Physiotherapy is a healthcare field that helps people with physical problems. A more specialized level of this care is called Advanced Practice Physiotherapy, or APP. This involves physiotherapists who have expert clinical and analytical skills to help patients with very complex needs. One way to measure the quality of healthcare is to look at patient satisfaction, which is how pleased a person is with the care they received. This satisfaction is influenced by both human factors, such as the practitioner's skill and attitude, and system factors, like wait times and clinic location.

While it has been thought that patient satisfaction with APP is high, there has not been a comprehensive review of all the evidence from different healthcare settings around the world. The objectives of this research were to measure patient satisfaction with APP on an international scale and to identify the specific human and system-related reasons behind that satisfaction.

To do this, researchers conducted a "systematic mixed studies review." This means they performed a structured and thorough search for all available studies on the topic, including those that presented data using numbers and those that used descriptive, non-numerical information. The search included major research databases and other sources like reports and conference papers, covering all studies published up to September 9, 2025. Two researchers worked independently to screen the studies for relevance, extract the key data, and assess the quality of the research.

The researchers analyzed the number-based (quantitative) studies and the description-based (qualitative) studies separately before combining the results. They used established methods, known as GRADE and GRADE-CERQual, to rate how certain or confident they could be in the evidence they found. In total, 35 studies were included in the review; 8 were rated as high quality, 16 as moderate quality, and 11 as low quality.

The analysis of the studies that used numerical data found evidence of high overall patient satisfaction. This evidence also suggested high satisfaction with the human aspects of care and mostly high satisfaction with the system-related aspects. However, the researchers rated their certainty in this numerical evidence as "very low."

The analysis of the studies based on descriptive data provided more specific insights. There was moderate-to-high confidence in evidence showing that human factors contributed to patient satisfaction. These factors included the physiotherapist's proficient communication and interpersonal skills, their credibility and competence as experts, their ability to empower patients and help them with self-management, and the thoroughness of their assessments.

There was also moderate confidence in evidence showing that system-related factors contributed to patient satisfaction. These factors included fast access to specialized care, convenient clinic locations and amenities, and care that was well-coordinated with other parts of the healthcare system, also known as "integrated care."

In conclusion, both human qualities of the advanced practice physiotherapists and the characteristics of the healthcare system contribute to high patient satisfaction. The evidence suggests with high confidence that the physiotherapists themselves are essential to patient satisfaction, which is a finding consistent with research in other healthcare professions. Because the certainty in the evidence from number-based studies is very low, more high-quality research is needed to guide the future development of APP services.