The American Physical Therapy Association (APTA) today released "Five Things Physical Therapists and Patients Should Question." The list was written as part of the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely® campaign. It offers evidence-based ways to support conversations between patients and physical therapists about the care that truly is necessary, based on individuals' particular circumstances.
APTA is the first nonphysician group to release a Choosing Wisely list. Since the program started in February 2012, more than 50 medical specialty societies have released such lists. The Choosing Wisely campaign is supported by health care provider groups, regional health collaboratives, and consumer partners that are helping to put the recommendations into practice. With the release of APTA's list, the campaign now will cover more than 300 tests and procedures that provider organization partners say are overused and unnecessary. These tests and procedures should be discussed between patient and provider.
"A well-informed patient is a well-treated patient," said APTA President Paul A. Rockar, Jr., PT, DPT, MS. "The Choosing Wiselycampaign addresses the patient's role in good health care. We are happy to join this effort to help patients make better-informed choices."
APTA's 5 recommendations:
- Don't employ passive physical agents except when necessary to facilitate participation in an active treatment program.
- Don't prescribe underdosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual's abilities and goals.
- Don't recommend bed rest following diagnosis of acute deep vein thrombosis after the initiation of anticoagulation therapy unless significant medical concerns are present.
- Don't use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement.
- Don't use whirlpool for wound management.
To help patients understand what those recommendations mean for them, APTA has partnered with Consumer Reports to create a freeconsumer-friendly summary in both English and Spanish. Consumer Reports already has reached more than 100 million consumers with Choosing Wisely information through its network of consumer communications partners.
"We welcome APTA as the first nonphysician organization to join the Choosing Wisely campaign," said Tara Montgomery, senior director for health impact at Consumer Reports. "We applaud APTA's courage in addressing overuse and salute the association's encouragement of informed patient-doctor dialogue. By understanding what works and what to question, patients can get the most from their physical therapists," she said.
To create the list, APTA invited its more than 88,000 members to submit items for inclusion. More than 170 submissions were received. APTA convened an expert workgroup of physical therapists, representing a broad range of clinical expertise, practice settings, and patient populations. The association employed a modified version of the Delphi technique—a widely used and accepted method of gathering data from respondents within their domain of expertise—to rank and prioritize recommendations based on the Choosing Wisely criteria. An extensive literature search was conducted on the highest-ranked submissions. The expert panel reviewed the literature and ranked the recommendations based on the established criteria. The final 5 recommendations were selected through a survey that was open to all APTA members; the instructions were to select 5 items from a list of 9. The final list, then, was presented to the APTA Board of Directors for approval.
"Care that is best for the patient always has been the priority of the APTA membership," said Rockar. "Choosing Wisely is an outstanding effort. Its mission to foster better, more efficient care through informative dialogue between patients and health care providers dovetails perfectly with the goal of APTA's Integrity in Practice campaign."
To learn more about Choosing Wisely and read more about APTA's recommendations and their supporting evidence, visitwww.ChoosingWisely.org. To see all of Consumer Reports' Choosing Wisely materials, spanning more than 90 topics, go towww.consumerhealthchoices.org/choosing.