Background: Rheumatic and musculoskeletal diseases (RMDs) are chronic, often lifelong conditions associated with persistent pain, stiffness, fatigue, and reduced physical function. These symptoms significantly impact daily activities, employment, social participation, and long-term independence. Non-pharmacological interventions, particularly physiotherapy, are essential components of evidence-based RMD management and are recommended in international clinical guidelines. Physiotherapy supports mobility, pain management, functional capacity, and self-management throughout the disease course. However, reimbursement policies within the public health system have traditionally restricted access to a limited number of physiotherapy sessions, applying uniform caps that do not account for disease chronicity, variability, or individual patient needs. This mismatch has resulted in unequal access to care and has left many people with RMDs without adequate long-term rehabilitation support.

Objectives: To advocate for equitable, needs-based access to physiotherapy for people living with RMDs by securing an increase in reimbursed physiotherapy sessions within the public health system.

Methods: A patient-led advocacy initiative was designed and implemented in close collaboration with rheumatologists, physiotherapists, and other key stakeholders. Quantitative data were collected to document physiotherapy needs across major RMDs, including rheumatoid arthritis, fibromyalgia, and spondyloarthritis, focusing on disease burden, functional limitations, and rehabilitation requirements. These data were complemented by patient testimonies highlighting the real-life consequences of insufficient physiotherapy, including loss of independence, reduced ability to work, deterioration in mental well-being, and increased reliance on informal care. The combined evidence was synthesized into a structured, evidence-based advocacy proposal. Formal dialogue and sustained engagement with health authorities were undertaken, emphasising unmet patient needs, health equity, alignment with clinical recommendations, and the long-term health and socioeconomic benefits of adequate physiotherapy coverage.

Results: The advocacy initiative resulted in a significant and measurable policy change, leading to a substantial increase in the number of reimbursed physiotherapy sessions for people with RMDs. Before the intervention, patients were uniformly limited to a total of nine physiotherapy sessions, regardless of diagnosis or disease severity. Following policy approval, disease-specific entitlements were introduced, allowing up to twenty-four reimbursed sessions for people with rheumatoid arthritis, twelve sessions for those with fibromyalgia, and forty-two sessions for individuals with spondyloarthritis. This reform enabled improved access to continuous and individualised physiotherapy, better reflecting clinical needs and patient-reported outcomes. Patients reported enhanced functional capacity, improved symptom management, and greater ability to maintain independence and participation in daily life.

Conclusions: This initiative demonstrates the capacity of patient organizations to act as effective agents of change within health systems when advocacy is grounded in robust data and lived experience. By successfully influencing reimbursement policy, the initiative addressed a long-standing unmet need and reduced structural inequities in access to essential non-pharmacological care for people with RMDs. The outcomes highlight the importance of integrating patient perspectives into health policy decision-making and confirm physiotherapy as a critical pillar of sustainable, person-centred RMD management. This advocacy model is transferable and can be adapted by patient organisations in other settings to strengthen access to rehabilitation and improve health equity within public health systems.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.