The Influence of Patient Sex,Provider Sex,and Sexist Attitudes on Pain Treatment Decisions

Research suggests that patient sex, provider sex, and providers' sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers' sexist attitudes were associated with these differences. Ninety-eight health care providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F[1, 96] = 4.51, P < .05, ${\mathrm{\eta }}_{\mathrm{p}}^2$ = .05) and mental health referral (F[1, 96] = 3.89, P = .05, ${\mathrm{\eta }}_{\mathrm{p}}^2$ = .04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers' sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than for male pain patients, and providers' sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities.PerspectiveThe results of this study suggest that patient and provider sex, but not providers' sexist attitudes, influence pain care. These findings may inform efforts to raise awareness of sex/gender differences in pain care and reduce disparities.     

The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study

BackgroundSelf-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients’ health outcome. Contemporary pain management theories and models also suggest that a good patient–professional partnership enhances patients’ ability to self-manage their condition.Objectives(1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient–professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain.Design and settingThis quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient–professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients’ health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients’ life situation. Patients were recruited following initial consultation and followed up three months later.ParticipantsA total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief.MethodsSelf-reported measures of HRQoL, patient–professional partnerships and self-management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling.ResultsThere was no association between patients’ self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (−0.38, p < 0.01). A patient–professional partnership was not found to be beneficial for patients’ HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (−19.09, p < 0.01).ConclusionsThis study suggests that the increase in patients’ self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient–professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain.     

Randomised Controlled Trials on the Efficacy Of Spinal Manipulation Therapy in The Treatment of Low Back Pain

Abstract

Low back pain presents a major challenge to health care professionals within both primary and secondary care. Spinal manipulation therapy is one option from a range of treatment techniques which until recently has lacked credibility, in part due to a dearth of published, plausible explanations of the mechanisms through which it works. Such explanations are starting to emerge but rigorous evaluations of spinal manipulation therapy over other treatment modalities remain few in number. This paper builds on the review by Mohseni-Bandpei et al. (Mohseni-Bandpei MA, Stephenson R, Richardson B. Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomised controlled trials. Phys Ther Rev 1998; 3:185–94), by reviewing literature in particular randomised controlled trials published in the field since that date. It is concluded that the efficacy of manipulation for patients with acute or chronic low back pain remains unconvincing and that the literature remains blighted by inconsistency of definitions of interventions and by methodological flaws.     

The impact of age and gender on the ICF-based assessment of chronic low back pain

Purpose: To evaluate the impact of age and gender on the international classification of functioning, disability and health (ICF)-based assessment for chronic low back pain.

Methods: Two hundred forty-four chronic low back pain patients (52% female) with a mean age of 49?years (SD =17.64) were interviewed with the comprehensive ICF core set for activities and participation, and environmental factors. After conducting explorative factor analysis, the impact of age and gender on the different factors was analyzed using analyzes of variances.

Results: Results revealed that older patients experienced more limitations within “self-care and mobility” and “walking” but less problems with “transportation” compared to younger patients. Older or middle-aged low back pain patients further perceived more facilitation through “architecture and products for communication”, “health services”, and “social services and products for mobility” than younger patients. Regarding gender differences, women reported more restriction in “housework” than men. An interaction effect between age and gender was found for “social activities and recreation” with young male patients reporting the highest impairment.

Conclusions: The study demonstrated that the comprehensive ICF core set classification for chronic low back pain is influenced by age and gender. This impact is relevant for ICF-based assessments in clinical practice, and should be considered in intervention planning for rehabilitative programs.

• Implications for rehabilitation

• It is important to consider age and gender differences when classifying with the ICF.

• The intervention planning based on the ICF should focus on improvement of bodily functioning and mobility in older patients, facilitation of household activities in women, consideration of work-life balance and recreation (e.g., through mindfulness based stress reduction), and reduction of dissatisfaction with rehabilitation in younger patients.

• It is important to offer patients the opportunity to participate in intervention planning based on the ICF.

