Exploring ways to replace low-value care with high-value care in physiotherapy

Abstract

Despite an increase in the use of physiotherapy services in Australia, the need to replace low-value care with high-value care in physiotherapy has received little-to-no attention. The overall aim of this thesis is to explore strategies to replace low-value care with high-value care in physiotherapy.

Chapter Two explores the importance of the Choosing Wisely campaign in addressing low-value care in musculoskeletal health and the evidence behind the success of the campaign in medicine. Chapter Three explores physiotherapists’ attitudes, views, and beliefs towards the Australian Physiotherapy Association’s (APA) Choosing Wisely recommendations and the barriers and facilitators to physiotherapists using them. Chapter Four investigates whether language influences physiotherapists’ willingness to follow the APA Choosing Wisely recommendations. Chapter Five investigates the effectiveness of Choosing Wisely recommendations in reducing physiotherapists’ intentions to refer for imaging and use electrotherapy for low back pain compared to no recommendations. Chapter Six presents the findings of a systematic review that determined the proportion of clinicians that are aware of five imaging decision rules (Ottawa Ankle Rules, Ottawa Knee Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study (NEXUS) and Canadian Computed Tomography Head Rules) and the proportion that use them in practice. Our results suggested low awareness and use of these five imaging decision rules. Chapter Seven presents the findings of a systematic review that evaluated the effectiveness of various implementation strategies for increasing clinicians’ use of the five validated imaging decision rules mentioned in Chapter Six.

This thesis has filled important gaps in evidence and has the potential to make a positive shift from low-value to high-value care in the field of physiotherapy and also holds promise for improving healthcare practices more broadly.