Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 2, 2026
Date Accepted: May 26, 2026
Practice Areas, Skills and Core Competencies of Advanced Practice Physiotherapists working in Tertiary Care in Germany: Protocol of a Three-Round Delphi Study to Establish Expert Consensus
ABSTRACT
Background:
Specifically in primary musculoskeletal care settings, the employment of Advanced Physiotherapy Practice (APP) roles seems to be safe, as well as clinically and financially effective. In tertiary care settings, the implementation of APP roles is still in its infancy. A structured identification of relevant APP roles and a definition of practice areas, needed skills and core competencies is widely pending.
Objective:
To identify and prioritise the most relevant areas of tertiary care for the implementation of APP roles within the German healthcare system. Additionally, it is aimed to achieve expert consensus on practice areas, needed skills, and core competencies relevant to execute identified roles.
Methods:
Fifty national experts will be invited to participate in a three-round Delphi survey. Participants will purposively be sampled among physiotherapists with extensive clinical and / or academic experiences in German tertiary care. Data will be pseudonymized and collected via online questionnaires. In Delphi round one, close-ended questions on relevant APP roles and open-ended input on practice areas, skills and core competencies will be queried. Open-ended questions will be structured according to key domains of the NHS multi-professional framework for advanced clinical practice. In round two, participants will rate close-ended items on practice areas, skills, and core competencies that emerged from open-ended questions of round one. Each item will be rated on a seven-point-likert scale ranging from “not relevant at all” to “extremely relevant”. Consensus will be set on ≥ 70% agreement per item (including “5 – fairly relevant”; “6 – very relevant”; “7 – Extremely relevant”). Items with agreements of ≤ 30% will be excluded. Items of 31–69% agreement will be re-evaluated in round three. Descriptive statistics (median, interquartile range, absolute and relative frequencies) will be used to visualize response patterns, and McNemar and Wilcoxon signed-rank tests will be applied to explore changes between rounds.
Results:
Data collection will take place between January and April 2026. Results of this Delphi survey will be reported as planned by submitting it to a peer-reviewed scientific journal in July 2026.
Conclusions:
Findings will support evidence-based APP role development and contribute to optimizing tertiary care areas relevant to physiotherapy care in Germany. Clinical Trial: https://doi.org/10.17605/OSF.IO/7G9A8
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