[Core competencies of physiotherapists for direct access of patients with musculoskeletal disorders in the German healthcare system - A Delphi survey].

Authors

Pia Herz, Jan Paul Iske, Anne Jarck, Kerstin Lüdtke, Phillip Thies, Annika Schwarz

Published in

Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

Musculoskeletal disorders (MSKDs) are among the most common global health issues. They are major contributors to functional limitations and reduced health-related quality of life. Direct access to physiotherapy, which has already been established in many countries, is now being increasingly discussed in Germany as a potential solution for demand-oriented care. This study aimed to develop a consensus-based competence framework for physiotherapists in direct access for MSKDs.
Based on an existing scoping review (ScR) framework, a Delphi survey with experts from research, teaching, and practice was conducted. Competencies were rated on a four-point Likert scale; revisions and additions were made via free text fields. These were analyzed using the AQUA method. The questionnaire was adjusted iteratively after each round.
The Delphi survey involved experts from research, teaching, and practice (n = 22). During three rounds, 69 competency elements were consented. The experts contributed 18 new competency elements, and 24 revisions were proposed. After round three, all reached the consensus criterion (≥75% agreement). The final core framework includes 33 competencies. The response rate exceeded 86% in all rounds.
The results refine and expand the competence framework of the underlying ScR and distinguish between generic physiotherapy competencies and direct access-specific requirements. They align well with international standards while integrating context-specific regulatory and structural conditions of the German healthcare system. The framework developed provides a solid basis for further professional alignment and developmental processes, as well as for curricular development and the qualification of direct-access physiotherapists for MSKDs. The findings suggest that existing competencies in direct access are applied within an expanded framework of responsibility and decision-making.

PMID:
42401496
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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