Physiotherapists' attitudes, views, and beliefs about Choosing Wisely recommendations: A qualitative study

Priti Kharel; Joshua R Zadro; Chindhu S Sundaram; Kirsten McCaffery; Rachael H Dodd; Charlotte McLennan; Christopher G Maher

doi:10.1016/j.msksp.2022.102610

Physiotherapists' attitudes, views, and beliefs about Choosing Wisely recommendations: A qualitative study

Musculoskelet Sci Pract. 2022 Oct:61:102610. doi: 10.1016/j.msksp.2022.102610. Epub 2022 Jun 20.

Authors

Priti Kharel¹, Joshua R Zadro², Chindhu S Sundaram³, Kirsten McCaffery⁴, Rachael H Dodd⁴, Charlotte McLennan², Christopher G Maher²

Affiliations

¹ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia. Electronic address: priti.kharel@sydney.edu.au.
² Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.
³ Quality of Life Office & Centre for Medical Psychology and Evidence-based Decision Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 35750018
DOI: 10.1016/j.msksp.2022.102610

Abstract

Objective: Explore physiotherapists' attitudes, views, and beliefs towards the Australian Physiotherapy Association's (APA) Choosing Wisely recommendations.

Design: Qualitative interview study.

Methods: We conducted semi-structured interviews with physiotherapists who were registered to practise in Australia. We purposively recruited participants with different demographics, clinical backgrounds, and years of experience to achieve diversity in views and opinions. Interviews explored barriers and facilitators to adopting the APA's Choosing Wisely recommendations, and strategies to increase adoption. Interviews were recorded, transcribed verbatim and analysed thematically.

Results: We interviewed 19 participants (79.2% of 26 who expressed interest to be interviewed). Mean (SD) age of participants was 33.4 (11.6), mean (SD) years of experience was 10 (11.4), 90% were male (n = 17) and 53% worked in private practice (n = 10). Most participants were slightly (42.1%, n = 8) or at least moderately familiar (42.1%, n = 8) with the recommendations. Barriers to adopting the recommendations included 1) clinicians' beliefs, experience, and knowledge, 2) patients' clinical presentation, their beliefs, and expectations, 3) workplace demands and culture, and 4) vague and restrictive language, and lack of awareness. Facilitators to adopting the recommendations included 1) physiotherapists' beliefs and practise patterns, 2) organisational support, and 3) clear and appropriate recommendations. Suggested strategies to increase adoption of the recommendations were 1) interventions targeting clinicians, 2) amendments to the recommendations and 3) increased awareness and access to the recommendations.

Conclusion: These findings will inform the development and dissemination of future Choosing Wisely recommendations, and development of strategies to replace low-value physiotherapy with high-value physiotherapy.

Level of evidence: IV.

Keywords: Choosing wisely; Low-value care; Overuse; Physical therapy; Physiotherapy.

MeSH terms

Attitude of Health Personnel
Australia
Female
Humans
Male
Physical Therapists*
Physical Therapy Modalities
Qualitative Research