• For intervention planning professionals should bear in mind the resource-oriented approach of the ICF (e.g., facilitation through environmental factors), and a collaboration with other professionals.

     

Beliefs about appropriate pain behaviour: gender differences between health care professionals and non-health care professionals in Hong Kong

Aims. The purpose of this study was to examine the effects of participants’ gender on their beliefs regarding gender‐appropriate pain behaviour among health care professionals and non‐health care professionals. Background. Gender may influence beliefs about appropriate pain behaviour among health care professionals and non‐health care professionals. Methods. The study consisted of a survey of 152 participants, 38 male and 38 female health care professionals and 38 male and 38 female non‐health care professionals. Each participant completed both questionnaires, the Appropriate Pain Behaviour Questionnaire‐Female (APBQ‐F) and Appropriate Pain Behaviour Questionnaire‐Male (APBQ‐M). Results. Occupation had a significant effect: the health care professionals rated pain behaviours as more acceptable in both genders than the non‐health care professionals, F(1, 148) = 13·636, p < 0·01. Gender also had a significant effect: female participants considered pain behaviours more acceptable than male participants, F(1, 148) = 5·056, p < 0·026. There was a significant effect between APBQ‐M and APBQ‐F: for both genders in both occupations, pain behaviours in women were rated as more acceptable than in men, F(1, 148) = 105·469, p < 0·005. Conclusions. Health care professionals would consider overt pain‐related behaviours by both men and women to be more acceptable than non‐health care professionals. Both genders and both occupations would consider overt pain‐related behaviours to be more acceptable in women than in men. Relevance to clinical practice. Health care professionals need to be aware that their attitude to pain behaviours may influence their management of patients and that different genders experience pain differently. This has clear implications in terms of clinical treatment and diagnosis.     

An examination of gender stereotypes,ambivalent sexism,and dating violence as potential predictors of nursing students’ beliefs about intimate partner violence: A cross-sectional correlational study

AimThis study aimed to examine the role of the feminine or masculine gender stereotypes, ambivalent sexism and dating violence to predict nursing students’ beliefs about intimate partner violence.BackgroundAlthough there has been a growing interest in understanding the sociocultural contexts and the factors of the intimate partner violence, there is a serious lack of empirical research on different dimensions of this problem among nursing students.DesignA cross-sectional correlational design was used.MethodsThe data were collected from a sample of 520 university students from three nursing schools in Istanbul, Turkey. Participants were selected through convenience sampling. Data were collected with the sociodemographic form, the Beliefs About Wife Beating Scale, the Ambivalent Sexism Inventory, the revised Conflict Tactics Scale, and the Bem Sex Role Inventory.ResultsResults revealed that male participants were more prone to justify wife beating and believe that battered women benefitted from beating. Based on the results of the study, in addition to sex, region of birth, representing feminine or masculine gender stereotypes, hostile sexism, psychological aggression and having an injury due to experiencing violence in the latest relationship were the important predictors of nursing students’ beliefs about intimate partner violence.ConclusionsNursing curricula should include courses to enhance students’ awareness towards violence against women, sexism and gender equality. More, universities should provide counseling services for nursing students who experienced violence.     

Pilates-based core exercise improves health-related quality of life in people living with chronic low back pain: A pilot study

PurposeTo investigate the effects of Pilates exercise on improving health-related quality of life in people living with chronic low back pain.MethodsThis was a single-blind, randomised clinical trial. Thirty-nine physically active subjects aged between 30 and 70 years with nonspecific chronic low back pain for more than three months were recruited. The study employed a pretest-posttest design, with a 4 -, 8 -, and 26-week follow-up. For eight weeks, the intervention group participated in a group-supervised, mat-based Pilates program, while the control group received the usual pharmacologic and rehabilitation standard of care, including patient education on chronic low back pain. The primary outcome was self-perceived health status measured using the EQ-5D questionnaire in a structured form and a visual analogue scale. Secondary outcomes included intensity of pain and degree of disability.ResultsBy the end of the 8-week Pilates program, the intervention group achieved a better health-related quality of life on the EQ-5D visual analogue score than the control group. In assessing the trends in each individual group regarding pain, the intervention group demonstrated an earlier pain reduction than the control group that lasted until the end of the trial.ConclusionsAn 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain. This finding could inform clinicians of better alternatives when they suggest exercise interventions for chronic low back pain.     

