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EVOLVE: The Australian Rheumatology Association's 'top five' list of investigations and interventions doctors and patients should question


Morrisroe, K and Nakayama, A and Soon, J and Arnold, M and Barnsley, L and Barrett, C and Brooks, PM and Hall, S and Hanrahan, P and Hissaria, P and Jones, G and Katikireddi, VS and Keen, H and Laurent, R and Nikpour, M and Poulsen, K and Robinson, P and Soden, M and Wood, N and Cook, N and Hill, C and Buchbinder, R, EVOLVE: The Australian Rheumatology Association's 'top five' list of investigations and interventions doctors and patients should question, Internal Medicine Journal, 48, (2) pp. 135-143. ISSN 1444-0903 (2017) [Refereed Article]


Copyright Statement

Copyright 2017 Internal Medicine Journal

DOI: doi:10.1111/imj.13654


Background: The EVOLVE (evaluating evidence. enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices.

Aims: To determine the Australian Rheumatology Association's (ARA's) 'top 5' list of low-value practices.

Methods: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low-value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top 5' list from a list of 12 items via MonkeySurvey in December 2015 (reminder February 2016) .

Results: 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top 5 list (percent of rheumatologists including item in their top 5 list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order ANA testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%)​; Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%)​; and Do not order anti dsDNA antibodies in ANA negative patients unless the clinical suspicion of SLE remains high (45.3%).

Conclusions: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.

Item Details

Item Type:Refereed Article
Keywords:EVOLVE, evidence-based practice, implementation, low-value care, rheumatology
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Rheumatology and arthritis
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Jones, G (Professor Graeme Jones)
ID Code:123922
Year Published:2017
Web of Science® Times Cited:11
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-02-01
Last Modified:2018-07-23
Downloads:136 View Download Statistics

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