Manual Therapy Behavior Scale in Physiotherapists

Development of a Manual Therapy Application Behavior Scale Among Physiotherapists: A Validity and Reliability Study

The aim of this study is to develop a scale to assess the manual therapy application behaviors of physiotherapists in Türkiye, based on the Theory of Planned Behavior (Ajzen, 1991). A literature-based item pool will be created, and expert opinion (Delphi method) will be obtained to ensure content validity. The final scale will be administered online to physiotherapists, and construct validity and reliability analyses will be conducted. The study aims to contribute scientifically to the determination of manual therapy application behaviors in physiotherapy practices, the understanding of clinical decision-making processes, and the measurement of behavioral intention. No risks were anticipated for the participants, and data collection was voluntary.

Study Overview

• Status: Enrolling by invitation
• Conditions: Attitude of Health Personnel

Detailed Description

Manual therapy is an evidence-based intervention method based on manual techniques widely used by physiotherapists in the treatment of musculoskeletal disorders. However, clinicians' decisions to implement manual therapy are influenced by multidimensional factors such as personal attitudes, professional beliefs, institutional policies, educational experiences, and the culture of clinical practice. The use of behavior-based theoretical models is recommended to evaluate these factors together.

The Theory of Planned Behavior (Ajzen, 1991) is a powerful approach that explains individuals' intentions to perform a specific behavior through variables such as attitude, subjective norm, perceived behavioral control, and intention. Although this theory is frequently used to understand the clinical decision-making processes of healthcare professionals, there is no valid and reliable measurement tool in Turkey for measuring behavior toward manual therapy practices.

This study will develop a new scale adapted to Turkish culture to assess physiotherapists' manual therapy practices in a theoretically based manner. The research will consist of three phases:

Item Development Phase:

The item pool generated through the literature review will be presented to expert physiotherapists.

Expert Panel/Delphi Phase:

Experts will evaluate the items based on content validity, and items will be revised or removed based on consensus. In this phase, the Content Validity Index (CVI) and Content Validity Ratio (CVR) will be evaluated.

Statistical Analysis Phase:

The final scale will be administered online to physical therapists.

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Denizli
    • Denizli, Denizli, Turkey (Türkiye), 20160
      • Pamukkale University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population for this study consists of healthy adult physiotherapists actively working in public or private healthcare institutions or university hospitals in Turkey. Participants are expected to have basic training in manual therapy or clinical practice experience. Data collection will be conducted online, and participation is entirely voluntary. No medical interventions will be administered; data will be collected solely through a self-report questionnaire.

Description

Inclusion Criteria:

• Be actively working as a physiotherapist in Turkey (public/private hospital, university hospital, private clinic, etc.)
• Have received basic training in manual therapy or have clinical practice experience
• Be a healthy adult aged 22 or over
• Be able to read and understand Turkish (the survey language is Turkish)
• Agree to participate in the study voluntarily and provide individual informed consent

Exclusion Criteria:

• Professionals working in healthcare fields other than physiotherapy
• Physiotherapists without manual therapy experience
• Participants who complete the survey form incompletely, incorrectly, inconsistently, or provide duplicate entries
• Individuals who refuse to provide informed consent
• Individuals who withdraw their voluntary consent during the research process

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Phsysiotherapists; Healthy adult physiotherapists who are actively working in public or private healthcare institutions or university clinics in Turkey and have received training or basic practical experience in manual therapy. Participation is voluntary, and no clinical intervention will be performed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Manual Therapy Application Behavior Scale for Physiotherapists	"Manual Therapy Application Behavior Scale in Physiotherapists" is a 7-point Likert-type (1 = Strongly disagree, 7 = Strongly agree) self-report scale developed based on Ajzen's Planned Behavior Theory. Higher scores reflect more positive attitudes, stronger subjective norms, higher perceived behavioral control, and higher behavioral intentions among physical therapists toward manual therapy. Construct validity will be assessed using internal consistency (Cronbach's alpha), item-total correlations, test-retest reliability, and confirmatory factor analysis.	One-time evaluation during the data collection period

Collaborators and Investigators

• Sponsor: Uşak University
• Collaborators: Pamukkale University

Study record dates

Study Major Dates

• Study Start (Estimated): December 25, 2025
• Primary Completion (Estimated): March 25, 2026
• Study Completion (Estimated): March 25, 2026

Study Registration Dates

• First Submitted: December 8, 2025
• First Submitted That Met QC Criteria: December 8, 2025
• First Posted (Actual): December 22, 2025

Study Record Updates

• Last Update Posted (Actual): December 22, 2025
• Last Update Submitted That Met QC Criteria: December 8, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Physical Therapy Specialty; Surveys and Questionnaires; Clinical Competence; Attitude of Health Personnel
• Other Study ID Numbers: E-60116787-020-789576

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Because data is collected entirely on a voluntary basis, protecting participant privacy is a priority. Therefore, there are no plans to share Individual Participant Data (IPD) with third parties.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No