Information needs of people with low back pain for an online resource: a qualitative study of consumer views

Abstract

Purpose: To identify the information needs of people with low back pain (LBP) in Australia, and the preferred methods to present this information online, as a basis for development of a patient-centred website. Available online LBP resources are limited in quality and content and it is not clear if they are meeting the needs of sufferers. Method: Focus groups and semi-structured telephone interviews, involving 28 people with LBP. Results: Seven categories of information were identified: reasons for LBP, treatment and management options, self-help information, psychological and social dimensions, lay stories, quality assurance of information and roles of different healthcare professionals and locally available services. Identified preferences for online presentation included: multimodality, emphasis on visual media, readability and interactivity. Participants had been unable to obtain desired LBP information using existing resources. Conclusions: This study provides important guidance for development of a patient-centred website grounded in the expressed needs and preferences of people with LBP. Understanding the breadth of patients’ questions and concerns is essential for provision of patient-centred information and interventions. Incorporating these with the current evidence base would provide an accessible and relevant LBP patient education referral point, which is currently lacking.

• Implications for Rehabilitation

• Use of the internet to obtain health information is increasing, although there is little evidence that existing low back pain websites are meeting the expressed needs of health consumers.

• Our research suggests that people with low back pain have difficulty finding relevant and trustworthy information about the condition on the internet.

• Taking patient information needs and presentation preferences into account when designing online information material will provide people with low back pain an accessible and relevant educational resource that is currently lacking.

     

Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?

Introduction: Goal setting, led by the patient, is promising as an effective treatment for the management of chronic low back pain (CLBP); however, little is known about current practice. The aims of the study were to explore (1) current goal setting practice in CLBP among physiotherapists; (2) perceived barriers to goal setting in CLBP; and (3) relationship between clinician’s attitudes and beliefs and goal setting practice. Method: A cross-sectional observational survey. Results: The majority of respondents used goal setting with the main aim of facilitating self-management. The greatest number of goals were set with 50% therapist/50% patient involvement. The most common perceived barriers to goal setting related to time constraints and lack of skill and confidence. A higher biomedical score for treatment orientation of the therapist was associated with a lower patient involvement score. Conclusion: Goal setting is common practice for CLBP and is perceived as a high priority. It is more often a collaboration between therapist and patient rather than patient-led with treatment orientation of the physiotherapist a predictor of patient involvement. Education of healthcare professionals needs to include better understanding of chronic pain to orient them away from a biomedical treatment approach, as well as to enhance skills in facilitating patient involvement in goal setting.     

Association Between Type of Face Mask and Visual Analog Scale Scores During Pain Assessment

AimsTo examine the association between the type of mask worn by health care professionals and assessment of pain intensity in patients after orthopedic surgery using the visual analog scale (VAS).DesignA nonrandomized controlled trial conducted among 176 patients hospitalized in an orthopedic department of a hospital located in northern-central Israel from January to March 2021.MethodsIn the intervention group (n = 83), pain assessment using the VAS was performed by a health care professional wearing a transparent face mask, while in the control group (n = 93), pain assessment was performed by a health care professional wearing a standard nontransparent face mask. The initial assessment was performed by a nurse, and 15 minutes later, an additional assessment was performed by a physician.ResultsHealth care professionals wearing a standard non-transparent mask obtained higher VAS scores than health care professionals wearing a transparent mask. In addition, nurses obtained lower VAS scores than physicians. The discrepancy in VAS scores between nurses and physicians was found in 50% of cases. This discrepancy was more prevalent among female patients, patients after knee replacement or spinal surgery, and when health care professionals were wearing a standard nontransparent mask.ConclusionsThis study supports the use of transparent face masks by health care professionals in an orthopedic department, particularly by nurses. In addition, this study supports the assumption of problems involving the reliability of VAS.     

