High‐ and low‐value care in sport and exercise medicine: Areas for consideration

Abstract

High‐value care and low‐value care are concepts failing to receive attention in sport and exercise medicine. High‐value care refers to an intervention that provides a benefit or where the probable benefit exceeds the risk of harm. Low‐value care refers to an intervention that provides little‐to‐no benefit or where the risk of harm exceeds the probable benefit. To start the conversation, we apply the concepts of high‐ and low‐value care to the use of imaging, opioids, injections, surgery, and exercise therapy in sport and exercise medicine. We conclude with suggestions to help sport and exercise medicine clinicians replace low‐value care with high‐value care. In summary: (a) Only order imaging if you suspect findings that will positively guide the direction of treatment; (b) To reduce opioid use, ensure an adequate trial of non‐pharmacological and non‐opioid treatments; (c) Only provide injections when an adequate trial of non‐pharmacological treatments has failed, and the short‐term benefits outweigh the risk of long‐term harms; (d) Consider initial non‐surgical management for cases where evidence suggests early surgery is not necessary (eg, anterior cruciate ligament tears); and (e) Promote independence with exercise therapy (instead of extensive supervision) when feasible, acceptable, and evidence suggests it has equivalent outcomes (eg, post‐surgery).

The environmental impact of health care for musculoskeletal conditions: A scoping review

“…Approximately one third of health care is estimated to be of low value or 'wasted' [9][10][11]. For example, there is a large body of evidence attesting to widespread low-value health care practices for common musculoskeletal conditions such as osteoarthritis [12], low back pain [13], hip and knee pain [12], shoulder pain [14][15][16] and sports injuries [17]. Directing efforts towards eliminating these aspects of care would have the dual benefit of reducing harms associated with unnecessary care, and avoiding their harmful effects on the environment.…”

‘He explains it in a way that I have confidence he knows what he is doing’: A qualitative study of patients' experiences and perspectives of rotator‐cuff‐related shoulder pain education

“…Unnecessary or ‘low‐value’ care has been reported for RCRSP (Naunton, Harrison, Britt, Haines, & Malliaras, 2020a). Low‐value care describes an intervention that provides minimal or no benefit or where the probable benefit is outweighed by the risk of harm (Zadro, 2020). For example, a recent exploration of GP management of RCRSP between 2011 and 2016 demonstrated a reliance on the use of ultrasound, with 53.0% of patients referred for an ultrasound on their first visit (Buchbinder, Staples, Shanahan, & Roos, 2013).…”

Editorial: “A Touch of Physiotherapy”—The significance and meaning of touch in the practice of physiotherapy

“…In physiotherapy, this turn away from touch has been accelerated in recent years by a growing evidence-based practice movement arguing that touch equates to “low value care”, meaning care that is expensive to deliver and offers questionable efficacy ( 15 – 17 ). Many physiotherapists now argue that practitioners should not be touch-based, but instead concentrate on greater personal responsibility, activity-based therapies, and cognitive/hands-off forms of personal re-education ( 18 ).…”