Healthcare is fast-moving towards digitalization and physiotherapy is undergoing major changes, with healthcare systems being pushed by increased volume, scarce resources, and difficulty in accessing them (Wider et al, 2025). Traditionally hands-on, in physiotherapy, digital technologies are being adopted to increase coverage, achieve better outcomes and help deliver new business models, which align with the global sustainability goals. The opportunities and barriers of digital physiotherapy of less-developed regions: The urgency of the Coronavirus pandemic during a period of resilience of healthcare systems has emerged as an opportunity for digital physiotherapy and the same opportunities and barriers for digital physiotherapy in less-developed regions of the world (Mohammad et al, 2025). Beyond clinical practice, digital physiotherapy has economic, social (equity), and environmental (sustainability) context relevance by opening access, creating economic value, and minimising negative environmental impact. Realizing these benefits, however, requires traversing the complicated intersection of technology, business models and sustainability imperatives.

Those valuable gaps in the available literature are aimed to be addressed by this conceptual paper through the development of a framework on how the digital innovation in health may be conceptualised and applied in the practice of physiotherapy. Although several studies have focused on single considerations concerning digital health adoption, not a single one has incorporated an unresolved framework of addressing the multifaceted character of sustainability in healthcare innovation. To fill this hole, our study suggests the DPIF that incorporates the technological, business and sustainability views to inform the implementation process.

The objectives of the research in this paper are the following: first to conduct systematic review of existing literature on technological innovation in physiotherapy, and identify particular trends, opportunities and challenges; second to produce a highly comprehensive theory integrating the aspects of business strategy, technological innovation and sustainability; and third to consider implication of such a theory concerning the practice of physiotherapy, health care policy and sustainability.

Digital Health Evolution in Physiotherapy

The development of digital health physics has passed through a series of different stages, with the simplistic electronic health records, to the complex artificial intelligence-driven treatment systems. At the beginning, the use of early adoption was concentrated on efficiency in the administration sphere and basic capabilities of telehealth but lately, immersive technology, wearable devices, and predictive analytics were presented but they significantly change therapeutic relationship building and therapy outcomes.

Recent research literature highlights the transformative impact of artificial intelligence on healthcare delivery, as demonstrated by Mohammad et al. (2025), who illustrated the potential for increased educational equality through the integration of artificial intelligence and the subsequent improvement in healthcare outcomes. The application of physiotherapy with the help of AI turned out more independent and cheaper, which resulted in high-quality treatment plans that can even be accessible to the underprivileged population of the developing zone in the context of sustainable development goals and provide new opportunities to business in a segment of activity practiced by specialists. As revealed by Mohammad et al. (2025), the virtual reality (VR) and augmented reality (AR) technologies help to interact with the patient remotely and undergo rehabilitation, smashing the former barriers in the form of geographic limitations, mobility restrictions, lack of resources and so on, but they do not investigate their business possibilities and models of their sustainable organization. Wearable technology is another major innovation because they are worn to monitor the progress of patients at any given time and to determine and control the treatment on the fly (Adeghe et al, 2024). Such devices can further evidence-based practice by offering personalized data collection, which develops valuable intellectual property that can lead to competitive benefits and even novel income streams.

Business Model Innovation in Healthcare

Advancements in technology, evolving consumer requirements, and the necessity to remain sustainable give rise to a digital tidal wave of business model innovation in the healthcare sector, such as never before (Javanmardi et al., 2024). Traditional models of fee based have been substituted with the new outcome-but-not-volume based models of value care, particularly in the physiotherapy model as the outcome of the treatment can be measured and the success directly corresponds with the quality of life of the patient. According to Chibuike et al. (2024), the provision of healthcare is shifting to the digital platforms that eliminate the traditional provider-patient barriers. Models of platform-based physiotherapy practices can allow the physical therapy practice to expand outside geographical boundaries and retain the personalized care, establish network effects as a competitive edge and accessibility. Nikolli (2021) believes that healthcare subscriptions provide guaranteed income sources and facilitates ongoing interactions with patients and preventive measures. These models lower the financial barriers that are facing the patients and offer them continuing support in terms of health. Haavisto (2022) highlights that corporate wellness programmes are a rapidly expanding market in terms of digital physiotherapy, with businesses understanding the commercial importance of investing in employee health, generating B2B markets with consistent revenue flows.

