APTA Choosing Wisely List 2014-2015 PDF

Five Things Physical Therapists and Patients Should Question Don’t use (superficial or deep) heat to obtain clinically important long term outcomes in musculoskeletal conditions. 1...

Five Things Physical Therapists and Patients Should Question Don’t use (superficial or deep) heat to obtain clinically important long term outcomes in musculoskeletal conditions. 1 There is limited evidence for use of superficial or deep heat to obtain clinically important long term outcomes for musculoskeletal conditions. While there is some evidence of short-term pain relief for heat, the addition of heat should be supported by evidence and used to facilitate an active treatment program. A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life. There is emerging evidence that passive treatment strategies can harm patients by exacerbating fears and anxiety about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery. Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals. 2 Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls. Older adults are often prescribed low dose exercise and physical activity that are physiologically inadequate to increase gains in muscle strength. Failure to establish accurate baseline levels of strength limits the adequacy of the strength training dosage and progression, and thus limits the benefits of the training. A carefully developed and individualized strength training program may have significant health benefits for older adults. Don’t recommend bed rest following diagnosis of acute deep vein thrombosis (DVT) after the initiation of anti-coagulation therapy, 3 unless significant medical concerns are present. Given the clinical benefits and lack of evidence indicating harmful effects of ambulation and activity both are recommended following achievement of anticoagulation goals unless there are overriding medical indications. Patients can be harmed by prolonged bed rest that is not medically necessary. Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement. Continuous passive motion (CPM) treatment does not lead to clinically important effects on short- or long-term knee extension, long-term knee flexion, 4 long-term function, pain and quality of life in patients undergoing total knee arthroplasty (TKA). With rehabilitation protocols now supporting early mobilization, the use of CPM following uncomplicated total knee arthroplasty should be questioned unless medical and/or surgical complication exist that limit or contraindicate rehabilitation protocols that foster early mobilization. The cost, inconvenience and risk of prolonged bed rest with CPM should be weighed carefully against its limited benefit. As members of interprofessional teams involved in post-operative rehabilitation of patient following total knee replacement, physical therapists have a responsibility to advocate for effective alternatives to CPM for most patients. Don’t use whirlpools for wound management. Whirlpools are a non-selective form of mechanical debridement. Utilizing whirlpools to treat wounds predisposes the patient to risks of bacterial 5 cross-contamination, damage to fragile tissue from high turbine forces and complications in extremity edema when arms and legs are treated in a dependent position in warm water. Other more selective forms of hydrotherapy should be utilized, such as directed wound irrigation or a pulsed lavage with suction. These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider. Released September 14, 2014; recommendation #1 updated November 18, 2015 How This List Was Created The American Physical Therapy Association (APTA) invited all 88,000 members to suggest items for the Choosing Wisely® list. Communication of this request was distributed to members via website posting, e-mail blast and social media. APTA convened an expert workgroup 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 upon 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 final approval. APTA’s disclosure and conflict of interest policy can be found at www.apta.org. Sources Ulus Y, Tander B, Akyol Y. Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study. Int J Rheum Dis. 2012 Apr;15(2):197–206. Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009 May;89(5):419–29. Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther. 2001 Jul;81(7):1339-50. 1 Graham N, Gross A, Goldsmith C, Michlovitz S. Heat and cold for neck pain: A systematic review. Physiother Can. 2009;61:73-73. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004750. Gebremariam L, Hay EM, van der Sande R, Rinkel WD, Koes BW, Huisstede BM. Subacromial impingement syndrome—effectiveness of physiotherapy and manual therapy. Br J Sports Med. 2014 Aug;48(16):1202-8 Davis AM, MacKay C. Osteoarthritis year in review: outcome of rehabilitation. Osteoarthritis Cartilage. 