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

Kathleen Morrisroe, Ayano Nakayama, Jason Soon, Mark Arnold, Les Barnsley, Claire Barrett, Peter M. Brooks, Stephen Hall, Patrick Hanrahan, Pravin Hissaria, Graeme Jones, Veera S. Katikireddi, Helen Keen, Rodger Laurent, Mandana Nikpour, Katherine Poulsen, Philip Robinson, Muriel Soden, Nigel Wood, Nicola CookCatherine Hill, Rachelle Buchbinder

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9 Citations (Scopus)


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) ‘top five’ 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 five’ list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016). Results: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five 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 anti-nuclear antibody (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-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus 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.

Original languageEnglish
Pages (from-to)135-143
Number of pages9
JournalInternal Medicine Journal
Issue number2
Publication statusPublished - 1 Feb 2018


  • evidence-based practice
  • implementation
  • low-value care
  • rheumatology

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