Abstract
In his debate article “Should UK Physiotherapists Choose Wisely”, Dr. Graham Copnell discusses the topic of the Choosing Wisely campaign about reducing low-value care in the physiotherapy profession in the UK [1]. As physiotherapists and family physician members of the Choosing Wisely Canada community, we feel this article is extremely valuable. However, we think the conversation in the physiotherapy profession skate over the current message and the future of the campaign: improving quality of care [2]. A growing community is now engaging in developing strategies and interventions to effectively implement recommendations in practices [2]. Physiotherapists could be key facilitators is this endeavour.
Several Choosing Wisely recommendations target the care process of musculoskeletal disorders (choosingwiselycanada.org) for which physiotherapists possess a unique expertise in diagnosis and management. Various interventions have targeted physicians’ prescription behaviours to reduce advanced imaging use for low back pain [3]. Using history and physical examination executed by a physiotherapist may be a cost-effective alternative as a first-line assessment for the diagnosis of musculoskeletal disorders [4]. Other recommendations target the overuse of orthopedic surgery such as arthroscopy as the primary treatment for knee osteoarthritis. Proposed alternatives to support the recommendations include exercise therapy, for which physiotherapists are key providers [5]. The latest recommendations in Canada entitled “Opioid Wisely” concern opioid prescription for conditions including low back pain and knee pain. The challenge in implementing the opioid recommendations is that pain is often not a self-limiting symptom that will disappear without intervention, as was the case for antibiotic prescriptions [6]. Again, exercise-based rehabilitation and education are proposed as a potentially high-value alternatives to improve pain and quality of life [7]. Overall, the many sources of overuse in managing musculoskeletal disorders are leading to the development of high-quality models of care with the physiotherapist’s expertise at the center [8]. These interventions may eventually impact system-level outcomes by reducing overuse and promoting underused of high-quality options.
Physiotherapists worldwide need to engage in Choosing Wisely because their expertise may be a solution to support the implementation of many recommendations. Of course, this can only be done by first doing our due diligence of critically appraising the quality of our practices, as other professions are currently doing. We believe that physiotherapists face a special challenge where they need to both address low-value care within the profession, but also promote high-quality care, a truly positive message and solution to implement Choosing Wisely. It would be wise not to miss this opportunity for our profession and the patients we serve.Conflict of interest: None declared.
Citation
Promoting high-quality physiotherapy to support Choosing Wisely recommendations