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

Morrisroe, K, Nakayama, A, Soon, J, Arnold, M, Barnsley, L, Barrett, C, Brooks, PM, Hall, S, Hanrahan, P, Hissaria, P, Jones, G ORCID: 0000-0002-9814-0006, Katikireddi, VS, Keen, H, Laurent, R, Nikpour, M, Poulsen, K, Robinson, P, Soden, M, Wood, N, Cook, N, Hill, C and Buchbinder, R 2017 , 'EVOLVE: The Australian Rheumatology Association's 'top five' list of investigations and interventions doctors and patients should question' , Internal Medicine Journal, vol. 48, no. 2 , pp. 135-143 , doi:

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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 Type: Article
Authors/Creators: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
Keywords: EVOLVE, evidence-based practice, implementation, low-value care, rheumatology
Journal or Publication Title: Internal Medicine Journal
Publisher: Blackwell Publishing Asia
ISSN: 1444-0903
DOI / ID Number:
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Copyright 2017 Internal Medicine Journal

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