Comparison of two mobilization techniques in management of chronic non-specific low back pain

AimThe aim of the study was to compare between the effects of Maitland's postero-anterior (PA glide) mobilization and Mulligan's sustained natural apophyseal glide (SNAG) on pain, mobility, muscle activation and functional disability in subjects with chronic, non-specific low back pain.MethodsThe study was a two arm repeated measure design with random allocation of subjects (n = 33). Subjects in group 1 received Maitland's PA glide mobilization and those in group 2 received Mulligan's SNAG. Along with the respective mobilization technique, individualized exercises were common for subjects in both the groups. Subjects in both groups received treatment for 4 days a week for 4 weeks. The outcome measures were numeric pain rating scale (NPRS) scores, lumbar flexion and extension range of motion, erector spinae muscle activity and Oswestry low back pain disability questionnaire score.ResultsThe outcome measure scores showed statistical significance in time effect on NPRS (p = 0.001); lumbar flexion and extension range of motion (p = 0.001); erector spinae muscle activity (0.001); Oswestry low back pain disability questionnaire score (p = 0.001); group effect on lumbar flexion (p = 0.03) and extension range of motion (p = 0.05); and interaction effect (time x group) on lumbar flexion (p = 0.003) and extension range of motion (p = 0.002); and, erector spinae muscle activity (p = 0.05) at the 3rd lumbar vertebral level.ConclusionThe addition of Maitland or Mulligan mobilization techniques of the spine does not show a difference in the improvement of symptoms associated with chronic non-specific low back pain.     

The Association of Self-Reported Backpack Use and Backpack Weight With Low Back Pain Among College Students

ObjectiveBack pain has consistently ranked among the top general health complaints among college students, but few studies have examined risk factors for back pain in this age group. This cross-sectional survey evaluated the association between the self-reported annual low back pain with the estimated usual backpack weight among college students.MethodsData were collected from health education students during the spring semester of 2007 at the Colorado State University using an online survey. Adjusted odds ratios were calculated using logistic regression.ResultsFour hundred sixty-five (94.6%) health education students completed the online survey. The annual prevalence of low back pain was 29.2% (n = 136). A 25% increase in the odds of annual low back pain for each 4-kg increase in the estimated usual backpack weight was observed after adjusting for sex, smoking, reporting frequently feeling overwhelmed, and body mass index (adjusted odds ratio per 4-kg increase, 1.25; 95% confidence interval, 1.17-1.32). There was no evidence of an increased association of annual low back pain with carrying a backpack weight greater than 10% of the students body weight compared with those carrying less (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65).ConclusionsThe results of this study suggest that increasing reported backpack weight is associated with increased prevalence of annual low back pain. However, these results do not provide evidence to support the recommendation that the backpack weight necessarily be less than 10% of body weight.     

Self-management at the core of back pain care: 10 key points for clinicians

BackgroundA paradigm shift away from clinician-led management of people with chronic disorders to people playing a key role in their own care has been advocated. At the same time, good health is recognised as the ability to adapt to changing life circumstances and to self-manage. Under this paradigm, successful management of persistent back pain is not mainly about clinicians diagnosing and curing patients, but rather about a partnership where clinicians help individuals live good lives despite back pain.ObjectiveIn this paper, we discuss why there is a need for clinicians to engage in supporting self-management for people with persistent back pain and which actions clinicians can take to integrate self-management support in their care for people with back pain.DiscussionPeople with low back pain (LBP) self-manage their pain most of the time. Therefore, clinicians and health systems should empower them to do it well and provide knowledge and skills to make good decisions related to LBP and general health. Self-management does not mean that people are alone and without health care, rather it empowers people to know when to consult for diagnostic assessment, symptom relief, or advice. A shift in health care paradigm and clinicians’ roles is not only challenging for individual clinicians, it requires organisational support in clinical settings and health systems. Currently, there is no clear evidence showing how exactly LBP self-management is most effectively supported in clinical practice, but core elements have been identified that involve working with cognitions related to pain, behaviour change, and patient autonomy.     

Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls

Tomkins-Lane CC, Holz SC, Yamakawa KS, Phalke VV, Quint DJ, Miner J, Haig AJ. Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls.ObjectiveTo examine predictors of community walking performance and walking capacity in people with lumbar spinal stenosis (LSS), compared with people with low back pain and asymptomatic control subjects.DesignRetrospective analysis.SettingUniversity spine program.ParticipantsParticipants (N=126; 50 LSS, 44 low back pain, 32 asymptomatic control subjects) aged 55 to 80 years were studied.InterventionsNot applicable.Main Outcome MeasuresSeven-day community walking distance measured by pedometer (walking performance) and a 15-minute walking test (walking capacity). All participants had lumbosacral magnetic resonance imaging, electrodiagnostic testing, and a history and physical examination, including a history of pain and neurologic symptoms, a straight leg raise test, and tests for directional symptoms, reflexes, strength, and nerve tension signs. The study questionnaire included demographic information, a history of back/leg pain, and questions about walking, exercise frequency, and pain level, as well as the standardized Quebec Back Pain Disability Scale.ResultsBody mass index (BMI), pain, age, and female sex predicted walking performance (r²=.41) and walking capacity (r²=.41). The diagnosis of LSS itself had no clear relationship with either walking variable. Compared with the asymptomatic group, LSS participants had significantly lower values for all walking parameters, with the exception of stride length, while there was no significant difference between the LSS and low back pain groups.ConclusionsBMI, pain, female sex, and age predict walking performance and capacity in people with LSS, those with low back pain, and asymptomatic control subjects. While pain was the strongest predictor of walking capacity, BMI was the strongest predictor of walking performance. Average pain, rather than leg pain, was predictive of walking performance and capacity. Obesity and pain are modifiable predictors of walking deficits that could be targets for future intervention studies aimed at increasing walking performance and capacity in both the low back pain and LSS populations.     

Spotlight on Chronic Back Pain

ABSTRACT

The focus of the European Association of IASP (International Association for the Study of Pain) Chapters on chronic back pain is described. Reasons for selecting this type of pain and treatment approaches are discussed.

This feature is adapted from paineurope 2011; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.     

‘Your spine is so worn out’ – the influence of clinical diagnosis on beliefs in patients with non-specific chronic low back pain – a qualitative study’

BackgroundPatients’ beliefs have an important influence on the clinical management of low back pain and healthcare professionals should be prepared to address these beliefs. There is still a gap in the literature about the influence of patients’ perceptions of their clinical diagnosis on the severity of their pain experience and disability.ObjectivesTo identify the perceptions of patients with chronic non-specific low back pain regarding the influence of their clinical diagnosis on pain, beliefs, and daily life activities.MethodsQualitative study of 70 individuals with chronic non-specific low back pain. A semi structured interview was conducted about patients’ beliefs and perceptions regarding the influence of clinical diagnosis on their daily activities and pain intensity.ResultsMost participants believed that higher number of different clinical diagnoses for the same individual may be associated with high pain intensity and disability for daily activities and that pain and injury are directly related. Patients beliefs were grouped into four main themes: (1) pain has multifactorial explanation in physical dimension; (2) improvement expectation is extremely low in patients with chronic pain; (3) clinical diagnosis influences pain and disability levels; (4) clinical diagnosis is extremely valued by patients.ConclusionsPatients believe that there is a strong relationship between structural changes in the lower back, pain, and daily life activities; thus, providing evidence of a strong influence of the biomedical model on their beliefs.     

