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Evidence-based physiotherapy needs evidence-based marketing
  1. Joshua Robert Zadro1,2,
  2. Mary O’Keeffe1,2,
  3. Christopher G Maher1,2
  1. 1 Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
  2. 2 Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
  1. Correspondence to Joshua Robert Zadro, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; jzad3326{at}uni.sydney.edu.au

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Just over 20 years ago, an editorial titled ‘Now is the time for evidence based physiotherapy’ highlighted the need for high-quality research on the effectiveness of physiotherapy treatments.1 Today, we arguably have sufficient evidence to allow physiotherapists to choose an evidence-based approach to clinical practice. For example, the Physiotherapy Evidence Database (PEDro) indexes nearly 40 000 randomised controlled trials, systematic reviews and clinical practice guidelines. More recently, physiotherapy associations have dramatically increased the marketing of physiotherapy services. This reflects a rapidly expanding workforce and more jurisdictions allowing the public to directly access physiotherapy without the need for medical referral.

Marketing of physiotherapy sometimes draws on evidence but at other times makes claims for physiotherapist roles and services that are not supported by evidence. This could mislead the public and could draw attention away from the strong evidence base within physiotherapy. Consider these examples of marketing from the websites of physiotherapy associations and leading physiotherapy journals from the USA, Australia and UK.

Non–evidence-based marketing

Recent marketing that early physical therapy could help solve the opioid epidemic and save patients with low back pain (LBP) money is likely not evidence-based (online supplementary table 1). These claims were endorsed by influential academic journals, the American Physical Therapy Association (APTA; over 100 000 members) and social media handles with large followings (@MoveForwardPT; an initiative of the APTA with ~26 000 followers).

A good example is a viewpoint in the Journal of Orthopedic Sports Physical Therapy that argued early physical therapy could be part of the solution to the opioid epidemic.2 This article ignored (1) high-quality evidence that early physical therapy is more costly and provides no benefit over usual care for LBP,3 and (2) low-quality evidence that early physical therapy likely results in higher rates of opioids, imaging, injections and surgery compared with no physical therapy. The only support for early physical therapy for LBP came from the same low-quality studies4–6; the authors selectively compared costs and opioid use between early and delayed physical therapy. Those ‘selected’ findings6 were also reinforced by a news release from the APTA (and tweet from the Physical Therapy Journal):‘Early utilization of physical therapist treatment can reduce opioid use… (and is) associated with lower total health care costs.

The marketing around treatment timing ignores the importance of what treatment patients receive when they visit a physical therapist. Early access to harmful or ineffective physical therapy treatments (eg, kinesiotape and electrotherapy), irrespective of timing, is unlikely to improve patient outcomes7 or solve the opioid crisis. Treatment content should be marketed accurately as it is supported by thousands of trials and systematic reviews and is central to evidence-based physical therapy.

Examples of other non–evidence-based marketing include advocating for annual health check-ups with a physical therapist and promoting physical therapy (as a profession) on the basis of ineffective medical treatments (online supplementary table 1).

Evidence-based marketing

Physiotherapy marketing can align well with the evidence. The Journal of Physiotherapy 8 addressed the importance of reducing non–evidence-based physiotherapy and alluded to the need to focus marketing on ‘conditions that usually do not resolve spontaneously and where physiotherapy care is well supported by evidence’. This contrasts with marketing early physical therapy for acute LBP, a condition that has a favourable natural history.

Marketing from The Australian Physiotherapy Association (APA) and Chartered Society of Physiotherapy (CSP) acknowledges that not all physiotherapy treatments are effective, but also that not everyone with LBP needs physiotherapy (online supplementary table 1). For example, ‘Many people with acute non-specific LBP require minimal physiotherapy treatment’ (APA). These organisations also highlight the importance of team-based care: ‘Multidisciplinary pain management programmes including physiotherapy are an effective intervention for people with chronic pain and cost-saving compared to physiotherapy alone’ (CSP). Similar messages can also be found within the APTA: ‘(The need to close the evidence-practice gap) applies to physical therapy as much as it does to all other providers’ and ‘Care (for chronic LBP) is inherently multidisciplinary… and PTs should welcome the chance to be a part of these programs.’ (online supplementary table 1).

Marketing is new in physiotherapy. Associations should ground their marketing on rock solid research data. Marketing claims that go beyond the data will mislead the public and could lead to criticism that the profession is fighting for market share, failing to be part of team-based care and wanting to create a hierarchy among providers. In contrast, evidence-based marketing will increase public awareness of physiotherapists’ role in the healthcare system, foster effective team-based care and, most importantly, create realistic expectations so that patients leave physiotherapy appointments satisfied. This will provide the cheapest most effective type of marketing—word of mouth.

References

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Footnotes

  • Contributors All authors were involved in conception and design, drafting and revision of the manuscript, and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

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