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

Joshua Zadro; Aimie L Peek; Rachael H Dodd; Kirsten McCaffery; Christopher Maher

doi:10.1136/bmjopen-2019-031360

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

BMJ Open. 2019 Sep 20;9(9):e031360. doi: 10.1136/bmjopen-2019-031360.

Authors

Joshua Zadro¹, Aimie L Peek², Rachael H Dodd³, Kirsten McCaffery³, Christopher Maher⁴

Affiliations

¹ Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia joshua.zadro@sydney.edu.au.
² Musculoskeletal Health Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
³ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Abstract

Objectives: 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.

Setting: The Australian Physiotherapy Association emailed a survey to all 20 029 physiotherapist members in 2015 seeking feedback on a list of Choosing Wisely recommendations.

Participants: A 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 outcomes: We performed a content analysis of free-text responses (primary outcome) and used descriptive statistics to report agreement and disagreement with each recommendation (secondary outcome).

Results: There 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%).

Conclusions: 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.

Keywords: Choosing Wisely; content analysis; low-value care; physiotherapy; qualitative.

MeSH terms

Attitude of Health Personnel*
Australia
Humans
Physical Therapists / psychology*
Physical Therapy Specialty*
Practice Guidelines as Topic*
Societies*
Surveys and Questionnaires