ACC Work Capacity Certification of Fitness for Work by Physiotherapists in Aotearoa New Zealand: A Qualitative Exploration

Abstract

Physiotherapists in Aotearoa New Zealand currently play a central role in injury management and vocational rehabilitation under the Accident Compensation Corporation (ACC) scheme; however, they are not permitted to certify fitness for work. With increasing pressure on general practice and inequitable access to timely certification, particularly for Māori, Pacific, rural, and socioeconomically deprived populations, there is growing interest in the option of expanding certification responsibilities. This qualitative study explored stakeholder perspectives on legally enabling physiotherapists to complete ACC work capacity certification of fitness for work. Six participants representing diverse stakeholder groups were interviewed using a semi-structured guide, and data were analysed using reflexive thematic analysis. Four key themes were identified: Challenges within the current certification process; Vulnerable populations are struggling and need better support; Opportunity for physiotherapy to offer a positive solution; and Considerations to support physiotherapy to certify effectively. Participants highlighted physiotherapists’ expertise, availability, and collaborative practice as strengths, and supported legislative change with appropriate safeguards. Findings suggest that physiotherapists are well-positioned to enhance certification processes, improve access and equity, and support better outcomes for injured workers. They also provide discussion around key considerations for professional development and practice. This study provides timely evidence to inform policy and professional practice discussions regarding physiotherapy’s role in ACC certification.