Monday, September 15, 2014 Choosing Wisely: APTA Releases List of Procedures That PTs and Patients Should Question Passive physical agents that aren’t part of an active treatment plan, under-dosed strength training for older adults, and the use of whirlpools for wound management are among the "5 Things That Physical Therapists and Patients Should Question," according to a list recently announced by APTA. The list, developed through member suggestions and refined by an expert panel, is now part of a national campaign that encourages patients and health care providers to talk about whether a given procedure is really necessary based on the patient's individual circumstances. The list announced today is part of APTA's partnership with the Choosing Wisely® campaign from the American Board of Internal Medicine (ABIM) Foundation. The initiative aims to help consumers make informed health care choices by providing lists of procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. APTA is the first nonphysician group to release a list, joining more than 50 medical specialty societies. "A well-informed patient is a well-treated patient," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in a news release. "The Choosing Wisely campaign addresses the patient's role in good health care, and we are happy to join this effort." The 5 recommendations, which are expanded upon with citations at the Choosing Wisely website and in the downloadable list of "5 Things Physical Therapists and Patients Should Question," are: Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program. Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals. Don’t recommend bed rest following diagnosis of acute deep vein thrombosis (DVT) after the initiation of anti-coagulation therapy unless significant medical concerns are present. Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement. Don’t use whirlpool for wound management. The process for developing the list began with an open call for APTA members to submit their lists of questionable procedures. After receiving more than 170 submissions, APTA convened an expert group of physical therapists from a wide range of practice settings and areas of clinical expertise. The group reviewed all nominations and conducted extensive literature reviews to narrow down the list to 9 procedures. The list of 9 was presented to the 88,000 members of APTA, who voted on the final 5. To help patients and clients understand what APTA’s Choosing Wisely recommendations mean for them, APTA has partnered with Consumer Reports to create a free consumer-friendly summary, which will also be made available in Spanish. Consumer Reports already has reached more than 100 million consumers with Choosing Wisely information through its network of consumer communications partners. APTA's Choosing Wisely list is also the subject of a ProfessionWatch paper e-published ahead of print in Physical Therapy. The paper details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation in Choosing Wisely. The partnership is a component of the larger APTA Integrity in Practice campaign, an effort to support the profession of physical therapy as a leader in the elimination of fraud, abuse, and waste in health care. An APTA Center for Integrity in Practice has been created and will be developing resources throughout the course of the campaign, but already offers a primer on preventing fraud, abuse, and waste, and an online course on compliance and professional integrity. "Care that is best for the patient has always been a priority for APTA," Rockar said. "Choosing Wisely is an outstanding effort, and its mission to foster better, more efficient care through informative dialogue between patients and health care providers dovetails perfectly with the goal of our Integrity in Practice campaign."