Sustainability in Healthcare Innovation

The concept of sustainability in healthcare comprises environmental, economic, and social aspects that are the key to long-term sustainability. Environmental sustainability means turning into a healthcare field to a less carbon footprint by utilizing digital solutions that demand less travel and resources (Selvakumar et al., 2025). Economic sustainability requires monetarily steady business frameworks that provide inexpensive services whereas social sustainability focuses on equity, accessibility and community participation. Serra et al. (2022) emphasize that digital health solutions can make a substantial contribution to the environmental sustainability through decreasing physical material infrastructure requirements and patient transportation. The elimination of transportation-related gas emissions with preservation of the effectiveness of therapy occurs in telehealth physiotherapy sessions, but energy use of digital infrastructure and manufacturing devices should be included in overall sustainability evaluations. Palstam and Lange (2024) highlight the specific significance of social sustainability in the context of physiotherapy in the emerging markets where access to specialists healthcare is scarce. Digital technologies have the potential to reach underserved communities with qualified physiotherapist, which will not only enhance health equity, but also provide market opportunities provided that the implementation of such strategies follows the considerations of the cultural aspects, language, and familiarization with technologies. According to Sharma et al. (2025), the issue of affordability versus financial sustainability is the key to economically sustainable digital physiotherapy because digital solutions will lower the operational expenses but will introduce the elements of technology and training investments.

Emerging Market Considerations

According to Al Meslamani (2023), the use of digital physiotherapy in the emerging markets has unique opportunities and challenges. Such markets exhibit high latent demand of quality physiotherapy services, which opens the potential of immense development of new models of service delivery. However, implementation is hampered by infrastructure limitation, uncertainty over regulation, and cultural issues. Landjohou (2025) contends that mobile-first characteristics of technology adoption in most of the emerging markets favour the digital health implementation. The high penetration rates of smartphones enable the direct use of smartphones to undertake digital physiotherapy applications, which do not use the conventional healthcare infrastructure. This state of art technology leapfrog will allow the emerging markets to adopt the state of art digital health solutions without having to scale up a large scale integration of a legacy system. According to Colombage et al. (2025), emerging markets have healthcare financing systems that favor new payment arrangements which are congruent with delivery of digital services. The digital physiotherapy services can be sustainable financed by mobile money payments, micro-insurance schemes, and government health schemes, and this comprehension of the systems is indispensable in the success of market penetration and growth.

Digital Physiotherapy Innovation Framework (DPIF)

DPIF has three dimensions at its core: technological capability, business model innovation and sustainability imperatives. The framework acknowledges the reality that in order to succeed in digital health innovation, the composite of optimization processes across the three dimensions must be investigated as compared to the same on individual levels. The technical infrastructure, platform functionality, and integration capability to provide the digital physiotherapy in a sustainable manner is in the dimension of technological capability. These involve hardware specifications (equipment, sensors, connectivity), software systems (programs, data analytics, AI algorithms), and integration systems (electronic health records, payment processes, clinical processes), (Dinh-Le et al., 2019). The dimension of business model innovation deals with the commercial structure of digital physiotherapy deployment such as value creation design, revenue vehicle construction, collaborative plan and market positioning. This aspect is motivated by the fact that technological ability itself does not suffice unless business models are created which can determine long-lasting functioning and development. Vasudevan et al. (2025) show that sustainable leadership and employee performance are the keys to the success of an organization in the information science sector of Malaysia, which can be used in relation to digital physiotherapy organizations. The dimension of sustainability imperatives takes into account the environmental, social, and economic sustainability aspects in the framework. This aspect will make digital physiotherapy solutions play a positive role in the overall objectives of sustainable development, as well as the sustainability of business.

