Only complete questionnaires were analysed. Data were qualitatively checked for plausibility by two authors and discussed in case of differing assessments.

Statistical analysis was performed using the software R Version 3.3.2 (The R Project for Statistical Computing, Vienna, Austria).

Participants’ characteristics and current clinical practice were analysed using descriptive statistics such as frequency distribution and percentages.

Guideline adherence was defined as the accordance between guideline recommendations and the therapists’ treatment or diagnostic choices. Guideline adherence was determined using a point-based system. For both treatment and diagnosis, the benchmark for good adherence was set at ≥ 80 % [22] of the maximally achievable points.

To determine guideline adherence in the physical therapeutic diagnostic process, 23 items were evaluated. The NVL is an interprofessional guideline and contains information for physicians and other health care professionals. Thus, in order to be considered as criteria for guideline adherence in relation to the physical therapeutic diagnostic process, aspects listed in the NVL also needed to be listed in the CPG for LBP published by the Royal Dutch Society for Physical Therapy (KNGF) [20]. Further aspects of the NVL, which were not mentioned in the KNGF guidelines were discussed by the study team and supplemented if they were deemed to be relevant in the German physical therapeutic context.

The categorical data for the questions regarding treatment options were dichotomised. If treatment modalities were recommended in the NVL (↑↑ = strong recommendation for a treatment or ↑ = recommendation for a treatment), the answers ‘always’ and ‘often’ were awarded one point. In case of negative recommendations (↓↓ = strong recommendation against a treatment or ↓ = recommendation against a treatment), the answers ‘never’ and ‘sometimes’ were awarded one point. Treatments with an open recommendation (↔) were not considered in the scoring system. In the treatment section, the highest achievable point score was 32.

Combining guideline adherence of the physical therapeutic diagnostic process and the treatment section, a third dependent variable was defined. Participant’s total guideline adherence was fulfilled if at least 80 % of the maximum number of points in each section had been achieved.

Associations between participants’ characteristics and their guideline adherence were assessed using exploratory univariate logistic regression and reported as OR and 95 % CI. Guideline adherence was dichotomized in adherence and non-adherence. Potential determinants (sex, highest professional degree, years of professional experience, work setting) were selected based on the literature [13, 22, 23]. The factor `highest professional degree´ is particularly relevant, since in Germany the physical therapy education takes place predominantly at vocational schools (so called “Berufsfachschulen”) and only a few physical therapists (3 %) graduate from higher educational institutions [24]. To consider the specific characteristics and structure of the German health care system, further determinants (size of the city/municipality of employment, interprofessional collaboration) were examined for associations with guideline adherence. Questionnaires with missing values within the analysed variables were excluded from the regression. The level of statistical significance was set at p-value < 0.05.

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