CHOOSING WISELY BRAZIL: THE FIRST LIST OF RECOMMENDATIONS IN OBSTETRIC PHYSIOTHERAPY

C.C. Catai¹, P. Driusso², S. Pereira Botelho³, F.J. Jandre dos Reis⁴, L. Pasqualotto³, J.C. Rodrigues², A.C. Rodarti Pitangui⁵, C. Homsi Jorge⁶, L. Maciel de Freitas⁶

¹Ribeirão Preto Medical School, University of São Paulo, Health Sciences Departament, Ribeirão Preto, Brazil, ²Federal University of São Carlos, São Carlos, Brazil, ³Federal University of Alfenas, Alfenas, Brazil, ⁴Instituto Federal do Rio de janeiro, Rio de Janeiro, Brazil, ⁵Pernambuco State University, Petrolina, Brazil, ⁶Ribeirão Preto Medical School, Health Sciences, Ribeirão Preto, Brazil

Background: The Choosing Wisely Initiative aims to promote discussions between patients and health professionals about behaviors that may be unnecessary or, in some cases, could bring risks to patients.

Purpose: To describe the development process of the Brazilian Choosing Wisely list of obstetric physiotherapy.

Methods: This study was carried out initially by a group of women´s health physiotherapists of the Brazilian Association of Women´s Health Physiotherapy (ABRAFISM) and one experienced researcher in elaborating "Choosing wisely" lists . The research consisted of 3 stages. In the 1st one, a group of specialists suggested interventions that are used but that may be unnecessary or, in some cases, pose risks to patients. Every recommendation should have a justification and be based on evidence. In the 2nd stage the research group analyzed the suggestions and their justifications and in the 3rd stage, physiotherapists with more than 2 years of experience in Women's Health Physiotherapy voted whether or not they agreed with the inclusion of the recommendation in the final list. The final list consited of recommendations with more than 80% of votes from the specialists. The text of the list of recommendations was put in a standardized "choosing wisely initiative" lay-out together with the logo of the ABRAFISM to be widely publicized.

Results: The 1st stage included 16 experts (41.8 ± 10.6 years old) who sent 34 suggestions. After being discussed in the 2nd stage, the research group considered that 16 recommendations had scientific evidence, and these were voted in the 3rd stage by 224 physiotherapists (38.5 ± 08.1 years old). The final list included 5 behaviors that received over 80% of the votes as follow: 1- Avoid high-impact physical exercises and sports that have a high risk of abdominal trauma and falls during pregnancy, 2- Do not use therapeutic ultrasound, microwaves, short waves and other therapeutic resources that provide deep heat in the lumbar, abdominal and pelvic region during pregnancy, 3- Avoid exercises that can greatly increase the body temperature of pregnant women, especially in the first trimester of pregnancy, 4- Pregant women should not perform aerobic and resistance exercises if they presente vaginal bleeding, placenta previa, cerclage, decompensated preeclampsia, and who are dehydrated and 5- Reflect before using vaginal dilators to prevent perineal laceration and/or episiotomy in childbirth.

Conclusions: An initial brazilian choose wisely initiative in obstetric physiotherapy provided a list that will help physiotherapists and patients dialogue about unnecessary and harmful interventions.

Implications: This list will be important for patients and physiotherapists to discuss and to avoid low-value interventions in this area. Future researches are necessary to investigate the perception of professionals and patients about this and other choosing wisely lists in the broad specialty of women´s health physiotherapy.

Funding acknowledgements: To the Foundation of Clinics Hospital of Ribeirão Preto Medical School.

Keywords:
Chossing wisely
Women
Physiotherapy

Topics:
Research methodology, knowledge translation & implementation science
Professional practice: other
Pelvic, sexual and reproductive health

Did this work require ethics approval? Yes

Institution: São Carlos Federal University

Committee: São Carlos Federal University

Ethics number: 51932321.0.0000.5504