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Unnecessary health tests, treatments and procedures to avoid

Australian Physiotherapy Association vice presiden
Photo: Australian Physiotherapy Association vice president Phil Calvert
Physiotherapists say routine imaging for non-specific low back pain and for the cervical spine in trauma patients should be avoided.

The Australian Physiotherapy Association (APA) advice is part of 61 new recommendations for tests, treatments and procedures that are often unnecessary and can also harm Australian patients.

Physiotherapy’s peak professional body has joined 13 colleges and societies representing health practitioners including nurses, hospital pharmacists, pathologists, radiologists, GPs, surgeons and palliative care specialists, as part of the NPS MedicineWise Choosing Wisely Australia campaign.
The APA's six recommendations include urging physiotherapists against routinely using spirometry after upper abdominal and cardiac surgery, to avoid using electrotherapy modalities for patients with low back pain, and to avoid ongoing manual therapy for patients with adhesive capsulitis of the shoulder.

It also urged physiotherapists against requesting imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (OAR).

APA vice president Phil Calvert said the association’s recommendations are the result of almost 3000 responses to a member survey, which were then put to a panel of physiotherapy experts.

“We really recognise that the recommendations are just that - they’re recommendations, they’re to be used as a guide. We understand every clinical situation is different,” he said.

“I think physiotherapy as a profession is very, very good at looking at what it does critically - evaluating what it does.

“This forms part of that but I think the real thing that we’re focused on here is the opportunity to actively engage and have good conversations with our patients.”

One of the APA recommendations urges physiotherapists against requesting imaging for patients with non-specific low back pain, with trials consistently showing routine imaging has no advantages while there are potential harms, such as exposure to radiation.

“Imaging is instead recommended for cases of low back pain where there is a suspicion of an underlying medically serious disease, like cancer or infection. Patients with a higher likelihood of medically serious disease as the cause of their low back pain can be identified by red flags, like a history of cancer,” the recommendation states.

Mr Calvert said people presenting with the common problem of acute low back pain often mistakenly believe that imaging will identify the cause of their pain.

“We know that people who come to see a health professional will come with often very specific expectations about what their care might be,” he said.

“They might have a very strong expectation that an X-ray will be a part of that assessment process whereas the evidence strongly suggests that in most situations that’s not necessary - an X-ray doesn’t add to that information or to that treatment program.”

In its five recommendations, the Australian College of Nursing (ACN) says nurses should not routinely replace peripheral intravenous catheters or use urinary catheters to manage incontinence.

It also urges against the use of antipyretic medication, such as paracetamol or ibuprofen, to reduce fever in children unless children are demonstrating signs of distress, and for nurses to support people with diabetes to perform their own blood glucose monitoring without unnecessary intervention unless there’s a reasonable clinical indication.

ACN has also advocated for the OAR criteria to be met before using X-rays for patients with foot and ankle trauma.

The campaign’s recommendations include the appropriate and responsible use of antibiotics in a bid to reduce further development of antibiotic resistance.

In end of life and palliative care, recommendations include early discussion of advance care planning, early palliative care referral, use of oxygen for non-hypoxic patients and percutaneous feeding in advance dementia, and to not initiate or continue medicines to prevent disease in patients with a limited life expectancy.


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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords