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

doi:10.1136/bmjopen-2019-032329

Table 2

Percentage (median and IQR) of physical therapy treatment choices that involved treatments that were recommended, not recommended or had no recommendation

	Assessed by surveys of physical therapists¶				Assessed by clinical notes
Musculoskeletal conditions*	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	54	25	76	23	63	46	68	8
Not recommended	43	34	61	37	27	13	45	20
No recommendation	81	49	96	37	45	31	85	31

Low back pain	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	35	16	56	9	50	32	62	5
Not recommended	44	34	64	24	18	10	36	15
No recommendation	72	45	88	24	43	31	81	23

Neck pain and whiplash	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	85	82	94	6	–
Not recommended	38	35	67	5	79	66	89	4
No recommendation	97	72	98	6	57	26	84	4

Shoulder pain	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended§	93	90	94	4	76	68	79	3
Not recommended	90			1	8			1
No recommendation	79	69	88	4	62	57	77	3

Knee osteoarthritis/pain	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	58	49	65	5	65	65	66	2
Not recommended	45	35	55	6	21			1
No recommendation	98	88	100	5	53	42	64	2

Lateral ankle sprains	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	39	31	46	2	–
Not recommended	14			1	–
No recommendation	7			1	45			1

Plantar fasciitis	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	29			1	87			1
Not recommended	43			1	–
No recommendation	98			1	90			1

Knee arthroplasty**	Median (%†)	Q1	Q3	N	Median (%‡)	Q1	Q3	N
Recommended	93	83	95	5	65			1
Not recommended	52	42	67	4	43			1
No recommendation	62	23	95	4	2			1

*Summary values excluded shoulder pain and knee arthroplasty as they did not have guidelines that recommended ‘core’ physical therapy treatments.

†The percentage of physical therapists that report they provide (or would provide) treatments that were recommended, not recommended and had no recommendation.

‡The percentage of patients that received treatments from a physical therapist that were recommended, not recommended or had no recommendation 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.

§Recommended care was based on delivering treatment that was ‘likely to be beneficial’ according to Kulkarni et al.¹¹⁵

¶Summary values for knee arthroplasty include studies that assessed treatment choices by surveys to physical therapy departments.

**Includes one study that combined treatment practices for knee and hip arthroplasty.

N, number of studies; Q1, first quartile; Q3, third quartile.