A survey of physical therapists’ clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD)

Corkery, Marie B.; Edgar, Kristen L.; Smith, Christine E.

doi:10.1179/2042618613y.0000000048

Cited by 22 publications

(22 citation statements)

References 52 publications

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“…Some of them might have used outcome measures in their research projects which might have resulted in more familiarity with SOMs. This is similar to a study that showed that advanced certification and knowledge of guidelines appeared to play a role in the clinical practice of physiotherapists treating patients with whiplash-associated disorders (Corkery, Edgar & Smith 2014 ).…”

Section: Discussionsupporting

confidence: 86%

A comparative survey of Nigerian physiotherapists’ familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey

Odole

Oyewole

Akinpelu

2018

S. Afr. j. physiother.

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BackgroundThe need for physiotherapists to use standardised outcome measures (SOMs) is recognised and recommended in clinical practice guidelines in many countries.AimTo evaluate changes in physiotherapy practice in Nigeria on the utilisation of SOMs and physiotherapists’ familiarity with and knowledge of SOMs over the past decade.MethodsA comparative cross-sectional survey of present data with 2006 data was undertaken. The existing validated questionnaire of 2006 was used to assess physiotherapists’ familiarity with, knowledge of and utilisation of 16 SOMs.ResultsThere was a noticeable change in familiarity with and utilisation of 16 SOMs in the current data and in knowledge. Between 52% and 90% of physiotherapists were not familiar with 14 SOMs in 2006, whereas 51.4% – 85.8% of physiotherapists were not familiar with 8 SOMs in 2016; 77% – 97% and 63.4% – 97.3% of physiotherapists were not utilising SOMs in the 2006 and 2016 data, respectively. The least utilised SOMs in 2006 were Western Ontario McMaster Osteoarthritis Index, Chedoke McMaster Stroke Assessment and SF-36 Health Survey; in 2016, it was only the Chedoke McMaster Stroke Assessment. The Visual Analogue Scale and Gross Motor Function Measure remained the most utilised in both data. Duration of practice, age and sex were significant factors for the utilisation of and familiarity with SOMs.ConclusionThere was an improvement in the familiarity with, knowledge of and utilisation of SOMs over the past decade among Nigerian physiotherapists but the level of utilisation is unsatisfactory. Action is required if routine outcome measurement is to be achieved.Clinical ImplicationsUtilisation of SOMs is part of core standards of physiotherapy practice for effective management of patients. Although the utilisation of SOMs improved over the past 10 years, it is very low. Therefore, studies directed at finding factors responsible for low utilisation of SOMs among Nigerian physiotherapists are warranted.

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Section: Discussionsupporting

confidence: 86%

A comparative survey of Nigerian physiotherapists’ familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey

Odole

Oyewole

Akinpelu

2018

S. Afr. j. physiother.

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“…After removing duplicates and screening 8567 titles and abstracts and 254 full-texts reports, 94 studies were included (figure 1). Physical therapy treatment choices were investigated for low back pain (n=48 studies),11–58 knee pain (n=10),32 34 57 59–65 neck pain or whiplash (n=11),15 18 32 34 51 66–71 foot or ankle pain (n=5),72–76 shoulder pain (n=7),15 51 77–81 pre or post knee arthroplasty (n=6)46 82–86 (including one study of hip and knee arthroplasty86) and other musculoskeletal or orthopaedic conditions (where treatment choices were only reported in one study or where one of either recommended or not recommended treatments could not be inferred from guidelines or systematic reviews) (n=18) 87–104. We contacted 15 authors for data (regarding 18 studies): 12 responded and 5 were able to provide the data we requested (regarding six studies) 15 16 22 64 89 100.…”

