Survey design
The six original APA Choosing Wisely recommendations use largely similar language. No recommendations used positive framing (‘do X’) or provide alternatives to low-value care. All recommendations outline ‘what’ needs to be done, and none outlined ‘why’ the recommendation is important and ‘who’ the recommendation is targeted towards. Although Choosing Wisely recommendations from the APA should target physical therapists, there is evidence that recommendations from some professional associations target members of other associations.The language of the six Choosing Wisely recommendations was modified on four factors (Providing less detail (‘what’ the recommendation is) vs. more detail (‘what’ the recommendation is, ‘who’ the recommendation is for, and ‘why’ the recommendation is important).Using unqualified (e.g. ‘don't…’) vs. qualified language (e.g. ‘don't routinely…’)Providing positive (‘do X’) vs. negative framing (‘don't do Y’); andProviding alternatives to low-value care vs. not providing alternatives.Language characteristics and how they are varied for the best-worst scaling survey.To ensure readability and comprehensibility, we sought feedback from physical therapists on the re-worded Choosing Wisely recommendations. We conducted pilot testing with seven physical therapists to estimate how long it took participants to complete and assess comprehension. After the pilot testing, we decreased the number of questions from 15 in each block to 7 as the cognitive load of completing the survey was too high.