Table 3

Percentage (median and IQR) of physical therapy treatment choices that involved treatments that were recommended, not recommended or had no recommendation across different conditions

Musculoskeletal
Acute low back pain
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Must provide
Advice to keep active3213557701
Reassurance31
Consider providing
Group exercise147202
Combination of two or more of 1–339356095047526
1. Manual therapy1 45396896047786
2. Exercise724478106551826
3. CBT
Superficial heat3331425139433
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Paracetamol391
McKenzie3624376531
US, ES, TENS, IF34294971613294
Poor advice2 92288
Acupuncture63167
Traction54289161
External support3 22165
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Other advice4 705475114934625
Cold therapy5 29274453332342
Other electrophysical agents6 1652751412203
Work-related/ergonomic interventions1610287
Back schools117185
Other manual therapy7 882037793
Biofeedback1013
Subacute or chronic low back pain
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Must provide
Advice to keep active5635764
Consider providing
Group exercise2714402
Combination of two or more of 1–341285193220435
1. Manual therapy1 49305195825746
2. Exercise645178106432755
3. CBT101
McKenzie2819356321
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
US, ES, TENS, IF38234661816325
Traction9422106672
Acupuncture85157
External support3 2295241
Poor advice2 1067
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Other advice4 6857869
Superficial heat38274745138553
Cold therapy5 24143463218373
Other electrophysical agents6 1919423119154
Work-related/ergonomic interventions11622411
Other manual therapy7 107203
Back schools65265
Biofeedback1112
Iontophoresis31
Low back pain (duration not specified)
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Must provide
Advice to keep active3515030563
Advice and education to support self-management26223122116272
Reassurance161
Consider providing
Group exercise761
Combination of two or more of 1–3594686834244612
1. Manual therapy1 605787934234412
2. Exercise895291869618113
3. CBT471
McKenzie47365675811715
Superficial heat39285571610344
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
US, ES, TENS, IF6737758148305
Acupuncture4516484
Traction451561883106
Poor advice2 2665742312333
External support3 23143122224
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Other advice4 89779346833919
Work-related/ergonomic interventions71528742623292
Other manual therapy7 1910437106177
Other electrophysical agents6 1594182317408
Cold therapy5 75174136493
Relaxation therapy71121
Back schools451
Iontophoresis31
Neck pain8
Assessed by surveys of physical therapists9 Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Should provide
Importance of maintaining activity and movement9389962
Consider structured education10 in combination with 1, 2, 3 or 4
1. Multimodal care11 5116557732
2. Range of motion/flexibility and strengthening exercises89 (range of motion or flexibility only)849325554562
3. Clinical massage1116457722
4. Laser6141
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Relaxation therapy671131
US, ES, TENS, SWD27233123225393
Strengthening alone12 3115554562
Heat or cold therapy2517966894
Poor advice2 121
CBT81
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Advice on posture96121
Other exercise13 82739025944732
Acupuncture4038422
McKenzie351
Manual therapy alone14 31204128674904
Neural mobilisation221
Traction2013324432
Magnetic field therapy21
Collar11
Biofeedback
Acute whiplash
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Should provide
Importance of maintaining activity and movement8144873
Information on nature, management and course5641702
Consider structured education10 in combination with 1 or 2
1. Multimodal care11 8179842
2. Range of motion/flexibility exercises9086942
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Heat or cold therapy5346612
Poor advice2 115162
Collar74102
US, ES4272
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Other exercise13 9691973
Clinical massage861
Manual therapy alone14 8379862
Advice on posture or analgesics5332742
Work-related/ergonomic interventions392
Traction301
Laser, IF2418302
McKenzie91
Chronic whiplash
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Should provide
Importance of maintaining activity and movement8079802
Information on nature, management and course601
Consider structured education10 in combination with 1, 2 or 3
1. Multimodal care11 721
2. Range of motion/flexibility and strengthening exercises561
3. Clinical massage861
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Strengthening alone12 561
Heat or cold therapy4338482
US, ES, TENS, SWD3030302
Poor advice2 105152
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Advice on posture951
Other exercise13 9493952
Work-related/ergonomic interventions7471782
Manual therapy alone1 4 6859772
McKenzie101
Collar1122
Subacromial pain (surveys) or shoulder pain15 (clinical notes)
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended16 Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Likely to be beneficial
Exercise89859247267762
Manual therapy1 49208046159683
Laser36205222318272
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
IF, magnetic field therapy90181
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Any advice17 7977822911
Tape5954642151
Acupuncture5351542
Shockwave, ES, US, SWD, TENS, microwave current44336542613393
Heat or cold therapy38245544739542
Body awareness111
CBT41
Iontophoresis151
Knee osteoarthritis (surveys)18 and knee pain (clinical notes)19
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Must provide
Advice to stay active8978923
Self-management strategies20 8274913
Aerobic and strengthening66477236565662
Advice on footwear571
Weight loss interventions5451563
Advice on weight loss491
Consider providing
Heat or cold therapy62157356963742
Manual therapy1, traction or stretching60547657978792
TENS52325432121211
Walking aids85383
CBT31
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
ES, US, Laser, IF, SWD4320556211
Poor advice2 2315312
Acupuncture2220345
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Other exercise21 98881005751
Balneotherapy22 161
Iontophoresis81
Acutelateral ankle sprains
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Should provide
Exercise3931462
Consider providing
Rest, ice, compression and elevation23 121
External support24 341
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
US, ES, Laser141
Joint mobilisation31
Heat or cold therapy11
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Advice or education2212332
IF, SWD, Diadynamic current71451
Plantar fascitis
Assessed by surveys of physical therapists Assessed by clinical notes
Recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Should provide
Stretching1001
Manual therapy1 811871
Night splints291
May provide
Strengthening exercises and movement training941
Education and counselling for weight loss891
Laser, US, ES431
Not recommended Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Acupuncture311
No recommendation Median (% ) Q1 Q3 N Median (%¥ ) Q1 Q3 N
Shockwave101
Heat or cold therapy791
Other exercise25 961901
Other advice26 981
Prefabricated orthotics27 701
Orthopaedics
Knee or hip arthroplasty (surveys of physical therapists or physical therapy departments)28
Inpatients Outpatients29
Recommended Median (% ) Q1 Q3 N Median (% ) Q1 Q3 N
Exercise94949527666864
Not recommended Median (% ) Q1 Q3 N Median (% ) Q1 Q3 N
Passive range of motion695781211
Cold therapy28253022016252
No recommendation Median (% ) Q1 Q3 N Median (% ) Q1 Q3 N
Manual therapy30 931311
Advice or education5533772
TENS, electrotherapy01
Acupuncture01
  • The percentage of physical therapists that report they provide (or would provide) treatments that was recommended, not recommended and had no recommendation for a given condition.

