rehabilitation doesn’t end at the practice door. It begins where people live and take responsibility for their health. Learning from others is a critical step in this process. The future isn’t something that just happens – it’s something we shape. And this is where we at opta data Zukunfts-Stiftung step in with our optaVita workshops and eLearning formats that address these challenges: strengthening digital competence, changing mindsets and empowering practice teams not only to think about modern reha­bilitation but to actively implement it (opta data Zukunfts-Stiftung, 2025).

The future isn’t something that just happens – it’s something we shape. And ideally by joining forces with those who are already rethinking rehabilitation.