Framework Components and Relationships

The DPIF lists six essential elements that operate dynamically to determine implementation success: technology readiness, market demand, regulatory environment, financial sustainability, social impact, and environmental benefits. Technology readiness means analysis of accessibility and techniques of needed technologies, both hardware and software sides (de Larmalina et al., 2025). This analysis must have a look into current capabilities and technology direction and future technologies, which affects the implementation strategies. Market demand analysis entail the understanding of customer segments, customer need, preference and their willingness to pay to receive services of digital physiotherapy. It is to be analysed in terms of direct customers (patients) and indirect customers (healthcare systems, insurance providers, employers) who influence the adoption decisions. The aspect of regulatory environment covers issues on complex legal and regulatory forms that requires provision of health care and digital health technologies (Asamoah, 2025). These include licensing, data privacy, device and reimbursement that affects the viability of the business. Financial sustainability studies business models and economic effects of implementing digital physiotherapy, such as the revenue generation, restructuring of costs, investment needs, and advantages of the healthcare system. To make sure that the innovations are beneficial to societal progress, none of them have side effects, social impact assessment helps to evaluate the effects of digital physiotherapy on the health outcomes and social wellbeing of the community (Ha et al., 2023).

Environmental analysis provides the comparison of the environmental impact of digital physiotherapy to traditional delivery models, quantifying the reduction of carbon footprint, efficiency of the resources, and overall contributions to sustainability.

Implementation Pathway

The Digital Physiotherapy Implementation Framework (DPIF) describes a step-by-step approach to the introduction and encouragement of digital physiotherapy innovations, consisting of four steps, which are interrelated and integrated into one, Assessment, Design, Implementation, and Evaluation. Each of the stages involves discrete activities and decision points that are expected to guide the organizations between the initial preparation appraisal and the development of the business-model and evidence-based scale-up (Mosch et al., 2022). Assessment stage determines the conditions of the baseline by methodically analyzing both internal and external framework elements such as stakeholder requirements, market demand, technical preparedness, regulatory or legal limitations, and requirements of interoperability. Timely reading of the needs and requirements of comprehensive stakeholder interactions, specialized market forecasting, technological preparedness evaluation, and regulatory evaluation stand out as the priority activities that characterize the strategic decisions and the determination of risks (Roosink et al., 2024; Brommeyer et al., 2024).

Results of evaluation are converted into tangible actions at the design stage. Business-model design, technology and data-architecture planning, selection and contracting of partners, adaptation of clinical pathways, and development of a sustainability strategy are all activities (Pfitzer et al., 2024; Bodell et al., 2025). Explicit risk-mitigation steps — for privacy, clinical safety, and reimbursement — should be integrated into design choices (Mathias et al., 2024).

The implementation phase operationalizes the design using phased rollouts (pilot → iterative expansion) that enable real-world learning and adaptation. Pilot testing, structured collection of stakeholder feedback, continuous quality improvement cycles, and implementation-strategy tailoring are hallmark activities that improve adoption and fidelity (Appleton et al., 2023; Mosch et al., 2022).

The evaluation phase measures outcomes across implementation, clinical, technical, economic, and equity dimensions to inform optimization and scaling decisions. Robust measurement includes predefined implementation outcomes (acceptability, feasibility, fidelity, penetration) and impact measures (clinical effectiveness, utilization, cost-effectiveness). Evaluation outputs should feed back into strategy and design for subsequent cycles of improvement or scale-up (Konlan et al., 2025; Zhang et al., 2025).

