Introduction: Mental and cognitive health content has been integrated into Italian guidelines for nearly five years. Therefore, this study aimed to investigate how these recommendations have translated into practice by examining the perceptions and experiences of physiotherapists in Italy. Methods: A cross-sectional online survey was conducted between January 2024 and April 2025. Physiotherapists were reached through social media and official channels. Descriptive and regression analyses were used to examine participants' profiles, predictors of self-perceived competence, referral likelihood, and changes in educational training over time. Results: Among 423 physiotherapists, 39.4% and 60.7% reported low competence in managing cognitive and mental health issues, respectively. Physiotherapists working in neurological practice had higher odds of feeling competent in both cognitive (OR = 2.47, p < 0.001) and mental health (OR = 1.90, p = 0.040) care and of receiving cognitive care referrals (OR = 1.94; p = 0.003). Greater clinical experience was associated with confidence in managing cognitive health (p = 0.010). Reliance on physiotherapists as an information source was linked to lower competence in cognitive health (OR = 0.53, p = 0.023). Years of experience predicted the educational training undertaken for cognitive and mental health care (p = 0.034). Conclusion: The reported practice patterns may indicate care gaps and limited implementation of the national guidelines among physiotherapists in Italy. Since cognitive impairments and mental health issues are commonly encountered across physiotherapy specialties, we recommend that undergraduate curricula include more content in these areas and that additional opportunities for professional development be provided.
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