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 provide ongoing manual therapy for patients with adhesive capsulitis of the shoulder
Adhesive capsulitis (also termed frozen shoulder) is a condition characterised by spontaneous onset of pain, progressive restriction of movement of the shoulder and disability that restricts activities of daily living, work and leisure. Most studies indicate that it is a self-limiting condition lasting up to two to three years, although 40% people may experience clinically detectable restriction of movement and disability beyond this time point without significant pain. Well-designed randomised trials have not demonstrated any worthwhile clinical benefits from ongoing physiotherapy beyond the benefits of a simple home exercise program.
- Carette, S., H. Moffet, et al.. "Intra-articular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial." Arthritis & Rheumatism 2003;48:829-838.
- Buchbinder R, Youd JM, Green S, et al. Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial. Arthritis & Rheumatism 2007;57:1027-37.
- Page MJ, Green S, Kramer S, Johnston RV, McBain B, Chau M, Buchbinder R. Manual therapy and exercise for adhesive capsulitis (frozen shoulder), Cochrane Database Syst Rev 2014;8:CD011275.
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