# Participation of physical therapists in medical fee-based dialysis-prevention interventions: a nationwide survey in Japan

## TL;DR

This study explores why physical therapists are not involved in dialysis prevention programs in Japan, finding that reimbursement rules are a major barrier.

## Contribution

The study reveals the extent of physical therapist involvement in dialysis prevention and identifies systemic reimbursement barriers in Japan.

## Key findings

- Physical therapists participated in dialysis prevention interventions in less than 5% of facilities.
- The main reason for non-participation was the lack of reimbursement criteria requiring their involvement.
- Insufficient personnel and unassigned roles also hindered their participation.

## Abstract

Exercise is recommended to prevent dialysis; however, the involvement of physical therapists is not a criterion for reimbursable medical fee calculation in Japan. Consequently, eligible patients may not receive appropriate exercise guidance. We aimed to clarify the extent of physical therapist participation in dialysis-prevention interventions reimbursed under the current Japanese healthcare system and to identify reasons for non-participation related to reimbursement criteria.

In January 2025, a 30-item questionnaire was distributed to all facility representatives registered with the Japan Physical Therapist Association to investigate medical fees and physical therapist involvement in dialysis prevention. Dialysis-prevention interventions were defined as those reimbursed under the Japanese healthcare system: Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management (including Guidance of Patients with Severe Renal Impairment), and Chronic Kidney Disease (CKD) Dialysis Prevention Guidance and Management.

Of the 10,285 facilities surveyed, 1322 (12.9%) responded. Among these, physical therapists participated in Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management, and CKD Dialysis Prevention Guidance and Management in 4.8%, 3.5%, and 2.3% of facilities, respectively. The most frequently cited reasons for exclusion were “Inclusion of physical therapists is not a strict requirement for medical fee reimbursement,” “Insufficient personnel or time,” and “No role assigned by the dialysis-prevention team.”

Physical therapist involvement in dialysis-prevention interventions was limited, primarily due to current medical fee reimbursement criteria. Revising the healthcare system to facilitate their inclusion may enhance the delivery of exercise-based preventive care.

The online version contains supplementary material available at 10.1007/s10157-025-02763-z.