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Choosing Wisely Canada

Canadian Association of Physical Medicine and Rehabilitation

Low back pain is one of the leading causes of disability, with a lifetime prevalence of 40%. Routine imaging for low back pain in the absence of red flag symptoms does not change clinical outcomes including pain, function, quality of life and mental health. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. In comparing early versus late imaging for non-specific low back pain, there is ...

Choosing Wisely Canada

Canadian Association of Physical Medicine and Rehabilitation

Prescription pain medications have been shown to be effective for pain relief. However, a number of adverse events have been established. While pain reduction is an important outcome measure for patients, they also highly value improved function and quality of life. The addition of prescription pain medications does not always improve functional outcomes, or even pain. There is also a significant risk of long-term addiction. It is imperative that providers work with patients to establish ...

Choosing Wisely Canada

Canadian Association of Physical Medicine and Rehabilitation

Bed rest is often used to treat a variety of medical conditions. Prolonged bed rest causes major cardiovascular, respiratory, musculoskeletal and neuropsychological changes. Negative effects include thromboembolism, pneumonia, muscle wasting and physical deconditioning. Many of the negative effects begin within days of confinement, but consequences can last much longer. Specifically, in acute DVT/PE, bed rest has no impact on the risk of developing new PE. Furthermore, in acute low back pain, ...

Choosing Wisely Canada

Canadian Association of Physical Medicine and Rehabilitation

Urinary tract infections (UTIs) in catheterized patients are considered “complicated UTIs”. However, this term can be misleading and prompt clinicians to over treat infections in this population. It is generally recommended that persons with spinal cord injury (SCI) be treated for bacteriuria only if they have symptoms. Specifically, the 2006 Consortium for Spinal Cord Medicine Guidelines for Healthcare Providers require that the following three criteria be met before an individual with SCI ...

Choosing Wisely Canada

Canadian Paediatric Society

Cough and cold remedies sold over the counter often contain combinations of several medications. Research shows that they are not effective when given to children. They can, however, cause serious harmful effects, including accidental overdose, particularly when combined with other medications. For these reasons, since 2008, Health Canada has advised against their use in children less than six years of age.