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24 Overdiagnosis, overtreatment and low-value care in physiotherapy: a scoping review
  1. Joshua Zadro1,2,
  2. Christopher Maher1,2,
  3. Mary O’Keeffe1,2
  1. 1School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
  2. 2Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia


Objectives The aim of this scoping review was to define concepts and map the available research in the area of overdiagnosis, overtreatment and low-value care relevant to physiotherapy by answering the following questions:

  1. When did the concept of ‘low-value’ physiotherapy start to be discussed in the literature?

  2. What terms are being used to describe overdiagnosis, overtreatment, and low-value care relevant to physiotherapy?

  3. What is the prevalence of physiotherapy care that is low-value, high-value, or unknown value, and does this differ across areas of physiotherapy practice?

  4. What proportion of physiotherapy care is delivered in accordance with evidence-based clinical practice guidelines?

  5. Which strategies aimed at improving the quality of physiotherapy care are effective?

Method A keyword search will be run in MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, AMED Scopus and Web of Science (earliest record to April 2018) combining terms synonymous with ‘low-value care’ and ‘physiotherapy’. Additional articles will be identified by hand-searching references lists and forward searching of included articles.

Articles discusses low-value physiotherapy (e.g. editorials, Choosing Wisely reports), investigating physiotherapy treatment practices and adherence to guidelines, and evaluating strategies to improve the quality of physiotherapy will be included. There will be no restriction on the physiotherapists clinical specialty (musculoskeletal, cardiopulmonary and neurological), work setting (e.g. private, public, community), experience, ethnicity, age or gender.

Two reviewers will independently perform the selection of studies and extracted key data (e.g. study characteristics, outcome data relevant to research questions). Disagreement will be resolved through discussion. Analyses will be qualitative for questions i–ii), and quantitative for questions iii–v) where data is considered sufficiently homogenous for meta-analysis.

Results This study will be reported according to the ‘Preferred reporting items for systematic reviews and meta-analyses’ (PRISMA) statement. At the time of submission we were extracting data from the included studies. Hence, I am confident to present the full findings of this review at the conference.

Conclusions Overdiagnosis, overtreatment and low-value care – care that provides little-to-no benefit or causes harm, and that is an unwise use of scarce health resources – are concepts receiving substantial attention in medicine. However, it is unclear how much attention these concepts are receiving in physiotherapy. Understanding whether these concepts are receiving attention in physiotherapy and evaluating the prevalence of low-value physiotherapy is important because the profession is rapidly expanding. Identify the areas of physiotherapy practice where the quality of care must improve and identifying effective strategies for improving guideline adherence in physiotherapy could have enormous implication for improving the health of millions of people worldwide who seek physiotherapy each year.

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