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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}

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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 …

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