Section: Resultsmentioning

confidence: 99%

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

2019

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ObjectivesPhysicians often refer patients with musculoskeletal conditions to physical therapy. However, it is unclear to what extent physical therapists’ treatment choices align with the evidence. The aim of this systematic review was to determine what percentage of physical therapy treatment choices for musculoskeletal conditions agree with management recommendations in evidence-based guidelines and systematic reviews.DesignSystematic review.SettingWe performed searches in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine, Scopus and Web of Science combining terms synonymous with ‘practice patterns’ and ‘physical therapy’ from the earliest record to April 2018.ParticipantsStudies that quantified physical therapy treatment choices for musculoskeletal conditions through surveys of physical therapists, audits of clinical notes and other methods (eg, audits of billing codes, clinical observation) were eligible for inclusion.Primary and secondary outcomesUsing medians and IQRs, we summarised the percentage of physical therapists who chose treatments that were recommended, not recommended and had no recommendation, and summarised the percentage of physical therapy treatments provided for various musculoskeletal conditions within the categories of recommended, not recommended and no recommendation. Results were stratified by condition and how treatment choices were assessed (surveys of physical therapists vs audits of clinical notes).ResultsWe included 94 studies. For musculoskeletal conditions, the median percentage of physical therapists who chose recommended treatments was 54% (n=23 studies; surveys completed by physical therapists) and the median percentage of patients that received recommended physical therapy-delivered treatments was 63% (n=8 studies; audits of clinical notes). For treatments not recommended, these percentages were 43% (n=37; surveys) and 27% (n=20; audits). For treatments with no recommendation, these percentages were 81% (n=37; surveys) and 45% (n=31; audits).ConclusionsMany physical therapists seem not to follow evidence-based guidelines when managing musculoskeletal conditions. There is considerable scope to increase use of recommended treatments and reduce use of treatments that are not recommended.PROSPERO registration numberCRD42018094979.

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“…Disagreement with blanket recommendations and valuing clinical experience over evidence could explain why some physiotherapists do not use guidelines to inform their treatment choices 10 13 18 19. For example, previous research found only 46% of physiotherapists believe guidelines should inform the management of low back pain (survey of n=274),11 66% apply guidelines to more than half of their patients with acute ankle sprains (survey of n=214)18 and 39% use guidelines to inform the management of whiplash more than three-quarters of the time (survey of n=237) 19. Challenging these beliefs could be an important first step towards replacing low-value care with evidence-based care in physiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapists’ views on the Australian Physiotherapy Association’s Choosing Wisely recommendations: a content analysis

et al. 2019

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ObjectivesChoosing Wisely holds promise for increasing awareness of low-value care in physiotherapy. However, it is unclear how physiotherapists’ view Choosing Wisely recommendations. The aim of this study was to evaluate physiotherapists’ feedback on Choosing Wisely recommendations and investigate agreement with each recommendation.SettingThe Australian Physiotherapy Association emailed a survey to all 20 029 physiotherapist members in 2015 seeking feedback on a list of Choosing Wisely recommendations.ParticipantsA total of 9764 physiotherapists opened the email invitation (49%) and 543 completed the survey (response rate 5.6%). Participants were asked about the acceptability of the wording of recommendations using a closed (Yes/No) and free-text response option (section 1). Then using a similar response format, participants were asked whether they agreed with each Choosing Wisely recommendation (sections 2–6).Primary and secondary outcomesWe performed a content analysis of free-text responses (primary outcome) and used descriptive statistics to report agreement and disagreement with each recommendation (secondary outcome).ResultsThere were 872 free-text responses across the six sections. A total of 347 physiotherapists (63.9%) agreed with the ‘don’t’ style of wording. Agreement with recommendations ranged from 52.3% (electrotherapy for back pain) to 76.6% (validated decision rules for imaging). The content analysis revealed that physiotherapists felt that blanket rules were inappropriate (range across recommendations: 13.9%–30.1% of responses), clinical experience is more valuable than evidence (11.7%–28.3%) and recommendations would benefit from further refining or better defining key terms (7.3%–22.4%).ConclusionsAlthough most physiotherapists agreed with both the style of wording for Choosing Wisely recommendations and with the recommendations, their feedback highlighted a number of areas of disagreement and suggestions for improvement. These findings will support the development of future recommendations and are the first step towards increasing the impact Choosing Wisely has on physiotherapy practice.

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A survey of physical therapists’ clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD)

Cited by 22 publications

References 52 publications

A comparative survey of Nigerian physiotherapists’ familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey

A comparative survey of Nigerian physiotherapists’ familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

Physiotherapists’ views on the Australian Physiotherapy Association’s Choosing Wisely recommendations: a content analysis

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