  • ¥The percentage of patients that received treatments from a physical therapist that were recommended, not recommended or had no recommendation for a given condition as determined by audits of clinical notes, audits of billing codes, treatment recording forms, clinical observation or surveys completed by patients.

  • 1Includes massage, mobilisation or manipulation.

  • 2Advice promoting bed rest or time off work.

  • 3Corsets, belts, braces, sticks or taping.

  • 4Includes advice on posture, heavy lifting, sitting or standing habits, avoiding painful movements, analgesics.

  • 5Including where heat and cold therapy could not be separated.

  • 6Including laser, infrared therapy, microcurrent therapy, SWD, and so on.

  • 7Includes neural mobilisation, Mulligan, Cyriax, myofascial release, and so on.

  • 8Insufficient data to stratify by symptom duration. We used the guidelines for chronic neck pain from online supplementary table 3 as they classify a greater number of interventions as high and low value.

  • 9Included two studies that combined treatment choices for neck pain and whiplash.

  • 10No study reported structured education so the below interventions are reported in isolation.

  • 11Includes mobilisation or manipulation and range of motion exercises.

  • 12We were unable to determine the percentage of strengthening that was delivered in isolation.

  • 13Any exercise not included in the above categories.

  • 14Includes mobilisation or manipulation, but we were unable to determine the percentage of manual therapy that was delivered in isolation.

  • 15Two studies combined physical therapy treatment choices for a variety of shoulder conditions.

  • 16There is no high-quality evidence supporting a recommended physical therapy intervention for shoulder pain.

  • 17Including advice on posture and advice to rest or reduce activity.

  • 18One study that combined physical therapy treatment choices for knee and hip osteoarthritis was not included in this table (Barten et al 2015) (see online supplementary table 3).

  • 19One study that combined physical therapy treatment choices for acute and chronic knee conditions was not included in this table (van Baar et al 1998) (see online supplementary table 3).

  • 20Includes exercise, weight loss, use of suitable footwear or pacing, but we were unable to assess the content of self-management strategies reported in the included studies.

  • 21Exercise that is neither aerobic nor strengthening.

  • 22Spa bath therapy (separate to hydrotherapy which is included within ‘other exercise’).

  • 23Only compression was mentioned in the included study.

  • 24Includes braces, boots or taping.

  • 25Exercise that is neither strengthening or movement training.

  • 26Includes advice on self-management, pacing,ergonomics, and so on.

  • 27Custom orthotics were provided by 63% of physical therapists.

  • 28One study that reported physical therapy treatment choices as assessed by clinical notes is not included in this table but is represented in the summary table (table 2).

  • 29Includes one study that reported physical therapy treatment choices for knee and hip arthroscopy combined.

  • 30Includes massage or mobilisation.

  • CBT, cognitive–behavioural therapy; ES, electrical stimulation; IF, interferential current;N, number of studies; Q1, first quartile; Q3, third quartile; SWD, short wave diathermy; TENS, transcutaneous electrical nerve stimulation; US, Ultrasound.