The Australian Physiotherapy Association
Recommendations from the Australian Physiotherapy Association on low back pain, clinical decision rules, incentive spirometry & frozen shoulder. The Australian Physiotherapy Association (APA) is the peak body representing the interests of Australian physiotherapists and their patients. The APA is a national organisation with non-autonomous state and territory branches and specialty subgroups. The organisation has more than 19,000 members and over 300 members in volunteer positions on committees or working parties.
Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated decision rule
Cervical spine imaging of every trauma patient is costly and results in significant radiation exposure to a large number of patients, very few of whom will have a spinal column injury. The Canadian C-Spine rule identifies patients who can safely be managed without imaging with high sensitivity.
- Michaleff ZA, Maher CG, Verhagen A, Rebeck T, LIN CC. Accuracy of the Canadian C-Spine Rule and NEXUS for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ 2012;184:E867-76.
The APA sought nominations from fellows and associates of the Australian College of Physiotherapy, directors of the Physiotherapy Evidence Database, clinical specialist APA members and academic physiotherapists to form an expert panel. The APA invited all members to submit evidence about interventions related to physiotherapy that should be questioned. From members’ submissions and the expert group’s research, the expert group formed a shortlist of 8 recommendations. The expert group then considered the shortlist in terms of the extent of the health problem, usage of the test or intervention, and the evidence that the test or intervention is inappropriate. From this analysis, the expert panel selected five recommendations to put to APA members. In a second round of consultation, the APA received nearly 2500 responses, and almost 900 comments. The expert panel then considered feedback and refined the recommendations. This resulted in the 6 recommendations put forward below, for which there was overwhelming majority support.
- 1 Don’t request imaging for patients with non-specific low back pain and no indicators of a serious cause for low back pain.
- 2 Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated decision rule
- 3 Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (localised bone tenderness or inability to weight-bear as defined in the rules).
- 4 Don't routinely use incentive spirometry after upper abdominal and cardiac surgery
- 5 Avoid using electrotherapy modalities in the management of patients with low back pain.
- 6 Don’t provide ongoing manual therapy for patients with adhesive capsulitis of the shoulder