American Physical Therapy Association
View all recommendations from this societyReleased September 15, 2014
Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program.
There is limited evidence for use of passive physical agents to obtain clinically important outcomes for musculoskeletal conditions. A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life. While there is some evidence of short-term pain relief for certain physical agents, the addition of passive physical agents should be supported by evidence and used to facilitate an active treatment program. There is emerging evidence that passive physical agents can harm patients. Communicating to patients that passive, instead of active, management strategies are advisable exacerbates fears and anxiety that many patients have about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider.
How The List Was Created
The American Physical Therapy Association (APTA) invited all 88,000 members to suggest items for the Choosing Wisely® list. Communication of this request was distributed to members via website posting, e-mail blast and social media. APTA convened an expert workgroup of physical therapists representing a broad range of clinical expertise, practice settings and patient populations. A modified Delphi technique was used to rank and prioritize the recommendations based upon the Choosing Wisely criteria. An extensive literature search was conducted on the highest rated strategies. The expert panel reviewed the literature and provided a ranking of recommendations based upon the established criteria. The final list of five strategies was selected through a survey open to all APTA members who were asked to select five items from a list of nine, all of which met the established criteria. The final list was presented to the APTA Board of Directors for final approval.
APTA’s disclosure and conflict of interest policy can be found at www.apta.org.
Sources
Chatzitheodorou D, Kabitsis C, Malliou P, Mougios V. A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain. Phys Ther. 2007;87(3):304–12.
Hooten WM, Timming R, Belgrade M, Gaul J, Goertz M, Haake B, Myers C, Noonan MP, Owens J, Saeger L, Schweim K, Shteyman G, Walker N. Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Nov. 105 p.
Hurwitz, EL, Carragee, EJ, van der Velde G. Treatment of neck pain: noninvasive interventions. Eur Spine J. 2008;17:123–52.
Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009;89(5):419–29.
Ulus Y, Tander B, Akyol Y. Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study. Int J Rheum Dis. 2012;15(2):197–206.
Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology. Phys Ther. 2001;81(10):1629–40.
