Overcoming Overuse: Improving Musculoskeletal Health Care

Zadro, Joshua R; Décary, Simon; O’Keeffe, Mary; Michaleff, Zoe A; Traeger, Adrian C

doi:10.2519/jospt.2020.0102

Cited by 21 publications

(9 citation statements)

References 12 publications

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“…15,19 A combination of the scientific process and modern methods of information distribution such as social media, have identified the value and importance of exercise not just within the physical therapy profession, but in health care as a whole. 20,21 While "active" exercise therapies such as heavy-slow resistance and sprint training hold a primary function in the management of athletes, exercise may not always provide the desired analgesic and therapeutic effect when the athlete is already in pain, be it either acute or chronic. 22 Further, in those with chronic pain, exercise induced hypoalgesia is reduced, 23 potentially limiting its effectiveness.…”

Section: Positive Utilization Of Physical and Manual Therapymentioning

confidence: 99%

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

Short

Tuttle²,

Youngman

2023

International Journal of Sports Physical Therapy

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Symptom modification techniques have been recently dichotomously labeled as either passive or active therapies. Active therapy such as exercise has been rightfully advocated for while “passive” therapies, mainly manual therapy have been regarded as low value within the physical therapy treatment spectrum. In sporting environments where physical activity and exercise are inherent to the athletic experience, the utilization of exercise-only strategies to manage pain and injury can be challenging when considering the demands and qualities of a sporting career which include chronically high internal and external workloads. Participation may be impacted by pain and its influence on related factors such as training and competition performance, career length, financial earning potential, educational opportunity, social pressures, influence of family, friends, and other key stakeholders of their athletic activity. Though highly polarizing viewpoints regarding different therapies create black and white “sides,” a pragmatic gray area regarding manual therapy exists in which proper clinical reasoning can serve to improve athlete pain and injury management. This gray area includes both historic positive reported short-term outcomes and negative historical biomechanical underpinnings that have created unfounded dogma and inappropriate overutilization. Applying symptom modification strategies to safely allow the continuation of sport and exercise requires critical thinking utilizing not only the evidence-base, but also the multi-factorial nature of sports participation and pain management. Given the risks associated with pharmacological pain management, the cost of passive modalities like biophysical agents (electrical stimulation, photobiomodulation, ultrasound, etc), and the indications from the evidence-base when combined with active therapies, manual therapy can be a safe and effective treatment strategy to keep athletes active. Level of Evidence 5

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Section: Positive Utilization Of Physical and Manual Therapymentioning

confidence: 99%

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

Short

Tuttle²,

Youngman

2023

International Journal of Sports Physical Therapy

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“…Musculoskeletal pain, including low back pain and osteoarthritis, is the leading cause of disability worldwide. 27 In light of growing concerns about the inappropriate use of tests, treatments and procedures for musculoskeletal pain, 28 guidelines are increasingly recommending shared decision making (eg, guidelines for knee osteoarthritis, 6 low back pain 7 and shoulder pain 29 ). Patient decision aids, tools designed to facilitate shared decision making, have also received increasing attention.…”

Section: Ebm Analysis: General Medicine Box 1 Case Study: Online Pati...mentioning

confidence: 99%

Problem with patient decision aids

Zadro

Traeger

Décary

et al. 2020

BMJ EBM

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Patient decision aids are evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. Research shows that patient decision aids increase knowledge, accuracy of risk perceptions, alignment of care with patient values and preferences, and patient involvement in decision making. Some patient decision aids can reduce the use of invasive and potentially low-value procedures. On this basis, clinical practice guidelines and international organisations have begun to recommend the use of patient decision aids and shared decision making as a strategy to reduce medical overuse. Although patient decision aids hold promise for improving healthcare, there are fundamental issues with patient decision aids that need to be addressed before further progress can be made. The problems with patient decision aids are: (1) Guidelines for developing patient decision aids may not be sufficient to ensure developers select the best available evidence and present it appropriately; (2) Biased presentation of low-certainty evidence is common and (3) Biased presentation of low-certainty evidence is misleading, and could inadvertently support, low-value care. We explore these issues in the article and present a case study of online patient decision aids for musculoskeletal pain. We suggest ways to ensure patient decision aids help patients understand the evidence and, where possible, support high-quality care.

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“…At the current stage of research, a common definition of medical overuse is still lacking and is also described in other terms such as low-value care trying to address the same complex phenomenon [6]. Unfortunately, most studies addressing PT overuse concern countries with direct access legislation [7]. In Germany, direct access to PT services is still a goal to achieve and thus limits the options of PT overuse measures since authorities of independent diagnostics and medication prescribing are not part of occupational curricula and PTs act on physicians' prescribing authorities which limits methodical approaches to investigate medical overuse in respective healthcare settings [8].…”

Section: Introductionmentioning

confidence: 99%

Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review protocol

2022

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Background The provision of low-value care services in low back pain management is a problem of global scope. Inappropriate imaging, overmedication, and overused invasive therapies are prevalent in physician services. Yet, little is known about overused low-value physiotherapy services. Most studies addressing physiotherapy overuse in low back pain management arose from countries in which physiotherapy is established in primary care. However, measures and instruments addressing physiotherapy overuse limitedly fit legislative conditions of health systems in which physiotherapy is a service of secondary care. Thus, this scoping review’s purpose is to map existing research designs and instruments aiming to detect overused low-value physiotherapy services taking specific healthcare settings and aspects of medical overuse into account. Methods The development of this scoping review is guided by the Arksey and O’Malley framework. A two-step, peer-reviewed search strategy in accordance with the PRESS checklist will be conducted on MEDLINE (PubMed), Web of Science, and CINHAL. Additionally, gray literature will be searched on Google Scholar. Preprints of empirical studies will be included. Initially, two reviewers will independently screen articles for eligibility by title and abstract. A third reviewer will mediate discrepancies. Uncertainties will be eliminated by a full-text analysis or by contacting the corresponding authors. A four-step analytical process will guide result reporting focusing on major research questions outlined in this protocol. Numerical and narrative tables, graphics, and narrative summaries will be the methods to summarize and collate results. In the final step, the German health system will serve as an exemplary setting and frame to practically apply results. Discussion Results of this scoping review will help researchers to systematically select overuse measures referring to aspects of the overuse typology, specific healthcare settings, and physiotherapy services. It will further provide information on the limitations of present studies and will give advice on how to address them. Moreover, this review will illustrate to what degree existing studies succeed to comprehensively cover the concept of the overuse typology. Systematic review registration This protocol has been registered on the open science framework (https://doi.org/10.17605/OSF.IO/PMF2G).

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Overcoming Overuse: Improving Musculoskeletal Health Care

Cited by 21 publications

References 12 publications

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

Problem with patient decision aids

Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review protocol

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