Choosing Wisely in Physical Medicine and Rehabilitation: Developing Canadian Recommendations for Resource Stewardship

Choosing Wisely Canada aims to reduce potentially harmful or unnecessary diagnostic investigations and practices in healthcare delivery. A committee of the Canadian Association of Physical Medicine & Rehabilitation surveyed the general membership seeking suggestions on new or revised Physical Medicine & Rehabilitation Choosing Wisely Canada recommendations. Draft recommendations were revised and refined with an emphasis on resource stewardship and alignment with the Choosing Wisely Canada mission. The updated 2023 Choosing Wisely Canada recommendations for physical medicine and rehabilitation are to avoid: (1) investigating and treating asymptomatic bacteriuria in patients with neurogenic bladder; (2) recommending more than a brief period of physical and cognitive rest after mild traumatic brain injury; (3) starting opioid treatment for chronic noncancer pain without exhausting other approaches; (4) ordering diagnostic imaging for low back pain in the absence of red flags; (5) repeating injections without evaluating patients' responses to them; and (6) recommending carpal tunnel release without first confirming nerve entrapment with electrodiagnostic studies or ultrasonography. We present unique implementation tools to equip practitioners with quality improvement strategies to adopt these recommendations into their practices. Future work will include developing recommendations that consider planetary health co-benefits, creating knowledge translation tools, and assessing the impact of recommendation adoption into clinical practice.