Cited by 309Clinical practice guidelines implementationMusculoskeletal pain and rehabilitationHealth Sciences Research and Education

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Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

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Zadro, Joshua, O’Keeffe, Mary, Maher, Christopher·2019·BMJ Open

DOI 10.1136/bmjopen-2019-032329PMC PMC6797428

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Abstract

Objectives: Physicians often refer patients with musculoskeletal conditions to physical therapy. However, it is unclear to what extent physical therapists’ treatment choices align with the evidence. The aim of this systematic review was to determine what percentage of physical therapy treatment choices for musculoskeletal conditions agree with management recommendations in evidence-based guidelines and systematic reviews. Design: Systematic review. Setting: We performed searches in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine, Scopus and Web of Science combining terms synonymous with ‘practice patterns’ and ‘physical therapy’ from the earliest record to April 2018. Participants: Studies that quantified physical therapy treatment choices for musculoskeletal conditions through surveys of physical therapists, audits of clinical notes and other methods (eg, audits of billing codes, clinical observation) were eligible for inclusion. Primary and secondary outcomes: Using medians and IQRs, we summarised the percentage of physical therapists who chose treatments that were recommended, not recommended and had no recommendation, and summarised the percentage of physical therapy treatments provided for various musculoskeletal conditions within the categories of recommended, not recommended and no recommendation. Results were stratified by condition and how treatment choices were assessed (surveys of physical therapists vs audits of clinical notes). Results: We included 94 studies. For musculoskeletal conditions, the median percentage of physical therapists who chose recommended treatments was 54% (n=23 studies; surveys completed by physical therapists) and the median percentage of patients that received recommended physical therapy-delivered treatments was 63% (n=8 studies; audits of clinical notes). For treatments not recommended, these percentages were 43% (n=37; surveys) and 27% (n=20; audits). For treatments with no recommendation, these percentages were 81% (n=37; surveys) and 45% (n=31; audits). Conclusions: Many physical therapists seem not to follow evidence-based guidelines when managing musculoskeletal conditions. There is considerable scope to increase use of recommended treatments and reduce use of treatments that are not recommended. PROSPERO registration number: CRD42018094979.

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Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. AMED, Allied and Complementary Medicine; CENTRAL, Cochrane Central Register of Controlled Trials; CINAHL, Cumulative Index to Nursing and Allied Health Literature.CC BY-NC · PubMed Central

Figure 2 Median percentage of physical therapy treatment choices that involved treatments that are recommended, not recommended and had no recommendation. (A) The percentage of physical therapists that report they provide (or would provide) treatments that are recommended, not recommended and had no recommendation for a given condition. (B) The percentage of patients that received treatments that were recommended, not recommended and had no recommendation from a physical therapist for a given condition as determined by audits of clinical notes, audits of billing codes, treatment recording forms, clinical observation or surveys completed by patients. *No treatment choices in this category(s) could be identified. LBP, low back pain; MSK: all musculoskeletal conditions (excluding shoulder pain and knee/hip arthroplasty); OA, osteoarthritis.CC BY-NC · PubMed Central

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Authors: Zadro, J., O’Keeffe, M., & Maher, C.
Affiliations: The University of Sydney (AU)
Corresponding author: Zadro, Joshua
ORCID: Zadro, Joshua
O’Keeffe, Mary
Maher, Christopher
Venue: BMJ Open
Publisher: BMJ
Published: 2019-10
Volume: 9
Issue: 10
Pages: e032329
ISSN: 2044-6055 (ISSN-L)
DOI: 10.1136/bmjopen-2019-032329
PMC: PMC6797428
OpenAlex: W2980198210
Cited by: 309
References: 110
Citations by year: 2026: 20 · 2025: 55 · 2024: 61 · 2023: 42 · 2022: 58 · 2021: 45 · 2020: 26 · 2019: 1
FWCI: 5.31
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
Locations: BMJ Open (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
HighWire Press Open Archive (submittedVersion)
Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: physiotherapy, evidence-based practice, clinical practice patterns, musculoskeletal disorders, guideline adherence, physiotherapists, treatment guidelines
MeSH terms: Humans, Musculoskeletal Diseases, Practice Guidelines as Topic, Guideline Adherence, Physical Therapy Modalities, Evidence-Based Practice, Physical Therapists

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Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

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