Background
Adoption of low back pain guidelines is a well-documented problem. Information to guide the development of behaviour change interventions is needed. The review is the first to synthesise the evidence regarding physicians’ barriers to providing evidence-based care for LBP using the Theoretical Domains Framework (TDF). Using the TDF allowed us to map specific physician-reported barriers to individual guideline recommendations. Therefore, the results can provide direction to future interventions to increase physician compliance with evidence-based care for LBP.
Methods
We searched the literature for qualitative studies from inception to July 2018. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study characteristics, reporting quality, and methodological rigour. Guided by a TDF coding manual, two reviewers independently coded the individual study themes using NVivo. After coding, we assessed confidence in the findings using the GRADE-CERQual approach.
Results
Fourteen studies (
n
= 318 physicians) from 9 countries reported barriers to adopting one of the 5 guideline-recommended behaviours regarding in-clinic diagnostic assessments (9 studies,
n
= 198), advice on activity (7 studies,
n
= 194), medication prescription (2 studies,
n
= 39), imaging referrals (11 studies,
n
= 270), and treatment/specialist referrals (8 studies,
n
= 193).
Imaging behaviour
is influenced by (1)
social influence
—
fr
om patients requesting an image or wanting a diagnosis (
n
= 252, 9 studies), (2)
beliefs about consequence—
physicians believe that providing a scan will reassure patients (
n
= 175, 6 studies), and (3)
environmental context and resources—
physicians report a lack of time to have a conversation with patients about diagnosis and why a scan is not needed (
n
= 179, 6 studies).
Referrals to conservative care
is influenced by
environmental context and resources
—long wait-times or a complete lack of access to adjunct services prevented physicians from referring to these services (
n
= 82, 5 studies).
Conclusions
Physicians face numerous barriers to providing evidence-based LBP care which we have mapped onto 7 TDF domains. Two to five TDF domains are involved in determining physician behaviour, confirming the complexity of this problem. This is important as interventions often target a single domain where multiple domains are involved. Interventions designed to address all the domains involved while considerin...
Sleep problems are prevalent in individuals with MS. Individuals who had clinically significant levels of anxiety were roughly two times more likely to have trouble sleeping when compared to individuals without anxiety. Efforts should focus on early identification and effective interventions for poor sleep in individuals living with MS.
Introduction: Studies that use objective assessments often only recruit individuals in the geographic region in which the study is being conducted, because the assessments require that the researcher and participant be face to face. This limits the number and variety of individuals who can participate. Telehealth is one approach that could be used to increase sample size and representativeness. The present analysis aims to evaluate the experience of individuals diagnosed with breast or prostate cancer, who participated by telehealth in studies investigating the effects of cancer treatment on sleep and cognition. Specifically, this study aimed to highlight potential benefits of using telehealth and identify ways to improve the process for future studies and Rural and Remote Health rrh.org.au
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