On “The American Physical Therapy Association's top five Choosing Wisely recommendations.” White NT, Delitto A, Manal TJ, Miller S. Phys Ther. doi: 10.2522/ptj.20140287.
Bibliographic record
Abstract
[ Editor's note: Both the letter to the editor by Belanger and colleagues and the response by White and colleages are commenting on the author manuscript version of the article that was published ahead of print September 15, 2014. ] It is with great interest that we learned of the American Physical Therapy Association's (APTA's) Choosing Wisely list of 5 things physical therapists and patients should question,1,2 as 3 of the 5 recommendations are related to the practice of therapeutic electrophysical agents. We would like to respond to the first recommendation: “Don't employ passive physical agents except when necessary to facilitate participation in an active treatment program.” In their article, White et al state, “As a partner in Choosing Wisely, APTA has a responsibility to update its list on a regular basis to ensure that the recommendations reflect the best and most current evidence…. If emerging evidence is of sufficient strength to alter conclusions on specific items, these items will be updated, amended or withdrawn.”2 Our purpose is to demonstrate that this first recommendation should be amended because the terminology and the evidence used to support its rationale are misleading, thus unfairly undermining the benefits that the evidence-based practice of therapeutic electrophysical agents can bring to the management of musculoskeletal disorders today and in the future. We believe that the arguments to follow have sufficient strength to justify our demand to amend the wording and rationale of this recommendation in a way that truly reflects the evidence used by APTA to come up with such a recommendation. Let us first consider terminology. The APTA recommends avoiding passive physical …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.094 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.010 | 0.008 |
| Open science | 0.007 | 0.003 |
| Research integrity | 0.030 | 0.032 |
| Insufficient payload (model declined to judge) | 0.078 | 0.107 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".