Recommending NSAIDs and Paracetamol: A Survey of New Zealand Physiotherapists' Knowledge and Behaviours

Background. Clinical guidelines recommend medications as first line treatment for many musculoskeletal injuries. As first line health professionals for musculoskeletal conditions, including sprains and strains, physiotherapists may be asked to recommend suitable medications. Currently recommending medications is outside of the physiotherapists scope of practice. However there is evidence that physiotherapists often do recommend medications, mostly simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Purpose. The aim of this study was to investigate the current knowledge and behaviour of New Zealand musculoskeletal physiotherapists regarding recommendation of non-prescription medications for the treatment of musculoskeletal sprains and strains. Method. 2438 New Zealand physiotherapists were surveyed, of whom approximately 948 work in musculoskeletal physiotherapy. Results. Of 278 respondents (29.3% response rate), 213 (81.0%) sometimes or often recommend oral NSAIDs to patients, and 216 (82.1%) recommend oral paracetamol. Most respondents (225, 85.5%) report that they routinely provide information on potential side effects, 181 (68.8%) on potential risks. Many refer to a pharmacist, however 146 (55.5%) make recommendations on dose, and 119 (45.2%) recommend specific brand names. When asked what the risks associated with NSAIDs were, most respondents (> 70%) were able to name at least gastrointestinal upset, ulcers or bleeding, while the proportion able to name respiratory, renal or allergic risks was lower (< 31%). Conclusion. These data indicate that a large proportion of New Zealand musculoskeletal physiotherapists are practicing outside of the general scope of physiotherapy practice with regards recommending medicines to patients. While a large proportion have a good knowledge of potential side effects and risks, the knowledge is incomplete and inadequate for this practice. (C) 2010 John Wiley & Sons, Ltd.