Kernkompetenzen von Physiotherapeut*innen für den Direktzugang von Patient*innen bei muskuloskelettalen Erkrankungen im deutschen Gesundheitssystem – ein Scoping Review

Introduction

In many countries, direct access to physiotherapy for patients with musculoskeletal disorders (MSKDs) has already been established. It presents an opportunity to optimize healthcare delivery within the German healthcare system, addressing the challenges of demographic changes and staff shortages. This study aims to identify the necessary competencies of physiotherapists for direct access practice, describes them, and compares them with the German Training and Examination Order for Physiotherapy (PhysTh-APrV) and the German Qualifications Framework for Lifelong Learning (DQR).

Method

A scoping review was conducted, including a systematic literature review in five databases (Medline, CINAHL, Cochrane Library, PEDro and ScienceDirect), supplemented by a non-systematic search in both Google Scholar and the gray literature. Publications were included if they described the necessary competencies for direct access to physiotherapy for patients with MSKDs in primary or emergency care. Non-German or non-English publications were excluded. Subsequently, content analysis of all included publications was performed. The competencies were analyzed, clustered into five categories, and compared to DQR and PhysTh-APrV.

Results

The literature search yielded 1,283 publications, 61 of which were included. A total of 24 competencies were identified and categorized into five domains: Assessment and Evaluation, Management and Interventions, Communication, Cooperation and Collaboration, Professionalism and Leadership. These competencies are covered by the DQR Level 6 competencies. The PhysTh-APrV does not provide sufficient qualifications for direct access practice.

Discussion and conclusion

The results highlight the required level of qualification for implementing direct access in the German healthcare system and define the competencies that physiotherapists need in this setting.