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Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review
Open accessAbstract
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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“Barriers to practicing the evidence-based therapies include a lack of access to resources that contain such evidence [92,93] and limited usable formats of the evidence [94].”
From Development and usability testing of a web-based and therapist-assisted coping skills program for managing psychosocial problems in individuals with hand and upper limb injuries: Mixed methods study (2020) · cites this paper as [92]
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George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021) · Journal of Orthopaedic & Sports Physical Therapy · doi:10.2519/jospt.2021.0304 · Cited by 607
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“review was that many physiotherapists often do not follow guidelines for management of musculoskeletal pain.(73) For example, Stevenson et al.”
BackgroundMaestroni, L., Read, P. J., Bishop, C. J., Papadopoulos, K., Suchomel, T. J., Comfort, P., & Turner, A. N. (2020) · Sports Medicine · doi:10.1007/s40279-020-01309-5 · Cited by 219
Nguyen, A. T., Lee, P., Rodriguez, E. K., Chahal, K., Freedman, B. R., & Nazarian, A. (2025) · The Lancet Healthy Longevity · doi:10.1016/j.lanhl.2025.100707 · Cited by 106
Grooten, W. J. A., Boström, C., Dedering, Å., Halvorsen, M., Kuster, R. P., Nilsson-Wikmar, L. B., Olsson, C., Rovner, G., Tseli, E., & Rasmussen-Barr, E. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05722-x · Cited by 105
Metadata
- Authors
- Zadro, J., O’Keeffe, M., & Maher, C.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Zadro, Joshua
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-10
- Volume
- 9
- Issue
- 10
- Pages
- e032329
- ISSN
- 2044-6055 (ISSN-L)
- 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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