Physiotherapists’ views on the Australian Physiotherapy Association’s Choosing Wisely recommendations: a content analysis

Abstract

ObjectivesChoosing Wisely holds promise for increasing awareness of low-value care in physiotherapy. However, it is unclear how physiotherapists’ view Choosing Wisely recommendations. The aim of this study was to evaluate physiotherapists’ feedback on Choosing Wisely recommendations and investigate agreement with each recommendation.SettingThe Australian Physiotherapy Association emailed a survey to all 20 029 physiotherapist members in 2015 seeking feedback on a list of Choosing Wisely recommendations.ParticipantsA total of 9764 physiotherapists opened the email invitation (49%) and 543 completed the survey (response rate 5.6%). Participants were asked about the acceptability of the wording of recommendations using a closed (Yes/No) and free-text response option (section 1). Then using a similar response format, participants were asked whether they agreed with each Choosing Wisely recommendation (sections 2–6).Primary and secondary outcomesWe performed a content analysis of free-text responses (primary outcome) and used descriptive statistics to report agreement and disagreement with each recommendation (secondary outcome).ResultsThere were 872 free-text responses across the six sections. A total of 347 physiotherapists (63.9%) agreed with the ‘don’t’ style of wording. Agreement with recommendations ranged from 52.3% (electrotherapy for back pain) to 76.6% (validated decision rules for imaging). The content analysis revealed that physiotherapists felt that blanket rules were inappropriate (range across recommendations: 13.9%–30.1% of responses), clinical experience is more valuable than evidence (11.7%–28.3%) and recommendations would benefit from further refining or better defining key terms (7.3%–22.4%).ConclusionsAlthough most physiotherapists agreed with both the style of wording for Choosing Wisely recommendations and with the recommendations, their feedback highlighted a number of areas of disagreement and suggestions for improvement. These findings will support the development of future recommendations and are the first step towards increasing the impact Choosing Wisely has on physiotherapy practice.

Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review

“… 13 Conversely, a recent consensus statement from Australian physiotherapists defined “high-value” physiotherapy (HVP) as “care that delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care” 14 (p. 4). As a recent concept, 15 HVP is often considered interchangeable with evidence-based practice (EBP). Although EBP is a key component of HVP, the latter has a clearer emphasis on cost-effectiveness and value.…”

Can language enhance physical therapists’ willingness to follow Choosing Wisely recommendations? A best-worst scaling study

“…This finding is similar to the content analysis where feedback on a draft list of the APA Choosing Wisely recommendations was sought from 543 physical therapists. 14 The study found most physical therapists agree that health professionals should avoid imaging for non-specific low back pain (75%) and electrotherapy for low back pain (52%). 14 These interventions are well-recognised and accepted examples of low-value care as most guidelines for low back pain discourage both interventions.…”

“…Evidence suggests clinicians may be more willing to follow Choosing Wisely recommendations if the recommendations were more detailed, 10 , 11 , 12 used unqualified language (‘must’ or ‘don't’) 13 and provided encouragement to deliver evidence-based care, particularly when discouraging the use of an intervention. 14 No studies have explored how the language of Choosing Wisely recommendations supports or discourages their adoption amongst clinicians.…”

Overcoming Overuse: Improving Musculoskeletal Health Care

“…11 Not all agree with recommendations to reduce some services (eg, only 52% of physical therapists agree that electrotherapy should not be provided for low back pain). 12 Without considering the type or amount of treatment, blind advocacy for physical therapy as a blanket alternative to medication or surgery could lead to overuse.…”