The state of the art of physical therapy in Portugal: current landscape, innovations, and future directions. An overview for healthcare professionals

Telerehabilitation (TR) refers to the application of digital technologies for the remote delivery of rehabilitation services, which has become a promising model to increase accessibility, improve adherence, and enhance outcomes, particularly in the case of geographically distant, capacity-constrained, or mobility-impaired populations. The COVID-19 pandemic has accelerated the adoption of telehealth in Portugal, with over 30% of consultations delivered remotely, yet TR remains unevenly implemented and is challenged by policy, infrastructure, workforce preparedness, and reimbursement barriers. This paper surveys the present landscape of TR in Portugal, mapping the current state of adoption, clinical evidence, enabling technologies, and systemic hurdles, and proposes strategic pathways for scaling sustainably, drawing on national pilots, European initiatives, and academic leadership. We survey: 1) compelling proof-of-concept from the Lisbon pulmonary TR program, with 98% completion, high usability (≈92%), and significant cost savings (€862k/year) through reduced hospitalizations; 2) Portugal's innovation ecosystem led by Sword Health (unicorn; €340M + funding), with validated clinical and economic impact across musculoskeletal and women's pelvic health; and 3) research excellence from University of Minho, NOVA University Lisbon, and Lusófona University, developing AI-driven motion assessment, VR-based neuro-rehabilitation, and human-centred design. Key enabling technologies include wearable IMUs and sEMG, depth cameras, AI models for exercise scoring and predictive analytics, and VR/AR environments that gamify engagement and support adaptive feedback; however, despite national strategic intent (PENTS) and EU collaborations (ROSIA, EIT Health), scale-up is impeded by the lack of TR-specific guidelines, interoperability obstacles, rural connectivity gaps, unclear liability frameworks, variable GDPR implementation, inadequate ICT training of physiotherapists (84.4%), and reimbursement frameworks mismatched with asynchronous, data-driven care. We propose a staged roadmap: near-term national guidelines co-created with professional societies; workforce upskilling and curriculum integration; interoperability standards across EHRs; targeted rural connectivity investments; and SNS reimbursement pilots to validate value-based and hybrid payment models, and medium-term priorities include hybrid care pathways integrating periodic in-person assessment with continuous remote monitoring; expansion beyond pulmonary and neuro-rehabilitation to cardiac, orthopedic, chronic pain, frailty, and pediatrics; and broader 5G-enabled functionalities for multi-sensor streaming and interactive VR. With the integration of policy, funding, and training with proven clinical and economic value, Portugal can translate world-class innovation into equitable access and quantifiable population health outcomes, making the country a European leader in patient-centred TR.