The Choosing Wisely campaign is an international initiative that aims to promote dialogue among professionals and help the population choose evidence-based care that is truly necessary and risk-free (1,2). The purpose of this study is to describe the development process of the Choosing Wisely Brazilian list of physiotherapy in women's health in the pelvic floor area.

Cross-sectional study based on the Choosing Wisely study in musculoskeletal physical therapy (3), through the Google forms platform. The process of developing the Choosing Wisely list in Women's Health/Pelvic Floor physiotherapy was divided into 5 stages. In the 1st stage to compose the panel of experts, physiotherapists with experience in Women's Health/Pelvic Floor were invited to collect a list of recommendations that are not based on evidence, do not bring additional benefits to patients and are commonly used in clinical practice according to the perception and justification of professionals. In the 2nd stage, all recommendations and justifications received by the specialists were analyzed by the research team, verifying their relevance and scientific basis. In the next step, step 3, the recommendations were sent to Choosing Wisely Brasil for correction and approval. Then, step 4, the statements that should not be used in the clinical practice of physiotherapists were presented and the national survey was carried out, verifying whether the professionals were in agreement or not with the recommendations. Finally, step 5, development and publication of the final list of pelvic floor recommendations.

A total of 25 physiotherapists participated in the expert panel and 63 recommendations were received during the first stage. After the consensus meeting, 52 statements were excluded, 28 because they did not comply with the Choosing Wisely criteria or because they were incomplete and 24 they were duplicates. Of the recommendations received, 11 were included and sent to a national voting by 222 physiotherapists (38.87 ± 8.59 years old). 6 were still excluded in this final phase because they were considered professional guidelines

So far, as preliminary results, 5 recommendations are included in the Choosing Wisely Brazil list: Physical Therapy in Women's Health/Pelvic Floor. Recommendations that received 80% or more affirmative responses (agreement) in the national vote:
1. Evaluation of the pelvic floor muscles using manometry is not recommended in women who are unable to contract these muscles
2. Do not perform indirect contraction exercises of the pelvic floor muscles and/or other muscle groups as a treatment for pelvic floor disorders.
3. It is not recommended to use programs such as the Paula method, hypopressive gymnastics, pilates, yoga as a treatment for pelvic floor disorders.
4. Do not perform any endocavitary, intravaginal or intra-anal procedure without informing or obtaining consent from the patient and/or legal guardian.
5. Do not perform any endocavitary (intravaginal) procedure in women who have not started their sexual life

The Choosing Wisely list of recommendations in women's health/pelvic floor physiotherapy will help practitioners and patients make appropriate decisions about the quality treatment and care they need.

Cassel CK, Guest JA. Choosing wisely: helping physicians and patientsmake smart decisions about their care. JAMA 2012;307:1801–2.
Scott IA, Duckett SJ. In search of professional consensus in definingand reducing low-value care. Med J Aust 2015;203:179–81
Reis FJJ, Meziat-Filho N, Soares RJ, Correia LCL. Choosing Wisely Brazil: top 5 low-value practices that should be avoided in musculoskeletal physical therapy. Physiotherapy. 2021;112:9-15