Background Musculoskeletal conditions such as back and neck pain - the leading cause of disability worldwide – are often managed by physical therapists. However, overuse of physical therapy is a well-recognized issue that can exacerbate the burden of these disorders. Drivers to overuse are not well understood and strategies to reduce it require a multidimensional effort from all stakeholders. Policymakers’ perspectives on overuse in physical therapy can provide valuable insight into the phenomenon and guide effective policy interventions to reduce it.

Objective Explore policymakers’ views on overuse, its potential harms, and main drivers, in musculoskeletal physical therapy.

Design Qualitative interview study.

Methods We conducted semi-structured interviews with Israeli policymakers, that included: healthcare managers representing all public health maintenance organizations, army, and government; senior members of the Israeli Physiotherapy Society (IPTS), Supreme Physical Therapy Council and Physiotherapy Union; higher education institutions; and researchers. Interviews explored policymakers’ perceptions of harm from unnecessary tests and treatments, drivers to overuse, the role of shared decision making and strategies to motivate physical therapists to combat overuse. Interviews were recorded, transcribed verbatim and analyzed thematically.

Results We interviewed 22 participants. Mean (SD) age of participants was 51 (9), mean (SD) years of experience was 24 (9), 50% were male (n = 11) and 77.3% worked in public practice (n = 17). Five main themes were identified from the transcripts, consisting of education gaps, misperceptions of harms and benefits of ineffective and unnecessary physical therapy test and treatments, health system organization, clinician factors and experiences, and patient preferences and beliefs.

Conclusion The results of this study will inform the development of effective strategies to reduce low-value care in physical therapy, such as creation of Israeli Choosing Wisely recommendations list - that target tests or treatments that has no net benefit or causes harm.