Manual therapy across the professional continuum: a comparative analysis of educational, accreditation, and specialty...

Manual therapy (MT) is widely used throughout physical therapy (PT), yet variability in terminology and conceptualization has been identified within research and professional discourse. Whether similar across frameworks establishing expectations for PT education and professional development remains unclear. This study compared how MT is defined, described, and represented across PT educational, accreditation, professional, and specialty frameworks.

A qualitative comparative document analysis used purposive sampling of documents from CAPTE, FSBPT, ABPTS, ABPTRFE, APTA, AAOMPT, ACOMPTE, and IFOMPT. Documents were reviewed for terminology, descriptions, interventions, clinical reasoning, educational and competency expectations, and specialty practice. Content analysis informed by framework analysis supported cross-organizational comparison. Two investigators independently reviewed and coded documents, resolving discrepencies by consensus.

Four overarching domains emerged conceptual foundations, clinical reasoning components, educational development, and professional identity. Profession-wide and entry-level frameworks predominantly emphasized procedural intervention, psychomotor competency, and educational outcomes, whereas specialty organizations described orthopedic manual physical therapy (OMPT) through clinical reasoning, evidence-informed care, biopsychosocial patient management, mentorship, and professional specialization. Cross-organizational synthesis identified six recurring constructs: procedural intervention, psychomotor competency, clinical reasoning, specialty identity, biopsychosocial integration, and terminology harmonization. Conceptual convergence was evident among OMPT specialty organizations.

MT is represented differently across PT organizations, consistent with their roles and levels of practice. These differences neither indicate deficient frameworks nor support a singular MT definition. Findings identify where conceptual differences emerge across the professional continuum, particularly between foundational MT and broader OMPT frameworks. Whether these differences influence how MT and OMPT are understood, taught, investigated, or applied warrants further study.