Can language enhance physiotherapists’ willingness to follow Choosing Wisely recommendations? A best-worst scaling study
Priti Kharel1, Joshua Zadro1, Chris Maher1, Giovanni Ferreira1, Martin Howell2, Kirsten Howard2, Sally Wortley2, Charlotte McLennan11The University of Sydney, Sydney Musculoskeletal Health, Camperdown, Sydney, NSW, Australia2The University of Sydney, Sydney School of Public Health, Sydney, NSW, Australia
Abstract
Background: Choosing Wisely recommendations could reduce physiotherapists’ use of low-value care.
Objective: To investigate whether language influences physiotherapists’ willingness to follow the Australian Physiotherapy Association’s (APA) Choosing Wisely recommendations.
Design: Best-worst Scaling survey
Methods: The six original APA Choosing Wisely recommendations were modified based on four language characteristics (level of detail, strength- qualified/unqualified, framing, and alternatives to low-value care) to create 60 recommendations. Physiotherapists were randomised to a block of seven choice tasks, which included four recommendations. Participants indicated which recommendation they were most and least willing to follow. A multinomial logistic regression model was used to create normalised (0=least preferred; 10=most preferred) and marginal preference scores.
Results: 215 physiotherapists (48.5% of 443 who started the survey) completed the survey. Participants’ mean age (SD) was 38.7 (10.6) and 47.9% were female. Physiotherapists were more willing to follow recommendations with more detail (marginal preference score of 1.1) or provided alternatives to low-value care (1.3) and less willing to follow recommendations with negative framing (-1.3). The use of qualified (‘don’t routinely’) language (vs. unqualified – ‘don’t’) did not affect willingness. Physiotherapists were more willing to follow recommendations to avoid imaging for non-specific low back pain (3.9) and electrotherapy for low back pain (3.8) vs. recommendations to avoid incentive spirometry after upper abdominal and cardiac surgery.
Conclusion: Physiotherapists were more willing to follow recommendations that provided more detail, alternatives to low-value care, and were positively framed. These findings can inform the development of future Choosing Wisely recommendations and could help reduce low-value physiotherapy.
Biography
Priti Kharel is a PhD student at the Institute for Musculoskeletal Health, University of Sydney. She is from Nepal and completed her Master of Public Health in the UK. Her research focuses on replacing low-value care with high-value care in physiotherapy.