2013 Oct;21(10):1414-24. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;(2) CD004258. Silva NL, Oliveira RB, Fleck SJ, Leon AC, Farinatti P. Influence of strength training variables on strength gains in adults over 55 years old: A meta-analysis of dose-response relationships. J Sci Med Sport. 2014;17(3):337–44. Raymond MJ, Bramley-Tzerefos RE, Jeffs KJ, Winter A, Holland AE. Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Arch Phys Med Rehabil. 2013;94(8):1458–72. 2 Valenzuela T. Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review. J Am Med Dir Assoc. 2012;13(5):418–28. Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Muller S, Scharhag J. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int. 2011;108(21):359–64. Nicola F,Catherine S. Dose-response relationship of resistance training in older adults: a meta-analysis. Br J Sports Med. 2011;45(3):233–4. Aissaoui N, Martins E, Mouly S, Weber S, Meune C. A meta-analysis of bed rest versus early ambulation in the management of pulmonary embolism, deep vein thrombosis, or both. Int J Cardiol. 2009;137(1):37–41. Anderson CM, Overend TJ, Godwin J, Sealy C, Sunderji A. Ambulation after deep vein thrombosis: a systematic review. Physiother Can. 2009;61(3):133–40. 3 Gay V, Hamilton R, Heiskell S, Sparks AM. Influence of bedrest or ambulation in the clinical treatment of acute deep vein thrombosis on patient outcomes: a review and synthesis of the literature. Medsurg Nurs. 2009;18(5):293–99. Kahn SR, Shrier I, Kearon C. Physical activity in patients with deep venous thrombosis: a systematic review. Thromb Res. 2008;122(6):763–73. Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, Pelland L, Noel MJ, Davis J, Drouin H. Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. J Rheumatol. 2004;31(11):2251–64. Grella RJ. Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation? Phys Ther Rev. 2008;13(4):269–79. 4 Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2014;2:CD004260. van Dijk H, Elvers J, Oostendorp R. Effect of continuous passive motion after total knee arthroplasty: a systematic review. Physiother Singapore. 2007;10(4):9–19. Viswanathan P,Kidd M. Effect of continuous passive motion following total knee arthroplasty on knee range of motion and function: a systematic review. NZ J Physiother. 2010;38(1):14–22. Institute for Clinical Systems Improvement (ICSI). Pressure ulcer prevention and treatment protocol. Health care protocol. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jan. 88 p. Association for the Advancement of Wound Care (AAWC) venous ulcer guideline. Malvern (PA): Association for the Advancement of Wound Care (AAWC); 2010 Dec. 7 p. Water use in hydrotherapy tanks [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2009 Aug 10 [cited 2014 Apr 23]. 5 Available from: http://www.cdc.gov/healthywater/other/medical/hydrotherapy.html. Berrouane YF, McNutt LA, Buschelman BJ. Outbreak of severe pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis. 2000;31(6):1331–7. McCulloch J, Boyd VB. The effects of whirlpool and the dependent position on lower extremity volume. J Orthop Sports Phys Ther. 1992;16(4):169–73. About the ABIM Foundation About the American Physical Therapy Association The mission of the ABIM Foundation is to advance The American Physical Therapy Association medical professionalism to improve the health (APTA) represents more than 88,000 physical care system. We achieve this by collaborating with therapists, physical therapist assistants and students physicians and physician leaders, medical trainees, of physical therapy nationwide. Physical therapists health care delivery systems, payers, policymakers, apply research and proven treatment to help people reduce pain and restore consumer organizations and patients to foster a shared ® movement after injury, illness or surgery; prevent injury; and achieve fitness, understanding of professionalism and how they can health and wellness. No matter what area of the body, physical therapists have adopt the tenets of professionalism in practice. an established history of helping individuals improve their quality of life. APTA seeks to improve the health and quality of life of individuals in society To learn more about the ABIM Foundation, visit www.abimfoundation.org. by advancing physical therapist practice, education and research, and by increasing the awareness and understanding of physical therapy’s role in the nation’s health care system. For more information about APTA, visit www.apta.org. For more information or to see other lists, visit www.choosingwisely.org.