Meaning of the study
low back pain
ADHESIVE CAPSULITIS
Our study highlights important aspects of language that could influence physical therapists’ willingness to follow Choosing Wisely recommendations and serve as a guide for writing future recommendations. Physical therapists were more likely to follow recommendations with more detail and recommendations that were positively framed, regardless of physical therapists’ characteristics or background (such as the clinical area of interest, years of experience, familiarity with the recommendations, and work setting). In contrast, all six of the APA's original recommendations were low on detail (i.e. only described the recommendation, and not ‘who’ it was for and ‘why’ it was important) and were negatively framed. These findings could explain why none of the APA's original recommendations made the top 10 most preferred recommendations.Choosing Wisely, a global initiative with over 1300 recommendations, aims to make clinicians aware of avoiding low-value tests or treatments that do not benefit patients or sometimes even lead to harm.Recommendations against imaging for non-specific low back pain and electrotherapy for low back pain were the most preferred recommendations. This finding is similar to the content analysis where feedback on a draft list of the APA Choosing Wisely recommendations was sought from 543 physical therapists.In the sub-group analyses, we found that musculoskeletal physical therapists were more willing to follow recommendations against imaging for non-specific low back pain and electrotherapy for low back pain when compared with non-musculoskeletal physical therapists. This could be because musculoskeletal physical therapists were more familiar with recommendations that advised against imaging for non-specific low back pain, electrotherapy for low back pain and manual therapy for adhesive capsulitis, as these are some of the major examples of low-value care in this area of practice.