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

What is it about?

Choosing Wisely is a major public awareness campaign that aims to facilitate open patient-therapist communication about low-value care and ensure patients receive healthcare that is evidence-based, safe and necessary. Professional societies that endorse Choosing Wisely typically release a list of 5-10 Choosing Wisely recommendations. Choosing Wisely recommendations are brief statements that outline tests or treatments that are unnecessary and potentially harmful, and are likely provided by some society members. Choosing 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. The Australian Physiotherapy Association sent a survey to all their physiotherapist members in 2015, seeking their views on a list of Choosing Wisely recommendations. We performed a content analysis of written feedback from physiotherapists regarding the Choosing Wisely recommendations. We also evaluated the proportion of physiotherapists that agreed and disagreed with each recommendation. Overall, 64% of physiotherapists agreed with the style of wording of the recommendations. Agreement with individual recommendations ranged from 53% (avoid electrotherapy for back pain) to 77% (only order imaging when validated decision rules suggest its necessary). The content analysis of physiotherapists' view on Choosing Wisely recommendations revealed that physiotherapists felt blanket rules were inappropriate (range across recommendations: 13.9% to 30.1% of responses), clinical experience is more valuable than evidence (11.7% to 28.3%) and recommendations would benefit from further refining or better defining key terms (7.3% to 22.4%). In conclusion, although 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.

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