Article Text

Download PDFPDF
Defining health and disease: setting the boundaries for physiotherapy. Are we undertreating or overtreating? How can we tell?
  1. J N Baldwin1,
  2. M J McKay1,
  3. C E Hiller1,
  4. E J Nightingale1,
  5. N Moloney1,
  6. N Vanicek2,
  7. P Ferreira1,
  8. M Simic1,
  9. K Refshauge1,
  10. J Burns1,3
  11. on behalf of the 1000 Norms Project Consortium
  1. 1 Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
  2. 2 Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
  3. 3 Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia
  1. Correspondence to Jennifer N Baldwin, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia; jennifer.baldwin{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Overdiagnosis and overtreatment is rife in medicine and has been identified in the discipline of sports medicine,1 as well as many others. Labelling healthy individuals with mild problems as ‘sick’ is concerning, notwithstanding the risks and costs of unnecessary treatment.2 Clinical decision-making depends on understanding the boundaries between health and disease. However, boundaries are often blurred due to complex and interactive psychosocial and cultural factors.

In the era of patient-centred care, the goal of treatment should be to address the individual as a whole and enable return to usual daily life. Targeting disability, rather than disease alone, must be a priority for clinicians, particularly in the case of diseases such as osteoarthritis that may be considered ‘par for the course’ of ageing. For example, osteoarthritis is a leading cause of disability worldwide, and this burden is set to rise alongside population ageing. Thus, cost-effective interventions are essential. Identifying disease and discerning when to intervene are salient concerns for clinicians, particularly in light of the problems of overdiagnosis and overtreatment. But when does a joint change from being ‘healthy’ to …

View Full Text


  • Contributors The 1000 Norms Project Consortium was established in 2012 to create a framework for the 1000 Norms Project. JNB and JB contributed to the concept, design and construction of the final draft of the manuscript. MJM, CEH, EJN, NM, NV, PF, MS and KR, contributed to the concept, design and review of the final draft of the manuscript.

  • Funding The 1000 Norms Project is supported by grants from the National Health and Medical Research Council of Australia (NHMRC #1031893) and the Australasian Podiatry Education and Research Fund, Australasian Podiatry Council.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Linked Articles