Josh Zadro discusses high vs low value care in musculoskeletal rehab, including imaging, injections, surgery, and PT. They explore utilization disparities, complex decisions in healthcare, effectiveness of exercise therapy, and optimism in research advancements.
High-value care in musculoskeletal rehab emphasizes cost-effectiveness and aligning interventions with patient values.
Economic incentives and patient expectations contribute to the overutilization of certain interventions in sports medicine.
Deep dives
Defining high and low-value care in musculoskeletal rehab and medicine
High-value care in musculoskeletal rehab and medicine focuses on delivering interventions that provide benefits where the clinical benefits outweigh the costs. This includes aligning interventions with patient values, being cost-effective, reducing waste, and ensuring high quality. Low-value care, on the other hand, may involve uncertain evidence, lack of cost-effectiveness, and interventions that do not align with patient values leading to challenges in defining what truly constitutes high value.
Drivers and reasons for low-value care
Economic incentives, such as pressure to see more patients for financial reasons, flawed dissemination of evidence, and a culture of healthcare consumption contribute to low-value care. Clinicians may feel compelled to provide unnecessary care due to patient expectations, fear of inaction, and the desire to give specific diagnoses. In sports medicine, resources, pressure to deliver cutting-edge care, and a focus on new treatments can lead to overutilization of certain interventions.
Challenges and considerations in imaging for musculoskeletal conditions
Imaging in sports medicine and musculoskeletal conditions should be justified by its potential to change management decisions, such as ruling out fractures. Decision aids like the Ottawa ankle rules can guide appropriate use of imaging. However, there is a gap between evidence-based guidelines and actual clinical practice, leading to overutilization of imaging, especially in conditions like back pain.
Effectiveness and considerations for surgery in musculoskeletal conditions
Surgical interventions for musculoskeletal conditions should be carefully considered, balancing the potential benefits with the risks. While surgeries like ACL reconstruction have shown benefits, procedures like knee replacements have mixed evidence. Physiotherapists play a crucial role in guiding patients towards surgery or non-surgical management based on individual needs, promoting shared decision-making and optimal patient outcomes.
Chris Hughen sat down with Josh Zadro to talk about High vs Low Value Care in musculoskeletal rehab and medicine. We dive into a variety of topics including high and low value care in the context of imaging, injections, surgery, and physical therapy.