Business strategy implications

Adopting the DPIF influences organizational strategy—particularly strategic positioning, sources of competitive advantage, and plans for sustainable growth. Firms should align digital physiotherapy investments with core competencies and clinical strengths to create differentiated value propositions (Mauro et al., 2024). Differentiation strategies often target specific patient cohorts, clinical specialities, or hybrid delivery models, in-person and digital, that combine clinical credibility with technological convenience (Stoumpos et al., 2023). Competitive advantage in digital physiotherapy may derive from proprietary platforms, exclusive clinical partnerships, superior user experience design, or advanced clinical protocols validated for remote delivery. The DPIF promotes the methodical acknowledgment and creation of these origins of benefits and brings in the planning of long-term sustainability (Pfitzer et al., 2024). In sustainable growth, growth objectives and resource- and quality-constraints should be in equilibrium. The DPIF encourages the focus of investments and methods of their implementation that are scalable and can maintain the quality of clinical care and expand access (Brommeyer et al., 2024).

Healthcare Policy Implications

Digital physiotherapy has regulatory, reimbursement and quality concerns. The policymakers should find a balance between empowering innovation and safeguarding both the patients and the system (Mathias et al., 2024). The regulations should be safe, data secured and interoperable, but should give the possibility to make improvements using an iterative process with adaptive approvals (Katz et al., 2024). Reimbursement models should account the value of digital physiotherapy other than payment for activities. Outcome-based and hybrid payment models may help to support high-value implementations and sustainability of the system (Salmanizadeh et al., 2022; Li et al., 2024). The quality assurance should be the technical and clinical ones. Standards, certification, and the ongoing monitoring of outcomes must uphold trust and good patient care when healthcare is provided digitally (Groom et al., 2024).

Education and training Implications

The introduction of digital technologies into the physiotherapy practice assumes the modification, curricula and the additional professional development in terms of digital literacy, clinical skills in terms of telehealth, and the governance of data and business and implementation skills (Røe et al., 2024; Trentini et al., 2025). The professional development programs are to be designed as one that combines technical training, change management, and entrepreneurial skills so that the clinicians will be in a position to lead and sustain digital innovations (Car et al, 2025). Universities and other institutions and organizations should invest in facilities and personnel infrastructure to ensure graduates are prepared to work in a hybrid setting, i.e., exposure to telehealth platforms, remote assessment tool, and outcomes measuring infrastructure (Saigi-Rubios et al., 2024)

Future Research Directions

Three critical priority areas of research will enable digital physiotherapy innovation to be advanced and to ensure it can be implemented sustainably.

Empirical validation of the DPIF involves in-depth case studies in emerging markets, in order to test the effectiveness of the framework and identify success factors. Longitudinal studies on outcomes of sustainability should be conducted, and comparative studies of successful and failed implementations should indicate key adoption factors. Research is needed to test financial performance, clinical effects, and wider social consequences, and to adjust the framework as a result.

The enhanced use of AI, machine learning, and predictive analytics to raise the quality of clinical decision-making in the cost-effective way should be the field of research of the technology integration. Major priorities involve standardizing across digital platforms and actual healthcare systems, enhancement in the user- experience of both patients and clinicians and creating standards of technical functionality to enable the optimal use of the platform.

There is also a requirement of policy and regulatory research, especially on issues of licensing, quality assurance structures and sustainable reimbursement mechanisms. Some issues of interest are flexible regulatory frameworks that incorporate both innovation and patient safety, value based payment systems that relate to health outcomes, and data governing systems that facilitate safe cross border services delivery.

The Digital Physiotherapy Innovation Framework (DPIF) provides a holistic framework to enhance sustainable digital innovations in health through the lens of technological, business and sustainability aspects. It supports the Sustainable Development Goals and creates economic opportunities at the same time as it deals with barriers to healthcare access. COVID-19 pandemic accentuated the necessity of strong digital health, which the DPIF is capable of addressing by offering inclusivity and equity. It is a multi-stakeholder endeavor, evidence-based, and facilitating policies on the basis of its success. As the DPIF actively undergoes the process of empirical verification and further development, it establishes physiotherapy as the forefront of a digitally-driven transformation of healthcare as a system and an indicator of how digital innovation can address the fundamental challenges faced by the world, as well as promote professional development and wellbeing in the society.

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