Draft recommendations and survey questions
| Context | Example recommendation from the APTA | Question | |
| Section 1 | The Choosing Wisely format deliberately uses ‘don’t’ or similar wording, and is expressly intended to incite discussion about interventions. One of the ‘5 Things Physical Therapists and Patients Should Question’ by the American Physical Therapy Association in 2014 was: | Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program. | In the context of the intent of the Choosing Wisely campaign, do you think style of wording is an acceptable method to engage the physiotherapy profession in a conversation about evidence-based clinical practice? |
| Draft recommendation | Explanation | Question | |
| Section 2 | Don’t use imaging where validated decision rules indicate imaging is not necessary. | Imaging should only be requested when clinically appropriate. Physiotherapists should use appropriate clinical decision-making tools, such as Ottawa Ankle Rules, Canadian C-Spine Rule and NEXUS, and should not be used imaging in cases of non-specific low back pain with no signs of serious pathology. | Do you agree that physiotherapists should not use imaging when validated decision rules indicate it is not necessary? |
| Section 3 | Don’t use incentive spirometry after upper abdominal and cardiac surgery. | Physiotherapists should not routinely use incentive spirometry after upper abdominal and cardiac surgery. Physiotherapists should instead consider adding other interventions to standard care. For example, there is high-level evidence for the addition of preoperative inspiratory muscle training when added to usual care. | Do you agree that physiotherapists should not use incentive spirometry after upper abdominal and cardiac surgery? |
| Section 4 | Don’t use electrotherapy modalities in the management of patients with low back pain. | Clinical practice guidelines don’t recommend electrotherapy modalities to manage low back pain. Physiotherapists should instead consider other interventions to manage low back pain, for example, exercise prescription and education. | Do you agree that physiotherapists should not use use electrotherapy modalities in the management of patients with low back pain? |
| Section 5 | Don’t use ongoing manual therapy for patients following acute adhesive capsulitis of the shoulder. | Physiotherapists should consider a range of other interventions to manage acute adhesive capsulitis, such as exercise to optimise function, education and appropriate management of pain. | Do you agree that physiotherapists should not use ongoing manual therapy for patients following acute adhesive capsulitis of the shoulder? |
| Section 6 | Don’t use ongoing physiotherapy in cases where there isn’t improvement in measurable patient outcomes. | Physiotherapists should facilitate and empower the patient’s independent management of chronic conditions. | Do you agree that physiotherapists should not use ongoing physiotherapy in cases where there is no improvement in measurable patient outcomes? |
APTA, American Physical Therapy Association; NEXUS, National Emergency X-Radiography Utilization Study.