Can language enhance physical therapists' willingness to follow Choosing Wisely recommendations? A best-worst scaling study.
Priti Kharel, Joshua R Zadro, Giovanni Ferreira and 5 others
PMID 37597492WHAT IT FOUND
Physical therapists said they were more willing to follow Choosing Wisely recommendations that explained why and who they were for, gave a positive action to do instead, and avoided negative "don't" framing.
Wording that said "avoid" or "don't routinely" made no difference.
Key findings
01Recommendations that provided alternatives to low-value care and gave more detail increased willingness to follow them, while negative framing decreased it.
02Whether the wording was qualified ("avoid", "don't routinely") or unqualified ("don't") did not change willingness to follow the recommendation.
03None of the six original Australian Physiotherapy Association recommendations, which were low on detail and negatively framed, made the top ten most preferred recommendations.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Over half of the people who opened the survey did not complete it, and demographics were collected at the end, so it is not possible to say whether the 215 who finished represent all physical therapists. Only twelve of the sixty recommendation versions used positive framing, so the true effect of positive wording may be over- or under-estimated. The outcome is stated willingness to follow a recommendation, not actual patient care, so it cannot show whether better wording changes what therapists do in the clinic. The sample was self-selected through newsletters, email and social media and was mostly musculoskeletal and experienced, so it may not reflect therapists in other settings or specialities.
Declared interests
None declared.
The easy way to misread this
Do not read this as evidence that reworded recommendations change patient care. Participants reported which wording they would prefer to follow in a survey; the study did not measure what they actually did with patients, and it does not prove any of the underlying treatments are effective or ineffective.