Person-centred education and advice for people with low back pain: Making the best of what we know

BackgroundThe first-line treatment consistently recommended for people with low back pain is patient education and advice. Regardless of the duration of low back pain, clinicians should provide education on the benign nature of low back pain, reassurance about the absence of a serious medical condition, and advice to remain active. There is little guidance on how best to provide this care.ObjectiveThis Masterclass will draw on recent evidence to explore how physical therapy clinicians could deliver person-centred education and advice to people with low back pain to refine their clinical consultation.DiscussionFirst, we highlight the potential value of providing validation to acknowledge the distressing experience and consequences of low back pain. Second, we describe a tool to open channels of communication to provide education and advice in a patient-centred and efficient way. Clinicians could consider using the Attitude toward Education and advice for Low back pain Questionnaire to gain an insight into patient attitudes toward education and advice at the outset of a clinical encounter. Finally, we provide options for tailoring patient education and advice to promote self-management of low back pain based on patient attitudes. We present evidence that a positive attitude toward messages about causes rather than messages about physical activity predicts intention to self-manage low back pain. We combine this evidence to suggest a pathway for clinicians to provide education and advice to people with low back pain within the time constraints of a clinical consultation.     

Coping and Management Techniques Used by Chronic Low Back Pain Patients Receiving Treatment From Chiropractors

ObjectivesThe purpose of this study was to describe coping strategies (eg, mechanisms, including self-treatment) that a person uses to reduce pain and its impact on functioning as reported by patients with chronic low back pain who were seen by doctors of chiropractic and how these coping strategies vary by patient characteristics.MethodsData were collected from a national sample of US chiropractic patients recruited from chiropractic practices in 6 states from major geographical regions of the United States using a multistage stratified sampling strategy. Reports of coping behaviors used to manage pain during the past 6 months were used to create counts across 6 domains: cognitive, self-care, environmental, medical care, social activities, and work. Exploratory analyses examined counts in domains and frequencies of individual items by levels of patient characteristics.ResultsA total of 1677 respondents with chronic low back pain reported using an average of 9 coping behaviors in the prior 6 months. Use of more types of behaviors were reported among those with more severe back pain, who rated their health as fair or poor and who had daily occurrences of pain. Exercise was more frequent among the healthy and those with less pain. Female respondents tended to report using more coping behaviors than men, and Hispanics more than non-Hispanics.ConclusionPersons with chronic back pain were proactive in their coping strategies and frequently used self-care coping strategies like those provided by chiropractors in patient education. In alignment with patients’ beliefs that their condition was chronic and lifelong, many patients attempted a wide range of coping strategies to relieve their pain.     

Can language enhance physical therapists’ willingness to follow Choosing Wisely recommendations? A best-worst scaling study

BackgroundChoosing Wisely recommendations could reduce physical therapists’ use of low-value care.ObjectiveTo investigate whether language influences physical therapists’ willingness to follow the Australian Physiotherapy Association's (APA) Choosing Wisely recommendations.DesignBest-worst Scaling surveyMethodsThe six original APA Choosing Wisely recommendations were modified based on four language characteristics (level of detail, strength- qualified/unqualified, framing, and alternatives to low-value care) to create 60 recommendations. Physical therapists were randomised to a block of seven choice tasks, which included four recommendations. Participants indicated which recommendation they were most and least willing to follow. A multinomial logistic regression model was used to create normalised (0=least preferred; 10=most preferred) and marginal preference scores.Results215 physical therapists (48.5% of 443 who started the survey) completed the survey. Participants' mean age (SD) was 38.7 (10.6) and 47.9% were female. Physical therapists were more willing to follow recommendations with more detail (marginal preference score of 1.1) or that provided alternatives to low-value care (1.3) and less willing to follow recommendations with negative framing (−1.3). The use of qualified (‘don't routinely’) language (vs. unqualified - ‘don't’) did not affect willingness. Physical therapists were more willing to follow recommendations to avoid imaging for non-specific low back pain (3.9) and electrotherapy for low back pain (3.8) vs. recommendation to avoid incentive spirometry after upper abdominal and cardiac surgery.ConclusionPhysical therapists were more willing to follow recommendations that provided more detail, alternatives to low-value care, and were positively framed. These findings can inform the development of future Choosing Wisely recommendations and could help reduce low-value physical therapy.