Choosing Wisely
UD physical therapy professor leads effort to identify questionable treatments
10:59 a.m., Sept. 18, 2014--Physical therapy clinics are outfitted with a broad range of treatment equipment, from balance balls, treadmills, and stretch bands to laser, ultrasound, and electrical muscle stimulation devices.
But what really works?
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The American Physical Therapy Association recently released a list of common treatments that physical therapists and patients should question. The list was developed through member suggestions and refined by an expert panel co-chaired by Tara Jo Manal, associate professor in the Department of Physical Therapy at the University of Delaware.
The list is part of APTA’s partnership with the Choosing Wisely campaign from the American Board of Internal Medicine Foundation. The initiative aims to help consumers make informed health care choices by providing lists of procedures that tend to be done frequently, but whose usefulness is called into question by evidence. APTA is the first non-physician group to release a list, joining more than 50 medical specialty societies.
The five PT treatments that should be questioned are passive physical agents that aren’t part of an active treatment plan, too-easy strength training for older adults, bed rest for blood clots, continuous passive motion machines after total knee replacement, and whirlpools for wound care.
“One of the things I think physical therapists are best known for is trying to identify best practice initiatives that will really assist their patients, especially in situations where the opportunity to provide more care is being reduced on a daily basis,” says Manal, who is also director of clinical services and residency training at UD.
“So the key is, can we identify things that are best practice initiatives and reduce the things that don’t add to the outcomes of our patients and do it in a way that really is informative to physical therapists so that we can provide enhanced care and we can educate our patients to understand why we’re making the choices we’re making?”
Manal points to the diversity of the list and its inclusion of practices that the profession would like to move beyond.
“Physical therapists now have a way to communicate with their patients and have a discussion about why they’re making their choices,” she says.
Consumer Reports is developing and disseminating the materials to help patients engage their physicians in these conversations and empower them to ask questions about what tests and procedures are right for them. Click here to read the full article, “Five Physical Therapy Treatments You Probably Don’t Need.”
Manal is also co-chair of PTNow.org, an APTA portal aimed at getting evidence into the hands of practicing clinicians at the bedside and making it available for further evaluation.
“This is a major initiative,” she says, “as my path is really on educating the next generation of health care providers and reducing variability of practice towards the most evidence-based effective frontline care. PTNow.org will live on as a primary portal for therapists to receive and search for evidence in the care of their patients.”
How the Choosing Wisely list was created
The APTA invited all 88,000 members to suggest items for the Choosing Wisely list and convened an expert work group of physical therapists representing a broad range of clinical expertise, practice settings and patient populations. A modified Delphi technique was used to rank and prioritize the recommendations based upon the Choosing Wisely criteria. An extensive literature search was conducted on the highest rated strategies.
The expert panel reviewed the literature and provided a ranking of recommendations based on the established criteria. The final list of five strategies was selected through a survey open to all APTA members, who were asked to select five items from a list of nine, all of which met the established criteria.
The final list was presented to the APTA Board of Directors for approval.
Article by Diane Kukich
Photos by Doug Baker and Evan Krape